? Switching from vetsulin to prozinc- Part 2

Smoky is doing better since going on Prozinc. I'm working on creating a link from my previous thread.
http://www.felinediabetes.com/FDMB/...etsulin-to-prozinc.168561/page-2#post-1837693

I'm hope that I did this right and the link works ok.

 

Glad he's doing so much better! The link works great.

 

I LOVE that blue last night, Lisa! There might be some rubber-like activity today but you're definitely getting results. Is Smoky eating better, etc.?

 

Yep. A little bouncing around but the blue and yellows are nice.

 

I was worried about higher numbers and now I'm worried about his numbers being too low. He was 352 in am today. The Cerenia seems to be helping with the nausea. He has been eating a lot lately but don't know how much nutrition he is actually getting. I'm glad to see the lower numbers, just not used to them.

 

Seeing the nice blue is scary but in a good way. You'll get used to it! Meanwhile I think the 3.5 u is a good dose. Let's see what his PMPS is.

Eating a lot is great news, given what Smoky has been through. He'll get more nutrition from his food when his numbers are down more consistently.

 

I like that yellow PMPS, Lisa!

 

Smoky PMPS was 194 so gave him a reduced dose of 1.5 units. Thank you @Kris & Teasel for all your help earlier.
Smoky was 393 at +2 so his BG went up a bit. I'll check him again at +4 to see if he goes up more or starts dropping.

 

Now you have some data for next time.

 

OK so I thought insulin was supposed to bring BG down not up. I'm learning that regulated means that the cat goes up and down, I think?

 

It depends. If the dose is too low (likely the case here but it was done to keep him safe) the BG will rise. Sometimes there'll be a food spike after dosing, often around +2. Your SS tells me that Smoky doesn't tend to spike at +2 so it's more likely from the low "token" dose you gave him.

Regulated means that a kitty's AM/PMPSs will be in the mid 200s and the nadir in the low 100s or high double digits consistently over time when a particular dose is given. In reality, many kitties need the dose tweaked slightly over time to keep them in those numbers.

 

I'm getting ready to test him for a +4 soon.
I'm curious if his BG will continue to go up and cause higher numbers foe AMPS

 

The lower dose might well put him higher at AMPS. As you get more experience dosing at lower PSs, your no shot number will probably come down and you'll be able to try larger doses at low-ish numbers with more confidence.

 

331 at +4 after pm shot

 

AMPS 314, back to the drawing board and the 3.5 unit dose I think. I hope this doesn't set him back too much. I guess the mini curve will have to wait.

 

This is to be expected, Lisa. You had to lower the dose on last night's low-ish PS because you have no data to tell you whether you can shoot a larger dose at this number. That's why we call it a token dose, meant to get a little insulin into him even knowing it's not enough. A no shot might have set him back further. Next time this happens, you can try the stall for 20 minutes and retest technique until he gets over 200 and then shoot a dose that's only slightly reduced.

These dicey situations are the ones that teach you a lot about dosing and your kitty's responses. Once numbers begin to come down dosing becomes an art as well as a science. Yes, you can get it wrong sometimes but if you have data from previous experiences, know your kitty's general trends and err on the side of caution you can do it more confidently.

I agree that your mini curve should wait.

 

Smoky was 143 at +6! That is in the blues. it is his lowest number yet.

 

He (and you) are doing well. He does seem to take time to "settle in" to a dose and reward your patience with some nice numbers.

 

That's wonderful! He sure got over the too low dose from last night quickly.

 

I'm trying to figure out how to dose. I heard you base it on his nadir, is that accurate? I can't get too many mid day tests in during the work week so how do I know what to give him?

 

With ProZinc, dosing decisions are made on the basis of both PSs and the nadir. However, if you have a bouncy cat, the PSs are often inflated from bouncing so more weight should be given to the nadir. Smoky doesn't seem to be particularly bouncy and that's a good thing.

Deciding on doses can be a bit of a mystery until you have lots of SS data and more FD miles under your belt - ie., experience. You can always post here to ask for input until you feel more confident in your own decisions. If you can't test mid day then a before bed test at +4, say, gives good info about how a given dose is working.

Here are some of the questions you'll learn to ask yourself:

1. My PSs are high. I wonder how low he went on this dose? (evening +4 might give a hint but high PS can mean dose is too low)
2. My PSs are really nice. Should I keep this dose? (check +4 in evening or sacrifice a little sleep to set your alarm for a +6 test)
3. How did he react in the past when I gave this dose at this BG?
4. What dose did I give in the past at this BG that turned out to be OK?
5. Am I in the correct dosing range for now? (look at SS trends and patterns)

There are lots of others but this gives you an idea of the thought processes involved.

 

My before bed test would be more of a +3 but I take meds to help me sleep. I can't get up in the middle of the night. How can you tell if a cat is bouncy?

 

Whatever evening tests you can get are good data. A bouncy cat might go from a yellow AMPS to a low blue nadir then up to a red or black PMPS. That's an example.

 

Oh that makes total sense to me now. How is Teasel doing lately?

 

Teasel is Teasel - keeps me on my toes and guessing because he never makes it simple! Nice AMPS and +6 today but his PMPS could be anything and the same is true for tomorrow's numbers.

 

I was thinking the same about Smoky, have to check him for PMPS in 30 minutes. I'm inspired by all the stories I've read on here about cats going into remission after a few months time. I don't know if smoky will get there, he has various other health issues.

 

All I'm hoping for with Teasel is some degree of regulation. He's one tough customer and I've been labouring at this since the end of January 2016.

 

Wow! so you are still trying to get Teasel regulated? I just did Smokys PMPS and it actually went down a little from +6 reading. 143,down to 137. guessing I shld stall before feeding and test again?

 

Yes, stall for 20 minutes and retest. No food. If needed repeat the stall. If after 1 hour he's still under 200 you'd be safest giving a token dose again. Then thought needs to be given to lowering the AM dose in the hope of getting shootable AM and PMPS.

BTW, don't assume that Teasel's case is typical. He's an outlier for sure - breaks all the rules, is almost totally unpredictable, bounces like a rubber ball, and on and on ... You're already getting a better response to ProZinc from Smoky and more easily than was ever the case with Teasel. I'm used to it now and I don't let it get me down.

 

I'm not even sure what a typical case looks like. I'm still pretty new at the sugar dance.

 

+40 minutes after pmps 178

 

Give it another 20 minutes, Lisa, and I think you'll be at a number where you can give more than just a token dose. He'll be close to an hour late for his PM dose but that's not a problem with ProZinc. You'll still be able to dose at your normal AM time.

I'll watch for your next test result.

 

Went down a little, 173 now.
I was thinking about giving him two units tonight

 

I think that's a good choice for this number. It'll give you more data to use in future. Now you know two techniques for dealing with a low PS - 1. stall and retest or 2. token dose. It'll be interesting to see tomorrow's AMPS.

 

I gave him two units. I don't have to work tomorrow so can get in a +4 before bed.

 

Smoky AMPS 314
+6 143
PMPS 137
+3 257

 

The higher BG is because of the lowered PM dose. What I see, Lisa, is that Smoky reacts very consistently to dose changes: when you gave the token PM dose of 1.5 u, he had a 393 and a 331 in the evening. Last night a token 2 u gave you a 257. He's higher this AM because of a reduced dose last night. This is a really good thing! As you get more data to verify this you'll be able to predict the effect of a dose pretty well.

 

He was 351 for AMPS and I gave him the 3.5 units. I slept 4 hours last night so need to try and grab a few more hours sleep. I plan on testing him at +6 just to see how he is doing.

 

Good dose this AM. Data today will (hopefully) validate what I said about him being consistent in his responses.

 

I wish I cld do a curve today but just too tuckered out for that. I'll have to settle for a few spot checks.

 

Things are looking good, Lisa. It's great that Kris is helping you figure out your doses and your choices are working really well. Hope it feels good that you are getting the hang of the dance steps in this sugar dance, and that his numbers are better.

 

Trying not to panic... just took smokys BG at +6.5 and it was 82. I waited about a minute and checked again and it was 74!
Isn't that a rather big drop from am. (351). I just gave him his lunch now. Should I be worried?

 

Yes, it is a big drop but he now has food on board and you're getting past ProZinc's usual peak action time period. I suggest monitoring at +8 and +10 or more often if you wish. His PMPS will be important in determining his next dose. The +6.5 BG alone tells me that 3.5 u is now too high. We need the PMPS to make a decision on the next dose.

He's doing really well on ProZinc!

 

I shudder when I think what would have happened if I followed my old vets advice to bump him from 3.25 units right to 4.
His current vet said to try between 3.25 and 3.5 so at least she is a little more cautious

 

Does this mean he needs less insulin right now than he did if the 3.5 appears to have been too much?

 

Yes, his good dose is likely lower now that he's responding well to the ProZinc. You switched him about 3 weeks ago and he'd been high for quite a while from his UTI, etc. Staying high can make them less responsive to insulin because the excessive BG affects the ability of the cells to behave normally. It can be called glucose toxicity. His UTI has been dealt with and switching insulins has, over time, remedied the problem so he responds well to the ProZinc now.

With FD, it's rare to find THE dose right away and that stays as the best dose going forward. Kitties who have spent lots of time in high numbers often need higher doses to get them moving down. Their cells are sluggish in their response to insulin. As numbers come down and stay down doses often have to be reduced because the cells become more sensitive to insulin and it takes less to keep BG under control.

That's a simple (perhaps too simple) explanation of why doses often need to be lowered.

 

No it's not, it's easier for me to understand it the way you put it.
He just finished his lunch so I'll wait at least two hours and check him again

 

Any BG updates, Lisa?

 

Just took one at 9.5 and it was 91. I'm getting a little worried. He was very hungry and is eating his dinner now

 

Should I get him some high carb food with gravy? He ate the rest of it earlier as a snack before lunch. I might have to skip his shot tonight if his numbers don't go up a little bit by PMPS. I have to work tomorrow and not sure at this point if I can run home at lunchtime and check him.

 

You still have 2.5 hours until his PMPS. That number will be the guide for dosing him. I'll have to be away from my computer then. Are you comfortable figuring out a token dose based on the experience of the last two evenings?

 

You gave him 2 u on 137 yesterday. You could try 1 u if he gets close to that or opt for no dose and pick up the slack tomorrow. Your choices have to be conservative because you can't test at lunch time tomorrow. Safety is the number 1 priority. I don't think you'll need high carb food.

 

I think I'll be alright. At what number would I not give a shot though?

 

OK thanks Kris, I'll keep an eye on his numbers and go from there.

 

For this situation (new data at good BGs, can't test in the night) how about anything below 137? I say that because you have data for 137 and a 2 u dose. Ultimately it's whatever you're comfortable with.

 

OK thank you. He might surprise me and have higher numbers later on. You never know with these FD kitties.

 

Hi Kris,
I know you are away from your computer at this time. I just wanted to give an update for smoky. He was 121 for PMPS, I can't monitor him tomorrow if I give pm shot and he does a repeat of today. I feel more comfortable skipping his shot tonight and wait and see what dose he may need in the morning.

 

Not Kris. But this sounds like a good plan. Tomorrow, I would probably still reduce a little in hopes of getting two shootable pre shots per cycle. Maybe try a skinny 3.5 or 3.25?

 

You read my mind, I was thinking of giving him 3.25 units depending on what his AMPS is in the morning.

 

Smoky at 396 for AMPS, no shot for pm last night. PMPS was at 121. Giving smaller dose for am today, either 3 or 3.25?

 

I'm not able to watch him during the day today so I thought I would play it safe and give him 3 units for am

 

Good choice, Lisa! You need him to be safe and you need peace of mind while you're at work. He's giving you a run for your money but it's all good.

 

OK so AMPS was 396 which I guess is not bad considering he had no insulin last night. PMPS was 284, a high yellow but still a yellow. I'm thinking it would be safe to give him 3.25 again since the 3 units didn't drop him down too low. Anyone have any thoughts on that?

 

That sounds good to me.

 

Just getting home now. I agree with Sue.

 

I should be able to get in a before bed test today. I'll go with the 3.25 then.

 

So much for the before bed test. That little stinker got up on the countertop and knocked the can of cat food onto the floor. The lid popped off and he was sitting there eating the food off the floor. The funny thing is that he is not really hungry. I have never seen him up on the kitchen counter and he usually just sits and waits for his food.

 

He migjht have just been feeling peckish....or justvreally likes that flavor and couldn't wait!

 

Smoky AMPS was 151, a nice blue number. Here we go again, got up late so can't stall this morning. I gave him 3.25 last night so I'm trying to figure out a safe dose for am. I'm thinking 2 might be OK or too much maybe?

 

I looked over smokys SS pattern, looks like he might be safe with 1.5 units for am. I don't want to skip shot and not have high enough numbers to shoot for pm.

 

I think 1.5 would be fine. Is that what you ended up with?

 

Just getting here. Your boy is doing really well. Yes, try the 1.5 u as you did for a token dose a few nights ago. You're getting to be a pro at making dosing decisions.

Little stinker is up on the counter because he's feeling better and has a streak of mischief in him!

 

I did give him the 1.5 plus an extra can of 3 oz food to graze on.

 

He has been hanging out with me more often instead of hiding or laying in his bed all the time.

 

I thought I would test Smoky on relion and AT2 using the same drop of blood. I don't normally compare readings between the two, just was curious about the gap in between them. I was surprised by the numbers though:
PMPS: 344- Relion
377- AT2
I am still making dosing decisions by my relion meter. I thought about backtracking a little and going back to the 3 unit dose. Anyone have any advice for me?

 

Those 3.25 seems to work fine with the pinks; maybe 3 for the yellows?

 

I gave him 3 units for pm.
I never thought about possible doses according to colors on SS. That's a good idea

 

Hi Lisa,

I was just out at a little Christmas get-together. I'm glad Sue was around to give you her input. Your dose of 1.5 u kept him safe today. That's why he's pink tonight.

 

Hope you had a great time out Kris.
I heard that human meters read a great deal lower than pet meters. I thought there would be a huge difference between the Relion and AT2 in BG numbers.

 

The difference between the two is variable. Some people say it's less at low numbers and more at higher numbers. Your best bet is to stick with the ReliOn and use the AT2 for curves when the vet wants them. Are you still using the vet who insists on the AT meter?

 

By the way, is there a spreadsheet available for the AT2 meter?

 

Yes there's a version with the label "Meter Calibrated for Feline Blood" in a red band across the top. Teasel's is that version.

 

I am still at the vet for cat clinic right now but have talked to a few other vets near me. The vets I spoke to are also big on using the AT2 meter for curves.

 

Most vets are. Oh well, you have an AT meter and can oblige them. The rest of the time you can use your ReliOn.

 

I actually like the AT2 better but could not afford the strips all the time.

 

Totally agree. That's why I use Freestyle Lite strips in my AT2 meter. They're made by the same manufacturer as the AT strips and are absolutely identical in every respect except that the AT strips undergo special batch testing to ensure that they give a correct reading when used in the AT meter set at a certain cat code. The FS strips read quite close to the same number as the AT strips and are about half the price, maybe less.

 

My friend who bought me the starter kit for the AT2 also gave me a box of 50 FS lite test strips. It's good to know they cost less although still more than Relion strips are. It's past my bedtime so I will have to wait and see how my boy is doing in the morning.

 

Smoky: AMPS: 206.
I've noticed that Smoky is higher numbers in am or pm but not both. Is that normal for FD kitties and can you give different doses am and pm due to that? I thought I would give him 2.25 for am?

 

Yes, this difference in AM and PM numbers can happen. Many people end up using "sliding scale" dosing where you give a different dose based on the BG. That's what Sue was referring to yesterday when she suggested 3.25 u for the pinks and 3 u for the yellows. You have to have enough data accumulated to decide on what to give because it's based on past experiences with a certain dose and what it did to BG. You also need a kitty who responds fairly consistently. I think Smoky is one of those kitties. If you decide you want to try this you can post here for advice as you've been doing. I don't do this with Teasel because he's too unpredictable.

I see you gave 2.25 u this AM. He'll be safe on that dose and you'll have more data to help you decide about sliding scale dosing.

 

I would rather give him the same dose each time instead of having to figure out what dose each time. I want him to be safe though when I can't be there to watch him. it's a catch 22 situation. Plus, I would think most vets would flip out over me changing his dose all the time.
How often should a cat be taken in to have bloodwork done? My current vet wants to do that every few months which could get expensive for me.

 

You have to do what you're comfortable with. Having said that, you've already done some dose changing in response to Smoky's BG when you had to lower it because of a surprise BG number. He's responding well to ProZinc and I think the effective dose will get lower over time. Just keep filling in your SS and posting here for an opinion.

As for how often to get blood work done, I think it depends on how Smoky is doing. My vet has recommended every 6 months for Teasel. Maybe once after 3 months for Smoky because he had a hard time earlier on and then after 6 months if all goes well? Could your budget handle that?

 

Re the nighttime/daytime differences - some cats just run lower one cycle than the other. It could be the difference in food/activity/stress - who knows? But it's pretty common. If you just think of it as lowering the dose when the preshot test is lower than normal, your vet might be on board?

 

I think my budget can handle twice a year for bloodwork.

 

Smoky was 206 AMPS, gave 2.25 units
PMPS was 215 and gave him 2.5 units
I hope that is not too much of a dose increase at one time. On the other hand, I think it's good that his am and pm BG were so close to each other.

 

Wow! Looking great, Lisa! You're right, similar AM and PM PSs are what we like to see.

 

BTW, what is the shelf life for prozinc?
Smoky started his on Nov 23 so it's been about three weeks. I've used about 60% of the vial so far. It's $120 a bottle here in PA.

 

If it's stored and handled properly most people find they can use the whole vial. How long that takes depends on your kitty's dose size of course. I get about 2 months out of a vial but never use it to the last drop. I read a hint on here somewhere a long time ago that you should reserve the last little bit in a vial in case you accidentally drop and break the new vial. This gives you a small emergency supply to have on hand until you can replace the broken vial. I thought that was a good idea so I've been doing that.

Another thing I do as a safeguard is to only start a new vial on a day when I can monitor just in case it's a bit more potent than the old one. So far, I haven't seen any drastic differences but better safe than sorry.

 

I did the same thing with Smoky, started him on insulin on a Monday when I was home. I know vetsulin says 6 weeks usage out of a vial. I think that's a great idea about saving the last of the old bottle. I kept the vetsulin in fridge when I got the prozinc. I probably shld throw out that vial now.

 

Looks like the 2.5 u last night was a good choice. Are you giving 2.5 u again this AM? Can you do a lunchtime test to see how low he goes? Being able to get lower BGs on a lower dose is a really good sign. The ProZinc certainly agrees with him.

 

I gave him a dose halfway between 2.5 and 2.75 units in am. I have meetings today so can't go home for lunch. I can run home tomorrow for lunch.