To Shoot or not to Shoot

Can some please have a look at Buddy's spreadsheet. For the last month, I have been consistently told not to shoot if BG is under 11, now I am being questioned about not shooting at the 8.4 #. I am not trying to rush this but he hasn't had insulin for 4 days. Should I have given insulin at some of these times. Is it OK to give it so infrequently and not give it more often than I do. I thought these numbers were great, but not giving his shot was the right thing to do. Thanks
https://docs.google.com/spreadsheets/d/1N4l3sXT5Tgt6lYUaUT9GGlzjBsKNXZKQ7mOwxR93CLg/edit?usp=sharing

 

Your spreadsheet says tight regulation, are you using the Modified ProZinc dosing method? Here's a link to the dosing sticky.

What you do depends on which method you choose to follow. If you are doing the SLGS method, you are doing everything correctly. If doing the Modified Method, the guidelines are a little different. Now that you have a decent amount of data and we know how Buddy handles ProZinc, can really start to fine tune.

I would for sure be testing for ketones, given that he had so many quick reductions in insulin.

I'd be considering drop doses or something like 0.1U vs going cold turkey no insulin...but only doing this on a day that you'll be around to test.

Tagging @JanetNJ and @Deb & Wink.

I do find it odd that his numbers have come down so fast, it's a bit unusual. How was he diagnosed? What symptoms were you seeing? Had he by chance received a steroid shot any time before being diagnosed?

Edit: being so new at this, you're doing everything correctly. It's better to err on the side of caution and ask for help!

 

I said I was using TR because the Vet started him at 2U. I'm not sure if that is right. I'm not sure how I would give 0.1U. There are only 3 lines on my syringe. How do I test for ketones? He did not receive a steroid shot that I know of. He had his rabies shot and Add on FVRCP just before. Are either of these steroids? He was drinking excessively and lost a little weight so I took him to the vet. He had Feline Geri Profile w T4/Urine/Cyst. So he hasn't had any insulin in 4 days, what do you recommend I do going forward? I am around to test. I am now very confused. I thought I was doing what everyone was suggesting. No shoot below 11.

 

Without insulin he's coming down on his own. I'm hesitant to tell you to shoot these numbers.

 

SLGS and TR are dosing methods. TR specifically is for Lantus and Levemir insulin, the rough equivalent on ProZinc is the Modified Method. Go ahead and give the sticky I linked a read through...the dosing method you choose is really about what you're comfortable with. One is a bit more conservative, the other a bit more aggressive.

As for a 0.1U dose, you really just "eyeball" it based on the markings your syringes do have. Many people also use calipers, but that may be a bit too complicated to introduce right now.

A drop dose is where you push the plunger down as far as you can towards the needle to get rid of all the air, insert into the vial, and then release it. The result is about a single drop of insulin in the syringe, really not even visible to you. When giving the shot, you have to push the plunger down and hold for 10 seconds to make sure the drop comes out.

As for ketones, here is a link to a thorough post. A lot of people here use the urine test strips you can get at any pharmacy, but some do you a specific type of meter that can test the blood. I use the meter because it's very hard to get a urine sample from my cat.

As we mentioned before, those 11 mmol, etc guidelines are for people who are new and without any data. Now that you have data, we can tweak things to keep him in a better BG range...but honestly he's pretty much already there.

Just saw Janet's reply - I agree, I'm also hesitant to say shoot anything. My main concern about stopping cold turkey is ketones, which is why I mentioned drop dose.

I asked about steroids because sometimes those can cause diabetes, and then it goes away.

 

I'd suggest this - test for ketones as soon as you can, ideally today. If there aren't any, I'd leave him with no insulin to see how he does...just continue to test at what would the AMPS, nadir, and PMPS times. If the nadirs start to climb back towards 100, consider a drop dose. But continue to test for ketones every day as well.

 

Hi Sue,

Did you switch Buddy from a higher to a lower carb diet after he was diagnosed diabetic?


Mogs
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Yes switched him to lower carb wet. NO dry at all.

 

Do you know the rough dates? Perhaps the end of January?

I know Mogs will pop back in, we ask because it's very odd to see such a drastic drop in numbers in a newly diagnosed cat without something else happening at the same time.

It looks like Buddy might be one of those lucky kitties with diet-controlled diabetes!

 

It looks like Buddy is benefitting greatly from the diet change.

Unfortunately, I can't suggest anything on the insulin side of things because I've not used Prozinc. I'm going to tag @Deb & Wink to ask her to make some suggestions on how to proceed.


Mogs
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I can tell you exactly. It was Jan 20. (Food on my visa)

 

That makes a lot of sense! See how his numbers started to drop pretty quickly right there?

I'd wait for Deb to reply to see if no shots are better than very small doses, but until then just keep doing what you're doing. I'd for sure skip the shot if AMPS or PMPS are below 8.5 mmol. In the 8.5-11 mmol range, it's your call - if you do give a shot, I'd recommend no more than 0.1U if you can measure it. Above 11 mmol, give 0.25U.

Please check ketones when you get a chance. And continue to test, you're doing a great job!

Just to reiterate - now that you have good data and Buddy's in such low numbers, the guidelines you started with will change a little bit.

 

Aren't credit card records wonderful!!!!!

Buddy isn't quite ready for an OTJ trial, from what I can see from the SS. I think you need to try a micro-dose. Do your insulin syringes have 1/2 unit markings on the barrel?

Pictures in this link show U100 syringes, but the concept is the same for placement of the syringe plunger using U40 syringes.
Sticky Insulin Care & Syringe Info: Proper Handling, Drawing, Fine Dosing (from over in the Lantus ISG, but they have all the good pictures.)

I'd suggest trying either 1 drop or 0.1U of Prozinc, and see how Buddy does on that amount. You'll have to monitor more, to make sure that Buddy's BG levels don't drop too low, too low being <50.

We also need you to get some tests in during the PM cycle. More than just the pre-shot test. Without being able to see what is going on at night, we only see half the picture and could be missing something important.

So, try to get a before bed test every night please.

 

@Deb & Wink - Thanks, Deb!


Mogs
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