Trying to figure out dosing for Gizmo

Discussion in 'Prozinc / PZI' started by WYMoreta, Dec 12, 2020.

  1. WYMoreta

    WYMoreta Member

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    Nov 13, 2020
    Hi All,

    I am new to the forum, and have only posted one thread before. I got lots of great advice on how to start tracking Gizmo's numbers, but I still have questions:

    1) The PROZINC DOSING METHODS page indicated that I shouldn't change anything for at least a week, then doing the 12 hour curve. However, in my original introductory discussion, I've had a few replies (and read other threads), that say Hill's Science Diet M/D is not a good diabetic cat food. After looking at the food spreadsheet I tend to agree. Should I change foods now or wait until she's been on the same food/dosing schedule? And I have done some curves.
    2) I have multiple civilian cats, and from what I've been reading overall a dry cat food is not recommended. Any good food recommendations from this group? I've been feeding them Hill's science diet dry food either indoor 1-6 or 7+ depending on age. Info about my Civvie cats:

    • Sherlock 12 year old male, on Thyroid medication
    • Cephas 9 year old male - no health problems
    • Chakra - 6 year old female no health problems
    • Shoni - 1 year old female no health problems.

    My tentative plan is:

    1) Leave her on M/D today, and try to get a curve throughout the day. (I've already started, and will try to get measurements every 2 hours).
    2) Switch her to Fancy Feast Pate (or straight cooked chicken if she won't eat fancy feast, but so far her appetite has been good) tomorrow, and at least to AMPS/PMPS numbers and use only 1 unit insulin unless her PS numbers are below 200, then don't give her anything.
    3) Stay on Fancy feast pate until next weekend when I can get another curve.

    Thanks in advance!

    (and there won't be any hurt feelings on my part if you say that my plan needs adjustment... I know I'm a newbie and I've got a lot to learn from a lot of smart people, but people can't help unless I ask the questions!)


    Adding link to first post:
    Hello - Gizmo and I are new to the forum
     
    Last edited: Dec 21, 2020
    Reason for edit: Adding link to first post.
  2. Shelley & Jess

    Shelley & Jess Member

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    I can't access your spreadsheet. Is sharing set for anyone with the link can view?

    - Recently diagnosed.
    - Was eating Hill's Science Diet Dry Food before DX - insane amount of carbs, I've seen Hill's dry food referenced from mid 30% to mid 40% carbs.
    - Switched to Hill's Prescription Diet m/d wet food - Dr. Pierson food chart 13% carbs
    This food switch alone can significantly lower BG numbers. (I can't see your testing data but looks like BG has already been impacted from the first food switch in your previous thread: Hello - Gizmo and I are new to the forum)

    - Now the plan is to switch to FF pate - Dr. Pierson food chart, FF pate 3% or less carbs.

    I urge caution. This is a huge total reduction in carb load in a short period of time. You need to be monitoring Gizmo closely - more than just an AMPS and PMPS when transitioning to lower carb food.
     
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  3. WYMoreta

    WYMoreta Member

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    I will try to figure out what's going on with the spreadsheet.

    In the meantime, Gizmo was diagnosed in late October of this year. She had been on Hill's metabolic for a long time, but the vet suggested M/D wet and dry as well as insulin. We switched her then (slowly of course from a blend of metabolic to M/D over a period of weeks). Then she started throwing up (I assumed because she was inhaling the dry food), so we went to straight wet M/D a couple of weeks ago.

    I *think* I fixed the link to my spreadsheet, but I can only tell if it works for me. Let me know if its still broke.

    Her numbers seem high today, but not scary high.

    Today's numbers (in case the link s still broken)

    AMPS 248
    shot 1 unit
    +2 441
    +4 285
    +6 205
    +8 208

    We are trying to get a curve today since I don't have to work.

    Thanks

    WYMoreta & Gizmo
     
  4. Pookie

    Pookie Member

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    Oct 10, 2020
    I can't give dosing advice, but wanted to let you know your SS link is working fine :)
     
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  5. Shelley & Jess

    Shelley & Jess Member

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    Thanks for including the DX date in your signature and spreadsheet link working now too. :)

    And, thanks for the further details about the food transition.

    Hill's m/d dry is 15% carbs (per Hill's website.) Still too high for a diabetic kitty. Removing that completely only a couple of weeks ago can make the difference too.

    Great job with the curve so far, let's see what the next two tests bring. Will you be able to get a couple tests in the PM cycle tonight? And a mini-curve or nadir check during tomorrows cycle. We want to try make sure you didn't catch todays curve during a bounce cycle or a bounce breaking cycle. Grabbing those mid cycle tests whenever you can will help fill in the blanks with what's going on with the BG.
     
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  6. WYMoreta

    WYMoreta Member

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    We will be able to get a couple more today, but probably none after her evening meal. I will try to catch a few extra tomorrow. So for now, I will keep her on the hills m/d at least through testing tomorrow. This stuff is complicated. Thanks for your feedback!
     
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  7. WYMoreta

    WYMoreta Member

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    Nov 13, 2020
    PMPS = 332. We gave 1 unit insulin. We can't measure anymore tonight, but would welcome suggestions based on whatever her AMPS values are.

    Thanks,

    WYMoreta
     
  8. Shelley & Jess

    Shelley & Jess Member

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    I'll watch for your AMPS tomorrow.
    Most days @JanetNJ is an early bird too and is more experienced with dosing recommendations.
    Please don't hate me, but can you grab a before bed test tonight? It may help us determine if she needs more insulin/less insulin or hold the dose tomorrow morning.
     
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  9. WYMoreta

    WYMoreta Member

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    Nov 13, 2020
    AMPS = 376. Thanks!

    1.5 units given.
     
    Last edited: Dec 13, 2020
    Reason for edit: Added insulin dose
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  10. Shelley & Jess

    Shelley & Jess Member

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  11. JanetNJ

    JanetNJ Well-Known Member

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    I think 2 was too much. I like the 1.5 dose idea. ID stick with that and see what happens. :)
     
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  12. WYMoreta

    WYMoreta Member

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    @JanetNJ

    I need to make a decision whether or not to buy more m/d now or to switch to fancy feast. I hate to buy expensive food for her when it’s not the best option, but I also understand the concern of not changing anything too fast. Thoughts?

    We are going to get a mid day test on her today.
     
  13. JanetNJ

    JanetNJ Well-Known Member

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    I am not fond of the prescription food. In the beginning I had a case of it... and I used it up because I didn’t wanna waste... but go ahead and get the fancy feast. You can do half and half for a while to transition
     
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  14. WYMoreta

    WYMoreta Member

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  15. WYMoreta

    WYMoreta Member

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    +6 hour measurement was 215, but PMPS = 69.
    She's eating now, 1/2 M/D 1/2 fancy feast pate.
    I don't think I should give her any insulin tonight.
    I will check her at +2 after dinner and post.

    Thanks for any recommendations thoughts!
     
  16. JanetNJ

    JanetNJ Well-Known Member

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    wow, that's unexpected. Give it another test just to make sure it's a correct number.
     
  17. WYMoreta

    WYMoreta Member

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    @JanetNJ

    +2 was 151. Definitely not giving her any insulin tonight.
     
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  18. JanetNJ

    JanetNJ Well-Known Member

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    1.5 may be too much. Might try 1.25.
     
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  19. WYMoreta

    WYMoreta Member

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    @JanetNJ
    AMPS 389. 1.25 units insulin. Breakfast 1/2 fancy feast pate, 1/2 M/D wet.

    Will test at +6
     
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  20. JanetNJ

    JanetNJ Well-Known Member

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    Good. Hopefully the lower dose will let you give a full dose pm
     
  21. WYMoreta

    WYMoreta Member

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    We did give 1.25 at dinner. I intended to give her 1.25 at breakfast this morning, and I'm positive I got *some* of it in, but it was a partial fur shot. I'll try to get a +6 today, but based on her numbers over the past 2 days should I consider going to 1.5?
     
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  22. JanetNJ

    JanetNJ Well-Known Member

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    No... at 1.5 it's giving too low of a pm preshot to get a second full shot in. THe point of lowering it was to see if things even out a bit, which they did last night letting you give the full dose. as a result you got a better am preshot this morning then the high 300's you were getting previously. Keep this dose a few days and lets see what happens. You can't tell if it's not enough after just one or two cycles.
     
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  23. WYMoreta

    WYMoreta Member

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    Thanks! We'll stick with 1.25.
     
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  24. WYMoreta

    WYMoreta Member

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    @JanetNJ
    She's steadily creeping up. AMPS = 380 this morning, and I've been sticking with 1.25. Yesterdays +6 was 314.
     
  25. Shelley & Jess

    Shelley & Jess Member

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    We expect her to be a bit bouncy from the skipped shot, partial fur shot and a couple of lows she's not used to. Hold the 1.25u dose, give her little body a chance to settle in and get those mid cycle tests when you can to see how the dose is really working.
     
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  26. JanetNJ

    JanetNJ Well-Known Member

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    Let’s give it today. If it’s not enough then go back to 1.5.
     
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  27. Shelley & Jess

    Shelley & Jess Member

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    You should probably figure out what dosing method you're going to follow so we're all on the same page. Depending on what Prozinc dosing method you choose to follow (SLGS or MPM) going forward this will be your/our guideline when to increase, decrease or hold the dose. It is especially helpful to be following a set protocol you can refer to when you need help with dosing decisions and no one is online to guide you.
     
  28. WYMoreta

    WYMoreta Member

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    Hi @Shelley & Jess
    I've read the PROZINC DOSING METHODS but I didn't understand what MPM meant. I have re-read the PROZINC DOSING METHODS to understand the SLGS method.

    Re-re-reading the PROZINC DOSING METHOD link, I *think* it means Modified Prozinc Method. However, MPM is not actually on that page, and it's not listed on the cat health terms page, or on the FDMB glossary.
    Does MPM mean Modified Prozinc Method?


    If I understand the SLGS method, I would need to wait a month before making any dosage changes. If COVID hadn't happened that's probably the method I would use. However, my schedule is somewhat more flexible these days (one good thing has come out of the pandemic I guess), so I'd probably opt for another method.

    Thanks for helping me understand this stuff. It's slow going.

    Angela
     
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  29. Deb & Wink

    Deb & Wink Well-Known Member

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    Yes.
    MPM = Modified Prozinc Method. It's not in any glossary and not called that specifically in the protocol. But I shortened the term months ago, back when the updated protocols were posted in February 2020. It's much shorter to type MPM than to type out the 3 long words.

    Just like Tight Regulation is abbreviated to TR in the Lantus ISG group, we needed a short abbreviation for the prozinc method that mirrors a lot of what TR is doing.
     
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  30. Shelley & Jess

    Shelley & Jess Member

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    I read your first post and it seemed you had a handle on the SLGS dosing method and then moved on to your food questions. Sorry if I misunderstood that you were talking about not changing the food for a week. Changing to a lower carb food is okay at anytime as long as you can monitor the BG closely during the food transition.

    SLGS (Start Low Go Slow) has you evaluating and making any needed dose changes weekly - unless kitty earns a reduction, you reduce the dose immediately.
    Hold the same dose for a week, do a curve at the end of the week and evaluate if the dose should be increased, decreased or held depending on the nadir.
    When following SLGS dose reductions are earned anytime kittys BG falls below 90 mg/dl.

    You got it!
    MPM (Modified Prozinc Method) allows for faster dose changes, every 3 to 6 cycles, and dose reductions are earned anytime kittys BG falls below 50 mg/dl. However, you'll need to test kittys BG multiple times per day, every day, both cycles to follow the MPM method safely. The Prozinc Dosing Method also recommends "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."
     
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  31. WYMoreta

    WYMoreta Member

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    Nov 13, 2020
    @Shelley & Jess & @Deb & Wink & @JanetNJ
    Thanks for all the info.
    We are settling on on using the MPM formula

    I have yet another question: How do you know if the shot is going into fat or subcutaneously? My Gizmo is still a chunk at 15 lbs, and when I try to tent her skin it's almost like I'm pulling up a layer of fat at the same time. I.e. the "tent" that is created is probably close to a 1/2 inch, and is much thicker than if I try to tent the skin on one of my civvie cats that are not overweight.
     
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  32. Shelley & Jess

    Shelley & Jess Member

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    Where are you shooting? Have you tried the sides? I shoot Jess in the sides and find it so much smoother. She's a good weight but thick in the scruff too.

    I just tried pinching my beefy boy civvie - no go in the scuff either but tented nicely in several areas on his sides.

    Have you seen this?
    49823824412_72fd707b6e_o.jpg
     
  33. WYMoreta

    WYMoreta Member

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    @Shelley & Jess
    Yes I've seen this. I've tried the side of the chest and the flank. I can tent it okay, it's just that it's "thick" and I think I must be pulling some fat up along with the skin, so how do I know how "deep" to go into the flap so that it isn't going into the fat?
     
  34. Shelley & Jess

    Shelley & Jess Member

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    I know exactly what you mean and it's a good question. Shooting the sides solved the problem for me so I didn't research it any further. I don't recall having read any threads that address this specifically. Now I'm curious in this answer too! Let's see if @JanetNJ or @Deb & Wink have anything to add or can point us in the right direction. If not, maybe a good question for the Main Health Forum.
     
  35. SashaV

    SashaV Well-Known Member

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    I do the shoulders. Much more loose skin easier to pull up :D
     
  36. Deb & Wink

    Deb & Wink Well-Known Member

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    I don't know for sure, if injecting into the fat would slow absorption or make the insulin act differently.
    Your goal with tenting the skin, is to make sure the needle doesn't poke all the way through the tent, and out the other side and you end up squirting the insulin into the fur.
    Goal is to get the insulin going under the skin. Not into muscle. That's the only guideline I remember in regards to this, not into the muscle.

    So yes, a good question for the Feline Health (Welcome & Main Forum).
     
  37. WYMoreta

    WYMoreta Member

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    @Deb & Wink

    Evidently I've been on reading overload. I know I read somewhere that injecting into fat slows absorption, but now I can't find it again. I /think/ it was on felinediabetes.com but not in the forum, but it could have been a link from that to another link.
     
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  38. Deb & Wink

    Deb & Wink Well-Known Member

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    There has been some anecdotal reports from various members, that shooting into the scruff can slow absorption of the insulin. But it's thought that does not really impact the overall BG levels much. But it can delay the onset.

    Here is an article that has more information about insulin absorption rates in HUMANS, more than you probably ever wanted to know. Cats can and do have similar reactions to insulin, so many things noted in this article apply to felines too.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6079517/

    I do remember someone from here that was injecting insulin into the muscle for their cat. Injecting into the muscle leads to faster absorption, because there are more blood vessels to help "distribute" the insulin quicker, than injecting SQ (subcutaneously).
     
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  39. WYMoreta

    WYMoreta Member

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    My vet originally recommended muscles, but vet tech recommended subcutaneously. Subcutaneously seems to be less likely to do something really wrong (inject into vein etc). However, I am wondering if the slowlness of absorption is not ideal based on some of my measurements, but I realize I'm still trying to get Gizmo regulated.
    I did find the 2018 AAHA Diabetes Management Guidelines for Cats and Dogs to be very good reading if somewhat dry. I am a visual learner so their flow charts are helpful to me.

    I will be seeing my sister soon, and she had a diabetic cat for 9 years (just lost her this year), and I hope to ask her about subcutaneous and how not to get it into the fat. I'll also talk to my mom who was an RN for years.

    I am still trying to get the roller coaster figured out.
     
  40. WYMoreta

    WYMoreta Member

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    @Deb & Wink & @JanetNJ

    I'm slowly feeling my way to a better dose for Gizmo and any advice will be appreciated. I also have a few other questions:

    1) I am travelling with my cat tomorrow (12 hour car ride). I keep reading about stress causing higher glucose readings. Should I up her dose tomorrow morning in anticipation of the rise? (I think the answer is no, but I won't find answers unless I ask the question). We have travelled with her before, and she tolerates it well, but obviously doesn't care for it.
    2) Gizmo was a chunk at 18+ lbs, then she lost 3 lbs which is what caused me to take her to the vet for bloodwork. In 1 1/2 months she's gained 9 oz (if the vet's scale is correct, she was checked this morning). I started feeding her fancy feast on 12/13. She gets 2 cans in the morning and 2 cans in the evening. With the exception of this afternoon when she got a few morsels of Hill's Science diet 7+, she has not been allowed to eat other's food. What would you recommend feeding her? Ideally she could lose some weight, but I am hesitant to do that while trying to figure out the correct dose for her.
     
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  41. WYMoreta

    WYMoreta Member

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    @Deb & Wink & @JanetNJ ,

    PMPS 194 - to dose or not to dose? Given that her morning numbers are almost always high, considering a dose of .25.

    Thoughts?

    Decided to give mini-dose.
     
    Last edited: Dec 21, 2020
    Reason for edit: updated what I decided.
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  42. JanetNJ

    JanetNJ Well-Known Member

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    I would, yes. 194 is basically the same as 200. GO for it.
     
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  43. Deb & Wink

    Deb & Wink Well-Known Member

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    No, I would not increase the dose, simply because you will be traveling with Gizmo and the stress may cause the BG numbers to be higher. There is the complication that you would need to stop and test in case she went LOWER during the 12 hour car ride than you expected. "Better too high for a cycle. than too low for one."

    Gizmo can get back on track BG wise. Being in a strange place will be stressful for her too. Just remember to take your hypo kit with you.

    Kind of a "catch-22" situation with Gizmo's weight. Too much weight usually leads to the insulin being used less efficiently, and can make it harder to regulate a cat.
    My recommendation would be to cut back a little bit on the food. Slow and gradual weight loss is what you want. So maybe cut back the food intake by 1/2 a can of Fancy Feast, and see how Gizmo does on that lower amount of food. Try this. Take away 1/4 can from the morning meals and take away another 1/4 can from the evening meals.

    What would you say is the ideal weight for Gizmo?
     
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  44. WYMoreta

    WYMoreta Member

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    @Deb & Wink
    I would say gizmos ideal weight is around 9 pounds.

    We will keep the hypo kit with us. The honey is packed. We will try to reduce slowly. I just wasn’t sure if she should be reducing at all. At least right now. I was kind comparing getting her BG regulated with me going through chemo years ago. Even though I did need to lose weight at the time, they didn’t want me to lose weight because of the chemo dosing.

    Thanks for all your help.
     
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  45. WYMoreta

    WYMoreta Member

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    @Deb & Wink , @JanetNJ

    Good morning. We survived the trip to see Wyoming very well. And contrary to what I thought would happen, her numbers were actually lower at my parents house, even though she was in a new place with 3 new people, 2 new cats, and a new dog. (12/22 -12/28/20). Have you ever heard of altitude affecting BG? I live at an altitude of 700 feet, but my parents at 7200 ft. I know that it affects blood oxygen levels, but no idea about BG.

    However, I am trying to work n her numbers, and she has been all over the map. I can do a more thorough test this weekend. What do you recommend? Every 3 hours from AMPS to PMPS???

    Also, what would you do for values in the 130-150 range for PMPS? Token shot?

    Thanks!
     
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  46. JanetNJ

    JanetNJ Well-Known Member

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    it's hard to give dosing advice when we don't know what is happening mid cycle. Please try to get a mid cycle reading every day that you can, and a before bed reading. It looks like 1.25 might be too much if you aren't getting a shootable number in the morning. You may have to reduce to 1 .
     
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  47. WYMoreta

    WYMoreta Member

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    @JanetNJ and @Deb & Wink ,

    I've got more mid-day numbers. They are not pointing to less insulin (at least to me). I have Sunday that I can do another day of 3 hour readings. Any suggestions for what to change?

    Thanks!
     
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  48. Deb & Wink

    Deb & Wink Well-Known Member

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    You can try to change the dose, so it's more even between the AM and PM shots.
    So maybe try 0.8 for both the cycles in a day, in a 24 hour period.

    Try to get at least 1 more test in the PM cycle, the "before bed" test.
    Alternatively, set an alarm to get a test around +5 to +7 in the evening (PM) cycle. Occasionally. Doesn't have to be every night.

    Next time you get a curve, try to switch up the test times. So instead of +3, +6, +9 try for +2, +5, +8, +11.
     
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  49. JanetNJ

    JanetNJ Well-Known Member

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    I might try 1 am and pm. You are shooting just once a day recently. If you lower the pm dose you are more likely to have a shootable am dose.
     
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  50. WYMoreta

    WYMoreta Member

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    Hi @Deb & Wink and @JanetNJ

    I got a lot of readings on Friday and today. However, I don't understand the readings. How can she be bouncing this much? I was hesitant to give her the .8 this morning when she was at 184, but after eating she went high.

    Thoughts?

    Angela
     
  51. Deb & Wink

    Deb & Wink Well-Known Member

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    My thoughts are that the 1.25U is too much for Gizmo right now. But the 0.8U dose isn't enough either.

    I'd suggest trying a 1U dose of Prozinc.
    As long as you are around to monitor, those high blue range BG pre-shot levels look safe to shoot the insulin.

    I see the note on your SS that Gizmo got into some of the civie's cat food on Friday PM. That could help partially explain the high AMPS of 417 on Saturday 1/9/21.
     
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  52. WYMoreta

    WYMoreta Member

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    I will try the 1.0. Today won't be a good day to monitor as she got into the civvie cat food this morning (I just got the surepet feeder and I learned that Gizmo can shove her way in while Sherlock is eating and get some of the civvie food). I plan to call surepet today to see if they can tell me how to force the feeder to close when it senses Gizmo's microchip, otherwise I'm not sure the surepet feeder will help us much in this house.
     
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  53. Pookie

    Pookie Member

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    Oct 10, 2020
    I'll try to find the video and link it, but I did see one video where they placed the feeder inside a box or basket and cut a hole large enough so only one cat could gain access. So if Sherlock was eating there wouldn't be room for Gizmo to stick his head in too, and if Sherlock wasn't eating it wouldn't matter of Gizmo did stick his head in because the feeder wouldn't open for him.

    ETA: We got a microchip cat feeder
     
    Last edited: Jan 11, 2021
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  54. WYMoreta

    WYMoreta Member

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    @Pookie - Thanks. I also called the company and they just set the feeder for "intruder mode" and "forced lid close" mode which should force the lid to close when it detects Gizmo. Hopefully that will work. If not, I will have to jury-rig something like you are talking about. I'm a little worried that the "tunnel" setup will cause my civvie cat to not use the feeder. He's a bit timid.
     
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  55. Deb & Wink

    Deb & Wink Well-Known Member

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    Sheesh Gizmo! Face palm when I read this. Gizmo sure isn't making this easy for you.
     
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  56. WYMoreta

    WYMoreta Member

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    @Deb & Wink - No she's not!

    @Deb & Wink & @JanetNJ -

    We've been very consistent with a dose of 1.0 for several days, but her numbers have been relatively high. A few of those days she got a few morsels of civvie cat food, but the last few days I have been vigilant in monitoring the cats at the cat feeder and ensuring she isn't sneaking in. Thoughts on going to 1.25?

    Thanks!
     
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  57. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    1.25 is probably fine, but is there any way you can get mid cycle tests in either during the day or a before bed test? ProZinc is dosed based on how low they go.
     
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  58. WYMoreta

    WYMoreta Member

    Joined:
    Nov 13, 2020
    @JanetNJ - today yes. Done! 218.
     
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  59. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    If he seems to stay in the yellows you might try 1.25 again
     
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  60. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Dose increase looks warranted to me too.

    You just started the new bottle of Prozinc today, so it may take a couple of cycles to see the full effects of that fresher Prozinc on the BG numbers.
     
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