? What on earth is going on with these numbers!?

Discussion in 'Prozinc / PZI' started by Kelsey & Lilly, May 26, 2019.

  1. Kelsey & Lilly

    Kelsey & Lilly Member

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    Mar 23, 2019
    I'm looking for some advice and/or explanation on what on earth could be going on with my Lilly's numbers??! She's been running, high, but with me working during the daytime, I am unable to get many mid-cycle tests during the week. Last weekend, we traveled out of town (which was a whole fiasco) so I figured she'd be mostly running high those days due to stress. This weekend, I wanted to make sure I got some midcycle tests, and yesterday she was flat and high and I figured she'd need a dose increase, then out of nowhere this morning she was 104! I did two readings to make sure it wasn't a fluke, and then stalled for 30 mins and gave a reduced dose. THEN she shoots up to over 300 at +2!!!

    She's eating low-carb FF pate, and there is literally no "bad" food in the house except the canned gravy stuff in her hypo kit. She's completely indoor, so I know she's not getting any forbidden foods. I am so incredibly frustrated, and the vet is equally confused. I've now been referred to an internal medicine specialist and that single visit will cost me $170 I don't have :(
    Any input you guys have????
     
  2. Daddy Jack's Mommy

    Daddy Jack's Mommy Member

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    Feb 18, 2019
    Hi Kelsey. I don't have too much experience, as I've only been here a few months. But from what I see in Lilly's spreadsheet, a couple things came to mind. First, why is she on such a low dose of insulin with her numbers being so high? There aren't a lot of mid-cycle numbers to go by, but from what you are able to get, she's not dropping too low. So she isn't bouncing. Has your vet suggested increasing her dose lately? In my opinion, it seems like she needs more insulin. And second, why are you changing her dose frequently? It's best to stick to the same dose consistently, unless her numbers go down too low between cycles or she gives you a very low pre-shot reading. I hope some more experienced members hop in here, but I think that you need to increase her dose. Increase by half a unit and stay there for 6 cycles or so - give it at least a few days to see what happens with her numbers. And really try to get at least one mid-cycle test in to make sure she's not going low before you increase by another half unit.
    Let's see what others suggest.
     
  3. Daddy Jack's Mommy

    Daddy Jack's Mommy Member

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    Feb 18, 2019
    I was just thinking about Lilly right now, and thinking maybe 1 unit of Prozac for about six cycles, monitoring mid-cycle just as much as you're able to do. And then increasing by .25 or .50 for another six cycles or so with a little bit of monitoring, if possible. I would be cautious in raising her dose if you can't get some mid cycle numbers. I'm going to tag @Djamila and @Rachel and they can give you some good advice.
     
  4. Kelsey & Lilly

    Kelsey & Lilly Member

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    Mar 23, 2019
    She's on that low of a dose because I was unable to consistently give her dose of 2 or even one unit, so I got the advice that smaller doses consistently would be better than skipping shots. (Here's a previous thread I posted about her in, where @Djamila gave some advice.) I agree with you, it looked like she needed more than 0.5, so I increased to 0.75. My plan was to get some more mid-cycle tests in this weekend after having her on 0.75 for a few days. (I work 45+ hours per week M-F and I'm just not able to get midcycle tests, and damn this diagnosis has already robbed me of so much sleep.) But then, I get this random 100 today, and I didn't feel comfortable giving a 0.75 at a 100. So, that's a long-winded answer to both your questions.
     
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  5. Daddy Jack's Mommy

    Daddy Jack's Mommy Member

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    Feb 18, 2019
    I understand. Just wait for a more experienced eye to advise you right now, because I'm too new to give you any advice. I completely understand about the lost sleep frustration! I very rarely woke up to check Jack during the night, because if I don't get enough sleep I'm downright miserable. Hopefully, somebody will hop on and give you some dosing advice to follow. By the way, Lilly is absolutely adorable.
     
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  6. Kelsey & Lilly

    Kelsey & Lilly Member

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    Mar 23, 2019
    Thank you so much! :) She's my little diva haha.
    I'm really relying on the forum/facebook groups right now, because my vet has gotten a little annoyed with me for poking (testing) her so much, and for reducing the dose below 1 unit. (She says below 1u is apparently below the recommended dose of Prozinc, but obviously there are plenty on here who give less than one unit.) The vet has referred me to a specialist in internal medicine, but the soonest they can see her is a month from now :(
     
  7. Daddy Jack's Mommy

    Daddy Jack's Mommy Member

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    Feb 18, 2019
    There are absolutely times when under 1 unit is the correct dose. Jack (my sugar baby) was kept on very low doses for quite a while while his pancreas was healing. Right now, he's on an OTJ (off the juice) trial, but I don't want to jinx it so... shh...
    I've even seen spreadsheets on cats who could only handle micro doses because they reacted, by going too low, on "normal" doses. There is not a one-size-fits-all dose, for sure. It's all about how a particular cat reacts to insulin. I hope you can get some advice from others, because it may be that you won't need to see a specialist if you can find the right dose for her. And...you are doing the right thing by poking and testing. Poke away!
     
    Last edited: May 26, 2019
  8. Kelsey & Lilly

    Kelsey & Lilly Member

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    Mar 23, 2019
    Well, I would say congrats but I don't want to jinx it either ;)
    Thank you for your input! I appreciate it!
     
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  9. Margie and Jackson

    Margie and Jackson Member

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    Apr 26, 2019
    Have you heard of the Somogyi effect? I’m not real experienced either, but sometimes high and low blood sugar levels happening close together can indicate that this is happening. In essence, the animal is getting a high dose of insulin, and the body is saving itself by creating glucose out of its own muscle, etc. I think a lot more information is on the stickys at the top of the forum.
     
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  10. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Hi Kelsey - Looks like Lilly is still bouncing around for you, huh? Looking back through that old thread (thank you so much for linking that -- helps my old memory!), it looks like you're still having the same problem - inconsistency with the doses. Not easy to do when you have an inconsistent cat, huh? Whenever you get a lower-than-normal PS number, the best thing to do is to stall for about 30 minutes and test again to see if the number is rising. Then if it's not, you can stall for another 30 minutes (total of one hour) and see if it's rising then. By then you can most likely get a high enough number to give the regular dose. Prozinc lasts 10-14 hours in a typical cat, and in that last hour or so, they can start to rise pretty dramatically sometimes. So stalling can often get you what you need.

    Next time Lilly isn't giving you a high enough number, give it a try and see if it helps you be able to hold the dose more consistently.
     
  11. Kelsey & Lilly

    Kelsey & Lilly Member

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    Mar 23, 2019
    In the notes in my spreadsheets, I've tried the stall tactic a couple of times now, and she just stays the same, even when I stall for a full hour. I have no choice but to reduce the dose if she's only at 100, right? That's the cause for my inconsistent doses. Should I still be giving the full dose if she's still in the normal range even after a stall?? (And, as I mentioned, I'm unable to stall really at all in the AM doses because I've got to get to work.)

    I've tried to get a lot of midcycle tests in this weekend to figure things out -- and I'm getting a large number of pinks all the way through. Several folks have suggested she's "bouncing," but I haven't seen a normal number mid-cycle in a while -- only at PS time (SO annoying!) Today's +6 is a high blue, but, she started at a bit lower than she normally is by AM. Doesn't that suggest she's not getting enough insulin (as Carolyn asked/suggested above)??
     
  12. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    It really depends on the cat. For many cats, when they are usually high, and get a lower than normal PS value, you can stall an hour, and then give the regular dose anyway, and they'll be fine. It doesn't work for all cats though. Some will dive, so you have to be prepared to monitor and intervene if needed. Not something you want to try on a day when you're gone at work the whole day, but on days like yesterday when you were going to be around to test all day anyway, it could have been worth a try.

    What's happening is that the insulin is just lasting longer -- and that's a good thing-- it's how the PS numbers come down because you'll start to get more overlap from one dose to the next. However, it takes a lot of trial and error and data collection to know if Lilly is a cat who can take a full dose on a low number, or not.

    Another thing you can try is to feed right after the AMPS test, even if she's too low, and then let the food raise her up a little faster so you can shoot. Again, works for some cats, not for others, and best to try it when you can monitor the first couple of times to see how it works for Lilly.

    It can get frustrating to manage all of this with a work schedule. You just have to be patient and know that figuring things out will take a little longer than it does for folks who are home a lot. So deep breaths and hang in there. You'll get this sorted in good time! :bighug:


    Oh, and as for dosing -- we can see the curve in today's cycle, which means it's not a bounce cycle. It's a legit cycle that can be used to determine dosing. And you (and Carolyn) are correct, it looks like 0.75 isn't enough insulin at this point. However, because Lilly is sensitive to dose changes, I think I'd keep this dose for a couple of more cycles instead of increasing. The reason is that if you go up to 1u, she's going to give you a low PS number again, and you'll be needing to leave for work and will end up reducing/skipping which we're trying to avoid. Better to let her run a little mediocre for a couple of days, and then give teeny teeny tiny bits more to move her to 1u. So maybe on Tuesday give her a fat 0.75, then keep that for a couple of cycles, and then if she's holding steady, you could try a little more for a couple of cycles, and then a skinny 1u for a couple of cycles, and that should bring you to the weekend again when you can monitor her as you increase to 1u. Some kitties are so sensitive that you have to kind of sneak in the increases and hope they don't notice. ;)

    Of course, if she gives you a low PS and you have to change the dose again, it all starts over. So you might just end up holding her at 0.75 until the weekend anyway.

    You might consider getting u100 syringes and using the conversion chart as they help with making teeny changes to dosing. Just something to consider when you're starting to get low on the current syringes. They tend to be cheaper too which is nice.
     
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  13. Kelsey & Lilly

    Kelsey & Lilly Member

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    Mar 23, 2019
    Ugh, patience is SO hard, isn't it!! Especially when I look at so many spreadsheets on here and see allllllllll the numbers filled in, all the time, and I feel so defeated and discouraged (and frankly a bit guilty) that I can't have that kind of time to be able to dedicate to this illness and to my cat. I can't help but feel like it's my fault for not knowing enough (like, for not going ahead and giving her her full dose yesterday) or not being home enough.... *sigh*....

    okay, okay, more of that patience stuff....
    But seriously, that's a good suggestion, and I guess that's all I can do at this point.
    Thank you SO so much for your help! I sincerely appreciate it!
     
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  14. Daddy Jack's Mommy

    Daddy Jack's Mommy Member

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    Feb 18, 2019
    Oh my goodness Kelsey! This is not your fault at all. I consider myself fortunate to have off 3 or 4 days a week to test Jack, and even with that I don't test as much as others do. I'm also fortunate because Jack has been easy and fairly predictable, with no real highs and no real lows. Your Lilly has given you a run for your money! You're a great cat mom, and we all do the best we can with the resources, time, energy levels, etc. that are available to us. I'm glad that @Djamila had good advice for you.
     
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  15. Kelsey & Lilly

    Kelsey & Lilly Member

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    Mar 23, 2019
    Thanks for your support and encouragement!! :bighug:
     
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  16. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    I second what Carolyn said! You're doing great. Please don't let guilt sneak in and bother you at all. You're doing a fantastic job taking care of Lilly! Honestly some of us (myself included) test more than we really need to. I'm fortunate to have a fairly flexible work schedule, and to work close enough to where I live that sometimes I can drive home and grab a test (and pick up my lunch which I far-too-often leave sitting on the kitchen counter!).

    This disease is frustrating and constraining, and tons of people don't even home test at all, or even euthanize their cats to avoid the hassle. You are giving Lilly really great care, and should be proud of what you are doing!

    As for not knowing things -- there is soooooooo much to learn about feline diabetes, and about dosing prozinc. It's not as straightforward as the other insulins and requires a ton of science and art, and sometimes just gut instinct. And a lot of trial and error. You're doing a great job of learning both the information here, and what Lilly needs specifically. Every cat is different (ECID), so no matter how much we learn, there are still variations and nuance.

    So all that to say...hang in there and know that you're doing just fine! :bighug::bighug::bighug:
     
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  17. Kelsey & Lilly

    Kelsey & Lilly Member

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    Mar 23, 2019
    Thank you so so very much for your support and the positive reinforcement. :bighug: I really needed to hear all that! I am trying my best, and also trying to stay positive at going at all this alone! Physically, anyway -- I'm glad this forum exists with others who are knowledgeable to offer guidance and virtual support! ;) I'm even re-considering my job prospects at the end of this temporary position I currently have, so that I can continue to be as available for Lilly as I even am now, or to avoid being even less available (e.g., longer commutes). My sister has human diabetes, so I was optimistic that things would be just fine for Lilly (and I still try to be), but obviously human diabetes can more or less care for themselves! I had no idea the about the lifestyle change that would come with her diagnosis, and I'm still frustrated about it.

    Anyway... sorry for the rambling bitterness... and again, thank you both so much for your support!
     
  18. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Me too. And I've been here since 2015 :(. All I can say is that it does get easier. As cats become more stable and predictable (which can take a long time, but it happens), this whole dance feels less constraining. And you'll also find your people. The people in your life that can help out - the pet sitter who will give insulin, the friend who will stop by and check on things, the sister who will let you cry and not just call you a crazy cat lady...those support people will make all of the difference in helping you get through all of this.

    So I've been noticing a pattern around here, and you are the first person who is hearing it: I'm noticing that cats who are young when they are diagnosed seem to be harder to regulate on Prozinc. Maybe other folks have already noticed that (there is a long and deep history on this forum, and while I have read a lot of it, I haven't read all of it!). Anyway, normally we wait until around six months to suggest someone switch insulins, but I'm going to go ahead and suggest it now. I think I'd talk to your vet and see if s/he will prescribe Lantus or Levemir instead. First because I think they work better for young cats, and second because they are just more stable and less constraining to your life. You still have to shoot every 12 hours, but they seem to be more predictable which might help your bouncy girl (and your own spirits). :bighug:
     
  19. Kelsey & Lilly

    Kelsey & Lilly Member

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    Mar 23, 2019
    Thanks for the support. Unfortunately my profession has required me to move annually, and I'm often (and currently) in locations without family or any friends to assist. Right now, I'm also living apart from my partner because of our jobs, which makes all of this even more stressful. So, I'm stuck having to travel with Lilly for now. I am in a kind of small town area, without many options for pet sitters experienced with BG testing and giving shots, and they all charge an arm and a leg of course extra fees if the owner requires these things as well as extra fees if they are required to do the visits at specific times (like every 12 hours).

    Regarding the insulin change -- I have an appointment with a veterinary internist (specialist) in a few weeks (the soonest they could get me in of course). I'll bring up the change in insulin. Fortunately, it looks like Lilly isn't bouncing up and down anymore, but unfortunately she is running obviously higher than she needs to be. I'm still trying to be patient with dose increases to avoid the bouncing to start again. In any case, from what I've read/heard about Lantus, I actually understood that it requires a more strict 12-hour schedule? If so, that's pretty much impossible for me and my fiance and our professional lives. I sometimes can't guarantee I'm going to be home by her 12 hour shot, or I have to leave early to get to a remote courthouse, so I actually need to shift her shot times somewhat often without much warning. Thoughts about that?
     
  20. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    Sounds like you have a lot going on these days. Looking at your spreadsheet, it doesn't look like you are changing her dose time by very much, and the majority of the time you're consistent. That shouldn't be causing the problem, and the amount of change I'm seeing in times shouldn't be a problem on Lantus or Levemir either. With any insulin, the more consistent the better, but we do have to live our lives and go to our jobs, and we can only do the best we can do. I know I can't always keep my times the exact same every day either as my work schedule varies a fair amount these days as well. I try my best. And that's it.

    I don't think there is any rush to switch insulin. Just something to think about/talk about with the specialist.

    It looks like you're doing great with the teeny tiny dose changes. And so far, she's steady, although as you already said, too high. I would just keep going with the slide upwards until the weekend when you can get a little more data. From last weekend's data, it looks like you have some room to increase without putting her in danger, so if you want to sneak her up towards 1.5 between now and Friday, I think it should be okay. Sometimes cats surprise us, but the 1u really wasn't doing much, and the protocol says if the nadirs are above 200, you can increase by 0.5u. Of course, not with a kitty like Lilly, but just sayin' that if you moved from 1u over this past weekend to 1.5u by this coming weekend, odds are in your favor that things will be okay.

    So all that to say, you're doing fine. Hang in there and know that even if we can't be there in person, you aren't alone either. You've got a whole forum full of people who understand. :bighug:
     
  21. Kelsey & Lilly

    Kelsey & Lilly Member

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    Mar 23, 2019
    Thanks so much. I'm trying!

    I had another thought today, as I'm thinking about Lilly and her doses... I haven't had a bounce since my trip out of town two weeks ago. BUT, her numbers have continued to be pretty high and she has a fairly flat curve. I'm wondering if perhaps something happened to the potency of the insulin in the trip?? I kept it in an insulated lunchbox with two ice packs, but maybe it didn't stay cool enough? Would that affect the potency? Is there any other way to find out without buying a whole new vial?? (I really don't have the funds to buy a new one, if that's not even the issue.) Just wanted to see what you thought? I'll collect more data on Sunday, after she's had 1.5u for 3 days.
     
  22. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    It's not impossible, but it's also not very likely. It's pretty rare the times when a vial has gone off around here. It doesn't look like your spreadsheet has data from the past couple of days, but assuming it's the same as earlier in the week, it does seem a little strange that she would suddenly stop bouncing.

    Are you noticing any other changes?
     
  23. Kelsey & Lilly

    Kelsey & Lilly Member

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    Mar 23, 2019
    Not that I know of. She sleeps most of the time, which has been pretty typical since her diagnosis and just before. Still peeing a lot, which is expected with her numbers. I'm just at a loss. We're pretty much back up to the dose that looked like it was too much for her, and all I'm seeing is pink.
     
  24. Djamila

    Djamila Well-Known Member

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    Aug 1, 2015
    It's not uncommon for cats to develop insulin resistance from time to time. you just keep going with the increases until all of a sudden you break through the resistance and they start coming down again.

    So try not to worry about it and just keep going. I say this in utter hypocrisy because every time it happens to Sam I worry about going up and up and then am always surprised when he breaks through :rolleyes:

    Hopefully you'll be smarter than I am ;)
     
  25. Kelsey & Lilly

    Kelsey & Lilly Member

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    Mar 23, 2019
    So based on today's "curve," I suppose it's safe to say we need to keep going up? Can I go straight to 2u or should I keep going slowly and go to 1.75?
     
  26. Jenna Josie

    Jenna Josie Member

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    Jun 30, 2018
    Yes, I would increase by .25. Gradual increases every three to four cycles (until that break through Djamila describes) are best so that you don't accidentally skip right over the "good" dose.
     
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