Adjusting dose new diabetic using Prozinc

Status
Not open for further replies.
christoph

christoph

Active Member
Could someone with experience with Prozinc check out Poncho's 12hr spread sheet and comment on last several days with low #s in am and high in pm? I'm assuming the goal is to get both BG numbers close therefore the two insulin doses per daily injection will be close providing amount of food given per 12 hr period is also close. Am I correct?
 
Yes the goal is definitely to have 2 shootable numbers so you can dose twice a day as ProZinc does not last 24 hours. I see some similarities that I have with Bud going on with Poncho. I don't think sliding scale dosing is working with Bud and I'm trying to find a happy medium. Even at 1 unit, you are getting a an unshootable AM number. How do you feel about maybe 0.5 or 0.75 units tonight even if Poncho is in the 400s or over to see if you get a shootable AM number?
 
Are you giving a shot three times a day? (I notice your tab says TID dosing). If so, I would do twice daily as you are giving pre shots that are too low to shoot.
 
I'm leaning toward gradually lowering the pm number until the am number rises to meet close to even. The vet has me going by a scale but I've been tweaking the shootable numbers (pm) lower for fear of another hypo event and to raise the am number.....which so far is working from the last 2 days readings. We have an appt with the vet today so I'll see if she presents a new scale. Poncho's still dealing with an URI and I'm still having to force feed. I'll probably try 0.75 tonight. Thanks.
 
Sue and Oliver (GA) said:
Are you giving a shot three times a day? (I notice your tab says TID dosing). If so, I would do twice daily as you are giving pre shots that are too low to shoot.
Click to expand...
I'm giving 2 shots daily. There are 2 spread sheets. I'm keeping both in case I have to switch again. I'm not very skilled with the computer so Haven't messed with the spread sheets other than to record. Thanks.
 
Ok. I get it. I'm with Stacy. I think I might go with .5 for a few cycles and see if you get two shootable pre shot numbers. It looks like one unit is too much and lasts too long.

If he has a UTI, that can definitely make the numbers higher. Is he on antibiotics? Could they be causing him to be finicky about the food? Eating less can lower the numbers so you may have two contradictory things working.

Since he is responding well to a small amount of insulin while having an infection, I'd watch the numbers carefully. Once the infection clears, he could drop lower suddenly.
 
He has been battling an upper respiratory infection for over a month now which was coming on before he was diagnosed Jan 15. I'm force feeding him 5-6 times (90-120 ml)and giving sub q fluid twice daily. He had a hypo event 2 weeks ago due to the vet having me give 1 unit when his BG # was 139 (Alphatrak2). He started to have a seizure but I got him back quickly, but I think it set him back as he was starting to eat a small amount on his own. I'm wondering if he developed a neurological problem because when he has tried to eat on his own he paws at the left side of his mouth and goes overboard with chewing after licking a tiny amount of wet food. The vet said his mouth/teeth look good. One thing after another with this poor guy.
 
Here's the scale my vet gave me a couple weeks ago with low number revision:
>400 give 1.5 unit
300-400 give 1 unit
200-300 give 0.5 unit
200< no shot
Revised 2/25: am BG @ 125-300 give 0.5 unit
<125 no shot
I try to calculate into the reading his URI and drop the dose by 0.25-0.5. This am BG was 132 so I opted not to give 0.5 unit
I wonder if this scale is too aggressive with the low numbers range.
 
What was the pmps last night? Did you give any insulin or was the last shot yesterday morning (.25 for a 230 on the Alpha Trak?)

I think he may be recovering from the UTI and thus his numbers are decreasing. IMHO, the best course here is caution. It would be nice if skipping a shot did not send him into the 400s for pmps. I guess one option would be to wait until the number is high enough to shoot (in the 200s+) and then give a drop. One way to do this with U40 syringes is to pull up .25 and then let a few drops out. Give what is left in the syringe. Be sure you can monitor after. This messes up your 12/12 schedule but it is messed up anyway. My goal would be to keep him under the renal threshold (we think it's around 250) so his pancreas can heal, but to keep him safe in the process. My thinking is that if he is 132 at amps - how low did he drop overnight?
 
A bit of back story, Sue. Poncho is pretty sensitive to insulin, even before he had some hypo experiences. The first time a vet tried to do a curve on 1.5 units of insulin, he crashed. That vet was an imbecile and didn't think to reduce the dose!

Keeping him below 250 is reasonable for right now.
 
Then maybe wait until he is in the 250s and give a few drops?

My concern is that skipping means a pmps in the 500s. Seems like there needs to be a way to keep him in a better overall range, so I was thinking chasing the number until it is in a shootable range, even if it means one shot a day?
 
So test BG @ +4 or +6 and give less than 0.25 if over 250 or wait until +12 and give 0.5 less than scale? The treating vet had me give 1 unit @ BG 139 two weeks ago and he crashed +5hrs so I'm being very cautious with her scale.
 
If you are comfortable with that, I think it might work. The only way to know is to try it when you can safely monitor, keep an eye on his numbers in the first few hours and then in that +5 range. Even if it's too little insulin, I am thinking it is better to have some in his system so you aren't looking at the 500s again tonight. (see my caution about his inappetite problems below)

Do you know how to steer a lower number with food? If he is in the 70s or so early on, feed a little more extra regular food. If he drops below 50, feed some gravy off high carb food (always should be in your hypo kit) and retest in 15-20 minutes to make sure he is rising, not falling. If he is still falling, rub some honey on his gums and do the test again in 15 mintues. Note these are ReliOn type numbers. If you are using the AlphaTrak, add approximately 30 to each number. If he is not still not eating, this makes the process more complicated and might be a reason to up that number above 250.

But ALWAYS go with your gut. If you don't feel some advice is wise, then disregard it. You hold the needle, you love the cat, you decide.
 
Just for today, so I don't have to play around with the insulin: If I feed him 1/3rd his daily amount before his evening BG test/shot would that help to keep his BG from reaching the highs then feed the rest of his daily food (2/3rd) starting just before and after evening shot bring his AM BG up to a shootable number? Now I wish I had given him 0.25 this AM , but he has the URI and sensitivity. Yesterday the vet said it's ok to have two daily numbers low and high. Sound right? I thought they should both be close so the dose is the same. My gut is still in the rookie stage and a bit unsure.
 
I think you were wise not to shoot anything this am. He was just too low. Your gut is right on. Human diabetics say bouncing around from high to low numbers feels like a roller coaster so no, having a high number in the pm and a low number in the am can't feel good. Much better to have a more even cycle. We say ProZinc has a smile shaped cycle. When regulated, the cat might be in the low 200s at amps, double digits (but not below 40/50 at nadir) and then slowly rise back up to about the range of amps at pmps. That's be the ideal to shoot (pun intended) for.

What might raise that amps is to feed once or twice overnight - say 3 hours and then six to eight hours after the shot. My thinking is that food then might stop a drop, if that is his pattern at night, and mean a shootable amps. If you don't want to get up and if he'll eat, you could leave out some frozen food for him to snack on as it thaws. Giving him food at pmps probably won't still affect his numbers if he is dropping around 5-7 overnight.

Do be aware you don't want him to eat more than 2 hours before your test/shot time. Food raises bg levels and you want the number you get for the test to be "true" and not food influenced. The thinking is you don't want to shoot more insulin than he needs just because food has brought up the number during that time.

Even if he is in the 400/500 range, I think I'd shoot .5. One unit gave you an unshootable amps as did 1.5. Another option is to test him early (maybe +9/10) and if he is in the 300-400s, go ahead and give .5 (or a little less if you want) then. There is no reason for you to stick to 12/12 today because he didn't get a shot this am.

Does any of this make sense?
 
Ok, that explains the high pm 511....I fed him when I got home from the vet between 5-6 with pre shot BG test at 8. So the ideal feeding time is within 2 hrs pre test/shot? I have to feed him 4-5 times daily so feeding should be within 2 hrs before and 2 hrs after test/shot given 12 hr schedule? I don't mind staying up most of the night to feed him....been doing that off and on for a month now.....so I'll try that. Thanks!
 
I didn't explain it well. You want to stop feeding 2 hours before the am/pm test so it will be a true test. You can feed after the test/shot and up to 2 hours before the next one. Just not in that 2 hour window before the test/shot twice daily. Make sense?
 
Sue and Oliver (GA) said:
I didn't explain it well. You want to stop feeding 2 hours before the am/pm test so it will be a true test. You can feed after the test/shot and up to 2 hours before the next one. Just not in that 2 hour window before the test/shot twice daily. Make sense?
Click to expand...
Yes....I got it. Thanks.
 
8 PM BG was 522. I want to be gradual so gave him about 0.75 dose and will feed him @ 11 and 2am and see what that does to his AM BG. Should I test at nadir ( is that +6 or +8 for Prozinc)? It looks like his URI is clearing up. I guess I'll have to let the vet know at next appt I strayed from her plan and hope she doesn't drop Poncho as a patient or insist I follow her scale.....he needs supportive care still.....sub q fluids, etc. I just can't take a chance with the dosing, which seems too high (and insulin has my respect/fear). This is the 3rd vet who's worked with him....very frustrating!
 
Last edited:
If you are up to feed him, you might just get a test. It'll give you some information about his patterns at night - does he drop fast or gradually drop over the whole cycle? Is the .75 a good dose?

It is hard for a vet to argue if you say you reduced the dose because you were scared to have him drop too low. If you say you wanted to be cautious and careful, I would think she'd understand.
 
Sue and Oliver (GA) said:
If you are up to feed him, you might just get a test. It'll give you some information about his patterns at night - does he drop fast or gradually drop over the whole cycle? Is the .75 a good dose?

It is hard for a vet to argue if you say you reduced the dose because you were scared to have him drop too low. If you say you wanted to be cautious and careful, I would think she'd understand.
Click to expand...
I hope she'll understand. Sorry, but what do you mean "Is the .75 a good dose"? I don't know how fast he drops.....except when the vet had me shoot BG139 with 1 unit he was hypo in 5 hrs....collapsed and started to seizure. I was right there and stuffed honey into his mouth to bring him back and stayed up all night testing/feeding. I can stay up.....what hrs should I test?
 
I meant that testing tonight might show you whether the .75 is a good dose. It's one of the questions testing might answer for you.

Maybe +3 to see how fast he drops and then in that 5-7 hour frame to try to catch the nadir?
 
Poncho's PM pre shot test was 522 (AlphaTrak2) and a fat 0.75 was given. He ate 10ml Hills AD afterwards and during the day he had eaten 40ml with no am shot (BG123). At 11:45pm his BG was 241 (Relion Confirm...low on AT strips) and he ate 20ml Hills, then at 1:45am BG (Relion) was 247 and he ate 15ml Hills. He was very lethargic all night. At 8am his BG (AlphaTrak) was 474 so gave him 1 unit and fought to get 20ml Hills in him. His URI is almost gone but still on antibiotic. Given his extreme lethargy and weakness I concluded he was in pain, so gave oral buprenorphine. I wasn't expecting that high an am number. He has a vet appt tomorrow and will see if she can run another test to check pancreatitis condition level. I'm assuming the 2am feeding and pain pushed his BG up? I don't get it....given the recent am readings and last shot dose.
 
Last edited:
Sue and Oliver (GA) said:
So kinda high and flat all night. That could be that he was not feeling well (I think giving the pain mess was certainly a good idea.). Or he was not feeling well and the dose last night was a little too little. Very hard to separate out cause and effect. If only they could talk!:(

Have you seen this thread on pancreatitis? Great resource

http://www.felinediabetes.com/FDMB/threads/a-primer-on-pancreatitis.83108/
Click to expand...
Very informative....thanks! I got fluids in him ok but he's really resisting the feeding so have to shorten the sessions and increase them through the day.

Update: PM BG 284....0.5 unit given.....pain med again midnight
 
Last edited:
AM BG 436....1 unit given. I'm leaning toward 0.75 as a good candidate for am/pm given the spread sheet.
 
Last edited:
Here's a new Prozinc dosing scale my vet gave me today. She wants to get am and pm BG numbers down to around 100 Alphatrak). I'm worried that's flirting with hypo territory.
AM 125-200....0.5 unit
200-300....1 unit
PM 300-400....1 unit
>400....1.5 units
What do you all think?
 
The low end is certainly lower than I would be comfortable with. Can you get some midcycle numbers during the day to see what is going on and how low he goes on the dose you are giving? I think I'd do that before I'd change the dose. Just using the pre shot numbers gives you so little of the actual story of what the insulin is doing.
 
DARN!!! BG was 260 this am and the second I gave the shot (a light 1 unit) he squirmed enough that the needle went through the tent onto the skin. Anyway there was a wet spot. I need to secure him better....1st time I've missed. Do I test @ +2 or +4 and shoot according to test number have that as the new shot time? I'll research what to do.
 
No re-shoot; you don't want to overdo and hypo him.
I'd use U-100 and go down to 0.2 units in the lower range of that scale IF I had data to show it would be safe for him.
 
I had another vet (not involved in Poncho's problem) recently say he tries to keep his diabetic patients' BG around 200 or a bit less, staying far away from a potential hypo. Does that sound right? Anyway, since Poncho's URI has cleared I want to go ahead and do a curve on him and get him regulated. I'm wary of the vets dosing at such low numbers so I'm going to use my gut in that range, but would appreciate some guidance. He's on buprenorphine for a few days so there shouldn't be anything messing with his BG levels other than food and insulin......and maybe a little stress. Is the scale ok above low range?
 
BJM said:
No re-shoot; you don't want to overdo and hypo him.
I'd use U-100 and go down to 0.2 units in the lower range of that scale IF I had data to show it would be safe for him.
Click to expand...
I'll wait until next shot. I'll have to get some u100 syringes......but don't have data re. that dose and safety.
 
Maybe this will help. We consider a cat to be regulated if they are in the mid200s at pre shot and double digits at nadir (but not below 50). A cat who is is remission tends to run between 40-120, off insulin. We usually urge new diabetics not to shoot under 200, until they have data. Once you have an idea of what a given amount of insulin might do to a given number, you can be more daring. Often people on ProZinc shoot at 150-180 but usually tiny doses (your U100 syringes and the conversion chart would come in handy here.) and only if they are confident it won't send the cat too low and when they can monitor carefully. So, keeping a cat in those regulated numbers is good, but most people want to eventually try for lower ranges, in hopes the cat will go OTJ. But it is important to do that carefully and safely.

A curve will give you an idea of what a given dose does. More nadir tests on other days would also be helpful. Then you would be more confident about developing your own scale.
 
Ok, so I need to start by doing a curve based on an am shot dose, testing every 2 hrs until +6 - +8 or just at nadir (which I'm assuming is around +6)? The vet is letting me borrow the Alphatrak so she gives me a limited amount of strips until the next appt, so I'd have to use my Confirm meter. Can one get the u100 syringes at any drugstore or Walmart or could I measure/mark the u40s at 1/4s with a fine tip felt pen? Concerning the scale I'm thinking I could start at 150 with 1/4 unit and 1/2 unit 200-300 (half the scale dose).
 
I wouldn't shoot at 150 until you have more data. I think 180-200 is a good starting point until you have more numbers. For example on 3/5 you gave .5 at 185. But you can't know if the next number at pmps was because the dose wasn't enough (I think unlikely) or if the nadir was low and the 456 at pmps was a bounce. Until you have some of the midcycle numbers, you can't be sure whether your doses are producing high flat cycles or a sharp drop and bounce back up. Once you see what a .5 on a 185 does midcycle, then you'll know whether it is too much or too little.

Walmart has U100s although some people report them harder to find. You want the ones with half unit markings. And be sure you print off the conversion chart so you can be sure what amount you are giving. Here's a link for the chart:


http://www.google.com/url?sa=t&rct=j&q=conversion chart U40 insulin&source=web&cd=1&ved=0CBkQFjAA&url=http://www.felinediabetes.com/insulin-conversions.htm&ei=1qz8VOrpJcudygTnkoGAAQ&usg=AFQjCNHEDqVcNLW_H_ygXaAvsuklZ7OUfA
 
Thanks. I think the recent high #s were pain related. On 3/6 he was on bupren. starting 5pm 3/5. Since he was eating 3/6 pm I thought his pain had subsided but his am # 3/7 was high again. I'm keeping him on pain med this week and hope I can get somewhere getting his am/pm #s in a good spot. Am I being too optimistic with the time needed for this? Tonights BG # will probably be high again so hopefully I'll be able to start gathering data tomorrow based on am dose.
 
All of WalMart's 3/10 ml U- syringes have half unit markings.
Each half unit tick measures 0.2 units of Prozinc.
 
Last edited:
Edit:0.2 units per half unit tick mark on U-100 - the num lock was off.
 
Poncho's 8pm BG last night was 593 (Alphatrak).....gave him 1.25 dose. This am 8am BG was 147.....gave 0.25 dose. At +4 tested with Relion BG was 78. Am I to be concerned? I'll retest at +5. The vet's scale called for 0.5 unit but I have had reservations re. her dosing amounts.
 
I wouldn't worry unless he gets around 50. Then I would just feed him some regular food (a little bit) and retest in 20 minutes to make sure he is moving up, not further down. If he'd get down to the 40 range, you'd want to give him some of the gravy off higher carb food and retest. Post on Health if he gets in that range.

I just can't figure out why he is so high at night and so low in the morning unless he has really been going low mid cyle and bouncing around. Maybe today will tell you.
 
Sometimes he's low in am and high pm and reverse. Yesterday am had a fur shot so his pm was high, lately I think pain has played a role.....who knows. Today I'm doing pre-shot tests with Alphatrak and in between with R. Confirm. He's getting pain meds and his URI is gone this week so I want to get as much data as possible. Is nadir with Prozinc +5 to +8 hrs or around +6?
 
Last edited:
Generally nadir is in the +5 to +7 range. It can vary though. Maybe try testing at each of those intervals if you can to see which is lowest. It'll help you know for later too .
 
+6 BG 237 (R.Confirm) He did eat after +4 test and a little self feeding @ +5 and I gave him prescribed vitamin c liquid also which has some sugar in it so that pushed BG up. Hoping BG will be flat or very slow to rise until 8pm shot.
 
Sue and Oliver (GA) said:
I wouldn't worry unless he gets around 50. Then I would just feed him some regular food (a little bit) and retest in 20 minutes to make sure he is moving up, not further down. If he'd get down to the 40 range, you'd want to give him some of the gravy off higher carb food and retest. Post on Health if he gets in that range.

I just can't figure out why he is so high at night and so low in the morning unless he has really been going low mid cyle and bouncing around. Maybe today will tell you.
Click to expand...
I tested at +4 78, then +6 237 (both with Relion) then at 8 BG was 494. He ate off and on 1st 6 hrs then at 5-5:30. Somehow need to push one # up and other down. I gave 1 unit @ pm shot hoping next am BG will rise. I need to close the gap. Maybe should've done 0.75 to bring up am # more? Make sense? Then keep am (or low range #s) dose low? Strange stuff!
 
I agree it is confusing. One idea to try to a 13/11 schedule. So, wait till +13 in the morning and hope he goes up a little. And at night give the shot an hour early before he goes super high.. You don't need to stick with an exact 12/12 schedule with ProZinc, as long as the number is always rising.
 
Status
Not open for further replies.
Back
Top