Update on Nicky and Question

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Luann and Nicky

Luann and Nicky

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Hello Everyone,

First of all I would like to thank everyone who helped me out yesterday with Nicky's dosing. He has been bouncing all over the place but at least for last night it looks like he settled down a bit. I am still trying to get a handle on the ProzZinc protocol. We discussed keeping him at the same dose for a few cycles. However, as you can see, he dropped over 50% this morning, so does that mean I should reduce his dose a bit?

-Luann
 
Hi, Luann - Well, he didn't go anywhere near the too-low zone (even though he dropped a lot; he may just be starting to settle into that 2.0 dose.)

Those are some nice blues you're getting in today's cycle. I might consider just holding at that dose for tonight's shot ... but let's see what kind of a # you get @ PMPS. You might know better by then whether he's actually gonna be bouncing on you.
 
HI Luann! I was just reading through the thread from yesterday (I wasn't around due to work stuff, so I wanted to get the whole picture before answering). I'm with Robin here...let's see what kind of preshot we get before making a call. Will you be able to monitor tonight?
 
I will be home to monitor tonight. I am picking up some U100 syringes (the correct ones) now, so I can fine tune the doses better. If I do reduce it will be a small reduction. I think Robin or Sue was correct, I was most likely making to large a reduction. I need to slow down (G). His predose check is at 5:30, he eats and I dose him around 6. I will let you know his number then. Thank you again for your very valuable advice.

-Luann
 
Luann, if you can monitor tonight, you might want to try upping that pm dose just a smidgeon - say to 2.25 - is up to you. (I'm thinking a small increase is better than going for a 2.5 again, looking at his SS.)
 
Yes, I can monitor him tonight. He was really hungry tonight. He ate 6 oz of FF. Since I now have the U100 syringes I will give him 2.25. Do you think it is possible that he needs a longer acting insulin or a depot insulin? Is it possible that he is not bouncing but just runs out of insulin to early?
 
Hmmm ... It may just be that he needs a slightly higher dose for his pm cycle. Are you 100% certain he's not getting into any other food sources in the afternoon/ early evenings? He does not go outside? And gets nothing to eat in the two-hours prior to his PMPS test? (Just checking. :) You know, crossing my t's & i's ...)
 
I gave him 2.2 U tonight. I know it sure seems like it, but I am absolutely certain he is not getting into any other food. The dry food is only out when he is in the bathroom eating his wet food. As soon as he is out, I put the dry food in the pantry. There is no more free feeding.
 
It is hard to tell if he bounced or if the insulin petered out. I'd guess he bounced since it has lasted through other cycles. I think 2.2 is a good choice. We didn't see a green but 100 was only one point away.
 
Thanks for that inf0, Luann. I only asked because we had a post a few days back about a cat who was opening the refrigerator when no one was around & eating food out of it. (Wow - I suppose she had to break out the child-proof locks!) I will tag Rachel & Sue on this for their sage thoughts:
@Rachel , @Sue and Oliver (GA) - What do you think about Luann's situation here?
 
I'm with Sue on this. I think a good 2.2 would be good.

I really think you saw a bounce. It's possible that the insulin is stopping short of the 12 hours, but it just looks so much like a bounce to me.
 
You mentioned that you test at 5:30 and then you give the shot at 6. You might want to consider to try and give the shot earlier i.e. say around 10 minutes after you test (while he is eating). Of course you need to be sure that he is going to eat but you typically know if he will or not. I can typically test, feed and shoot all in about 5-10 minutes. That way the dose if for that "pre=test" number and not a bigger number. Just a thought....
 
Good Morning Luann ~ I was thinking about Bubba and Nicky being all over the place with their numbers. It seems like Nicky has some much bigger differences. Have you ever tested your meter with the testing solution to make sure it is accurate to your testing strips? Just a thought.
 
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Good morning!!

Cindi, I actually dose Nicky as soon as he is finished eating. It takes him a long time to finish. He is a licker not a gulper. I tried dosing him while he is eating but he did not like it and that is when I got my first fur shot.

Bobbie, I have not tested my meter. That is a thought. My vet is not really keen on me using a human meter and is quite insistent that I get an AlphaTrak. She said they tested the human meters in their office and they deem them to unreliable. I may get an AlphaTrak as a backup. I test Nicky to often to use it regularly. I will see about getting some control solution and testing the human meter. I use the Relion Confirm.

My thought now is that Nicky is in a perpetual bounce because I have been dosing him to high. That is why I backed off to 1.8 this morning. I really have no clue <g>.

-Luann
 
Luann and Nicky said:
Good morning!!

Cindi, I actually dose Nicky as soon as he is finished eating. It takes him a long time to finish. He is a licker not a gulper. I tried dosing him while he is eating but he did not like it and that is when I got my first fur shot.

Bobbie, I have not tested my meter. That is a thought. My vet is not really keen on me using a human meter and is quite insistent that I get an AlphaTrak. She said they tested the human meters in their office and they deem them to unreliable. I may get an AlphaTrak as a backup. I test Nicky to often to use it regularly. I will see about getting some control solution and testing the human meter. I use the Relion Confirm.

My thought now is that Nicky is in a perpetual bounce because I have been dosing him to high. That is why I backed off to 1.8 this morning. I really have no clue <g>.

-Luann
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I feel your frustration. I too have a relion meter and called them (24 hours) 1800-631-0076 and they send it to you free. It will take about 10 days to get it.
 
Good morning Luanne,

I know you are frustrated but the beauty of the color coded spreadsheet is that you can look back over the past few days and see more blues, greens and yellows. He is really doing better overall. I know the individual numbers can be daunting, but remember, each number is just one number. Generally he is in lower ranges. Is he feeling better? Playing, peeing, pooping, peeing?

The biggest issue for new people is that they want it fixed right away. And doubly frustrating, it does work that way for some people. Some diabetics only require a food change and a little insulin and they are OTJ. But they are the rare exception, regardless of insulin. For most, it takes 3-6 months at a minimum before you start to see some definite downward trends. Remember, insulin is a hormone, not a pill that has immediate results. (Think menopause...). It takes every cat's body a different amount of time to learn to use the hormone efficiently and you can't impact that. Your job is to try to keep him safe, out of very high ranges and very low ranges. I love the analogy that it's a sugar dance and the kitty is leading and only he can hear the music!

So that's my lecture for the morning. I do hope Bobbie reads it also. You are both in the same place, trying to finesse something that is not under your control.

I'd see what 1.8 does (remember it's all data collection). I would guess he needs a little more - 2 or 2.2 looks good to me. Yes, it may make him bounce, but the longer time he spends in lower ranges the better, and he will bounce until he doesn't. Some people call it liver training, and every liver learns differently.
 
I read it Sue, thanks and I seem to need reinforcement a lot. I am better today with my anxiety about it all. Went into the garden and picked tomatoes. Good for the soul......
 
Rachel said:
I need you to live next door to me so I can get some home-grown tomatoes! For whatever reason, when I had tomato plants I got exactly one (yes one!) tomato...and it was a grape tomato!
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I would gladly share! We have a bummer crop this year. If it were me planting the tomato plants, I would probably yield one tomato as well. It helps to have a husband who majored in agriculture. :rolleyes: Now, I have to go stew the tomatoes for freezing. ;)
 
Well, I guess I overreacted this morning and was a bit frustrated. Thank you Sue for the pep talk. I do need to be patient. Nicky was diagnosed less than 2 months ago. He probably had a high glucose value for a bit before I started treating him, so it will take a while for his pancreas to get back on track. It is just that my lifestyle is not conducive for this rigid schedule. Fortunately, I (and my other two cats) have been able to adjust, so far, but it will get interesting when I have to start traveling for work. Nicky on the other hand is feeling much better, not nearly drinking or peeing so much, he is getting fed wet food which he loves and a whole lot of attention from me. He does not seem to be reacting negatively to the bouncing at all. All of you guys are great. Thank you so much for hanging in there with me.

-Luann

Regarding tomatos, when I had a garden, they were the only thing I could grow. Ironically, I do not eat raw tomatoes.
 
Luann and Nicky said:
Well, I guess I overreacted this morning and was a bit frustrated. Thank you Sue for the pep talk. I do need to be patient. Nicky was diagnosed less than 2 months ago. He probably had a high glucose value for a bit before I started treating him, so it will take a while for his pancreas to get back on track. It is just that my lifestyle is not conducive for this rigid schedule. Fortunately, I (and my other two cats) have been able to adjust, so far, but it will get interesting when I have to start traveling for work. Nicky on the other hand is feeling much better, not nearly drinking or peeing so much, he is getting fed wet food which he loves and a whole lot of attention from me. He does not seem to be reacting negatively to the bouncing at all. All of you guys are great. Thank you so much for hanging in there with me.

-Luann

Regarding tomatos, when I had a garden, they were the only thing I could grow. Ironically, I do not eat raw tomatoes.
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Funny about the tomatoes! Hopefully, you can get some resources to help you dose when your life gets crazy with traveling. Wish I lived nearby and could help you with that. :bighug: I remember when Bubba first got DX and I said to the Vet Tech, "well this is certainly going to be confining isn't it"? And she said that some of the vet tech there are always looking for extra $$ and take jobs dosing people's cats in the am or pm while they are working or on vacation. So maybe that could be a possible solution for you.
 
Nicky is going to be well over 500 today for his PMPS do you guys think I should dose at 2.5 or even higher this PM? Previously I dosed at 3U over 500 and it didn't look like he went below 50%. t didn't want to have such a big jump in his dose, but I think I need to. I can monitor tonight, but tomorrow I will be back at work.
 
Just a thought: Last night, when you got that 514 @ +1, keep in mind that you had given him a whopping 6 oz. FF for his meal - that's a LOT.
(Unless Nicky is a giant-breed cat, like a Maine Coon, you gave him a total of 9.5 oz food within that 24 hour period yesterday. Would think that's too much.) So is no surprise to me that you saw such a high # then. And he had dropped more than 50% last night by +5. So I'd be a bit cautious about upping his dose too much - could cause bouncing.

At PMPS, it would be my inclination to limit him to only 3 oz to 4 oz of FF. You might try a 2.0; my concern here is that if you raise the dose too much, he'll do the bouncy-bounce. So in short:

- Try to keep the food amount consistent - and appropriate for his ideal weight.
- And with the proper amount of food, try to hold the dose for several cycles - maybe at 2.0 for now? As there's been some significant dose-changing over the past 5 days. He may have a problem with too many changes that way, too.

Still testing for ketones, I trust?
 
I agree with Robin. A 2.2 or 2.5 would probably be good as that is in the range you have been shooting. A few high numbers are okay and you got some good data today. 1.8 isn't enough right now. You can use that info.

You can shoot 30 minutes early if you want - ProZinc is pretty adaptable that way.
 
Well, you had an interesting morning, Luann. Looks like your 2 was a nice dose even for a bounce.. Regardless, good catch today. I know you won't be home today so your dose looks safe. Depending on whether you can be around for nadir tomorrow, you could play it safe tonight or push a little. My thinking is that this am, he was really close enough to 200 to shoot, once you were sure he was rising, not falling. Once you have data and can monitor, you can shoot a number like 180 (just a little less than the shot before) and keep the momentum. If you will be at work all week and can't catch a nadir, then you can just play it safe during the week, and catch back up next weekend.
 
Hello,

OK, I am not sure I did the right thing, but Nicky had a PMPS of 388. I gave him 2U and at +3 he dropped to 82. Since he was early in the cycle, I figured that he would go lower, so I gave him a little low carb FF so he wouldn't go below 50 but bring him up a little. That seemed to work. Hopefully it won't send him sky high tonight. Should I have given him less than 2U tonight. I am trying to keep a consistent dose for awhile as Robin suggested but his numbers don't seem to allow that. I am thinking that I will lower him a bit tomorrow morning (1.8) since I am sure he would have gone below 50 if I had not intervened with food, that is unless he is really low in the morning (like this morning). Thoughts?????

-Luann
 
He is making this hard! Your dose should have been okay but that was a fast, sharp drop. Regular low carb shouldn't make him bounce though the fast drop to 82 might. Try to get another test in an hour. He could drop again. You can't relax until you have three rising tests and you are past +6.

You are doing this perfectly, Luanne. He is just reacting very wildly. I would guess because his pancreas is continuing to wake up and then sleep. I am wondering whether you should drop down to one unit and then slowly raise, if needed. What would you think about that for tomorrow? Is there a way you can leave out food so he can eat if he starts to drop? You can freeze the wet low carb and leave it for him. He can eat it as it thaws.
 
I am not going to be able to stay on. Please get some more tests in tonight To make sure he doesn't continue to drop. If he gets into the 50s, give him the gravy off some higher carb and retest in 20 minutes.

I am sorry we can't seem to give you better advice. He is just not reacting like we'd think he should. He acts like a kitty who'd like to get off insulin (anti jinx) and whose pancreas keeps jumping in to help.
 
He's killing me. I had to dose conservatively this morning because I won't be home to monitor. I hope I went low enough. I will try to stay home until +3 and then come home for lunch which will be around +6 or 7, then he is on his own. I just ordered the alpha trak meter sort of as a back up and also the control solution for the Relion Confirm. I need to make sure the monitor is working ok. I must say through all of this Nicky has been very happy, He has had no adverse symptoms at all. I on the other hand am getting very cranky and tired <g>.

Should I be starting another thread? This one is getting quite long.
 
Oh, Luann, I understand completely! Wish it were as simple as if "he does this, we do that" . I feel like I have a newborn and am so sleep deprived.... It's good that you are able to come home and check on him today.Fingers and Paws crossed.
 
You're doing great Luann! As Sue says, he's just reacting in ways we're not expecting. I think the lower dose will help. I'd get a test on the way out the door, and then if you can get home to check nadir, do. It does look like he bounced...but that's okay. We expected that from the sudden drop. Look at it this way...you got basically the same number today as last night, so this lower dose will hopefully help him avoid the sudden drop.

If you're concerned, I'd leave out some low carb food. Like Sue says, you can freeze it so it thaws slowly. Cats feel when they go low and will try to bring themselves up with food if there is some. I'm not sure if that's possible for you, but it's an option. :)

I'd start a new thread. You can always provide a link to this one so people can see back to it. A lot of other forums do that...since we're so small, most of us don't (it's easy to find older condos). Either way, a new thread may be good since this one is starting to get long.
 
I hope we can figure this out so you don't have to be up at night and can leave him during the day and feel he is safe. It doesn't look like he will drop low today so if it is easier to skip the nadir test, and just leave out some regular food, you should be able to do that.

I am sure the numbers are discouraging this morning. They are most likely a bounce from last night and indication that his pancreas has stopped helping for now. I'd suggest we just see where he is tonight and probably be conservative with the dose again. Once he settles down, then we can slowly raise the dose and see whether he drops into safe ranges.

The drop last night was crazy and very unusual. Seldom do they drop that far and that early in the cycle.

I am glad you aren't giving 3 Units and that you are monitoring carefully. You have most likely saved his life several times!
 
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