New ProZinc user working on dosage

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Mancat

Mancat

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Hi! I introduced myself here in one of the main forums and they recommended I come see you guys since you're the ProZinc experts and I just started my newly-diagnosed kitty on it about 6 weeks ago.

Here is the original thread: http://www.felinediabetes.com/FDMB/threads/overshot-correct-dose-help.145701/#post-1513174

I'm still working on the spreadsheet for testing. I plan on doing 2 more curves tomorrow and Monday. The only issue I'm having now is where to take her dosing.

TLDR (from the other thread) - I had her on low carb pate wet food and she was showing improvement with 2 units twice a day, two weeks ago. My vet recommended 3 units twice a day at that time and I made a mistake and started feeding her high carb gravy wet food at the same time. This morning I ran out and switched back to the pate wet food which I'll be changing her to immediately. Her numbers have gone high again and I think it's a combination of the high carb food plus too much insulin. I'd appreciate any suggestions!
 
Mancat said:
The only issue I'm having now is where to take her dosing.
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Have you already dosed her this morning? And if so, at what time did you do that in your time zone? (Please let us know which time zone you're in.)
What was your kitty's pre-shot blood glucose number this morning? Are you around to get any mid-cycle tests today? Please write back & let us know.
Thanks! - Robin

ALSO: What dose did you give, if dosed this a.m.?
 
I heard you're the go-to for ProZinc. Nice to meet you, Robin.

I have dosed her this morning. I am in the US, east coast. I get up at 5:20am for work everyday so I've just extended that to weekends to keep her on a regular schedule. She gets her shots at 5:30am and 5:30pm.

AMPS was 510 (5:30am)
+3 was 366 (8:30am)
+6 was 466 (11:30am)
I'm testing her 2 more times today for a + 9 and then PMPS.

Her current dose as per my vet's instruction is 3 units twice a day. However I've accidentally had her on high carb for 2 weeks along with the 3 units twice a day and people said that could be causing bad numbers. 2 weeks ago I did her second curve (using low carb food) on 2 units on twice a day her curve was:

AMPS - 326 (5:30am)
+3 - 249
+6 - 22o ish
+9 - climbed into the 300's
PMPS - 400

I don't remember the exact numbers sorry but I was excited because she was showing definite improvement there on the 2 units.
 
Mancat said:
I plan on doing 2 more curves tomorrow and Monday
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Hi Again Alisha!!

You really don't need to do a full curve every day....just always get the Pre-shot tests and then at least 1 more somewhere mid-cycle on the AM cycle and a "before bed" test on the PM cycle. Of course you can get more tests than that in too, but they don't HAVE to be "every 2 hours" every day

Think of the spreadsheet like a puzzle....sprinkle "pieces" all over it and the picture becomes clearer
 
Here is my only concern: From reading your original thread, it appears that you were not home-testing for the first two weeks of insulin therapy - is that a correct assumption on my part?

The reason I ask: On both sets of numbers you've provided - whether on the higher-carb gravy food or the lower-carb, it appears to me that your kitty cycles are tending more towards what we'd call "high and flat" - including high AMPS/PMPS #s. This could actually indicate that your kitty may be on a little too high a dose, as the body will respond to too much insulin by pumping glycogen (it finds a new source of glucose to compensate for too much insulin), and then the BG#s end up running high as a result.
 
Yes I was not home-testing for the first two weeks. My vet told me her body needed to adjust to the dose before testing again. After every dose change she's told me to wait 2 weeks. Also thanks Chris I'll work on the AMPS and then just do the full curve regularly.
 
Robin&BB said:
This could actually indicate that your kitty may be on a little too high a dose
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I'm not saying this is definitely what's happening ... but we'll know more as the patterns in your curves over the weekend emerge.

Unfortunately, we've found that it's often the case that a vet sends a pet-parent home with a new bottle of insulin and no encouragement to start home-testing right away (in some cases, vets discourage home-testing altogether); opting instead to tell you to bring your kitty back in two weeks, etc. This, we've found, is "old-school" thinking on the part of those vets as relates to best practices today in treating a diabetic cat: As shooting insulin into your kitty without a pre-shot BG check first every time can result in some serious (sometimes even deadly) hypoglycemic events.

Without a pre-shot BG test, you're literally "shooting in the dark." We do not recommend shooting insulin unless the AMPS/PMPS # is 200 or above. If it's not quite there yet, we recommend "stalling" (witholding food while you wait, and retesting BG every 15-20 minutes to see if the # will rise on its own, without food - something it often does when a kitty's getting excited about a meal). If after several retests while withholding food, the BG still doesn't rise to 200 or more, you generally would skip that dose.

So what I'm saying is: We really have no idea if your kitty's insulin dose was too high to begin with - and keep in mind that a cat's BG# can spike sharply (even 100 pts. or more) during a vet clinic visit due to stress, making it even more important that we check AMPS/PMPS every time before shooting insulin.

You're doing great with the testing now, btw - and will look forward to seeing those #s you're getting in a spreadsheet so that it will be easier for you to get to see/know your kitty's unique response to the insulin and whether or not a dosage adjustment is needed. :)
 
Before I forget: Did you tell us which brand meter you're using? This is important for us to know, too.
 
Welcome Alisha and Nala. Hope you can get your spreadsheet up and running soon. It sure would help us analyze Nala's tests. Sure am glad that you have been home testing...way to go! So just in case you need the instructions again, here they are again. Let us know if you need help with it and since you have all your test numbers, it would be helpful if you could back fill those.
 
Mancat said:
After every dose change she's told me to wait 2 weeks.
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Yeah that's "old school" thinking....It's important to test every cycle, every day....Nobody ever got our kitties to read any rules that said their body took 2 weeks to "settle" ;)

You just don't need to do a full "curve" every day....Just at least the 4 tests I told you about earlier if at all possible
 
I have the AlphaTrak 2 meter. She was all for home testing and saving money but she didn't tell me to test that often.
 
Hi Alisha! Welcome to our forum! So, to clarify, did you shoot 2 units or 3 units today?

Those mid cycles combined with the preshots will help tell us what's going on. Nala is now on all low carb food, correct? I think that might help make a difference in your numbers. I'm looking forward to seeing what you get as the day progresses!

Some info on this forum: we're pretty small, mostly active in the morning and evening. If you have an emergency, it's a good idea to post on Health to get some eyes on it as quickly as possible. Beyond that, I encourage you to spend some time reading our protocol and other people's posts. Also, take a look at some spreadsheets to see how their kitties are doing. Just reading up on all this should help as you figure out this sugar dance!
 
Mancat said:
I have the AlphaTrak 2 meter. She was all for home testing and saving money but she didn't tell me to test that often.
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Good to know which meter you use (I use the AT2, as well.) And please note this:
The "be watchful (for signs of hypoglycemia) BG# for an AlphaTrak 2 meter is considered anything less than 69 (meaning 68 or lower) HOWEVER, as you're still pretty new at this, I would prefer to have you raise that "be watchful" # to 80, which will provide you a little extra margin of safety.

So if at any point during a cycle (this would normally be around nadir/your cat's usual "low BG" spot in the 12-hr. cycle) Nala's BG drops to 80, you would steer with a little food (say, about 0.75-1 oz. of that food you have that has the gravy in it), then check BG# in about 15-20 minutes to make sure it's rising. If it's not rising, repeat this process until it does rise. If you can't be home to check around nadir, there's a safeguard for that situation, too. We have lots of people @ FDMB who, like you, work outside the home; many use a use a timed feeder: You just set it for the time desired, pop in a frozen puck of food before you leave for work, and if you set it for right before your kitty's usual low-BG point, it opens & there's something for your kitty to eat!
 
3 units today. She's been on 3 units for the past 2 weeks. Nala had high carb food this morning. She will be getting a mix of high and low tonight to get her through the transition and on to full low carb tomorrow.
 
Mancat said:
I know I don't have to do full curves over the next 2 days but I might anyway just to get a better idea of what's going on.
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You know, I think that's a good plan - will help you have a better idea of when your kitty tends to hit nadir before you have to go back to work on Monday.:)
 
No work Monday! Fortunately I have a government job so I'm off Monday and can do another 2 days of full curves for some intensive testing.
 
Oh. Should I keep her on the 3 tomorrow or drop it back to 2 with the low carb food and see how she responds?
 
Mancat said:
Let's see if it works now.
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Yep, it does! And I would seriously consider dropping the dose back to 2.0 units tonight.

ETA: And would want you to get in a couple of mid-cycle (around nadir) tests tonight, too.
(You have our sympathy re: waking up to do stuff like that - we've all been there!;):rolleyes:)
 
Well I just realized I only have 9 test strips left. I just ordered 50 more but they won't be here until Tuesday. I thought I had more. I can get in 3 more tests today (I'll do PMPS and then 2 after since you suggest that) and then 3 more tomorrow and Monday. It isn't as many as I like but I'll still have a clear idea. I will put her on the 2 units for her evening shot.
 
Mancat said:
Well I just realized I only have 9 test strips left.
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While I don't exactly endorse this method myself, I'll throw this out there only because you're in something of a pickle at the moment: You can probably get by with Abbott's Freestyle Lite human glucometer strips until your AT2 strips arrive on Tuesday. (Available at any Walmart or usual pharmacy, I think.) Some of our members use these strips with only a slight variance in the BG test #s on their AT2 meters; I believe they code the meter to "7" when using the Freestyle Lite strips - but please double-check that by doing a search on the forums for "Freestyle Lite strips," etc.
 
You could consider making the switch to a human meter. Many here use Micro or Confirm from Walmart with their corresponding strips. Also just a note to keep extra strips in your "hypo kit" for those just in case you get low numbers.
 
Hi and welcome. I see Robin is giving you some great advice here and had some questions about using the Freestyle strips in your AT meter. While I don't usually do this either, I have done some testing to see how they compared and my results were anywhere between 5% and 10% of the AT strip readings.

You do NOT need to recode your meter. Just leave it on the code you currently have for the vial of AT strips you were using. The code Robin mentioned is for users of the old AT meter.

It's entirely up to you whether you want to switch to a human meter or not. I would however suggest that before you do that, you discuss changing with your vet. I personally use the AT meter so that when I have discussion with my vet, who uses a pet meter, we are both talking the same language with the same understanding of how my girl is doing. I agree that it is a wise idea to keep an extra vial of strips in your hypo kit and just switch them out periodically to make sure they always have an appropriate expiry date.
 
I also use the Freestyle lite strips, and I just recently read somewhere, can't remember where tho, that the AT meter should be set at 7 or 36. But it sounds like that was for the old meter..... But I did a little testing by changing the codes and such and still came up with numbers within 2-3 points.

I know some don't like it, but I also feel that this puts me in the same page when I'm speaking to my vet. I tried the human meter for a while, but I always felt lost and confused, never confident. But that's just me, you should make the choice that you're most comfortable with.
 
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