Mancat/Nala's Curve updated!

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Mancat

Mancat

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Hey! I just wanted to say that I haven't disappeared and I didn't ignore all the excellent advice I received last week. I took everything to heart and I've been spending the week really documenting her bg. I went ahead and ordered the Freestyle test strips. I don't mind if they're a couple points because they're so much less expensive than the regular AT2 strips. Nala is doing well so far and I've tested her randomly throughout the week and every hour today to get a thorough picture on how she reacts after the shots. I wanted to give it time to make sure ALL of the high carb food got out of her system and I could get a clear picture with the low carb food. I'm not as experienced at reading the results so hopefully someone can help. It looks like has a nice, gradual curve down but then it spikes sharply before PMPS. Anyway, attached are her results thus far and I'm looking forward to the next dosage suggestions from you guys:

Also, I thought of a couple of questions:

How often do you test when your cat's dosage is established?
How do you personally feel about prefilling/preloading syringes?

Thanks a bunch!

https://docs.google.com/spreadsheets/d/1w2MGw3E6y_RmqJwhJN14E2iIAXpnsr0krln8j_FYJzE/pubhtml
 
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Hi! I can't see your SS...I sent a request for access. I'm going to search the board in a sec and try to find the instructions for what you need to do so we can all see the SS. :)

The syringes shouldn't be preloaded I believe. I can't remember the reasoning, but if you search the board, you might find some info. Are you saying you want to do that to make it faster at shot time or is there another reason?

Testing...well that's different depending on the cat. Generally speaking, we don't get a ton of cats who get a dosage established that they can stick to. Since ProZinc is an in and out insulin, we can change dosage every cycle (which isn't recommended right away. Some of us develop a sliding scale over time...but it's because it is the only thing that works for our kitties. Others need to hold a specific dose for a bit...). So, I guess what I would say is no matter WHAT...ALWAYS test before the shot. That's a must. I tried to get a nadir every single day that I was able to...which was usually just weekends. I also got a before bed shot...about +3 or +4 most evenings so I could be sure she wasn't headed in a downward trend. Beyond that, I ran the occasional curve.

The reason to get the preshots is obvious, but even after the kitty is regulated, a nadir whenever is good. That way, we can see if the insulin is taking her low or what and whether the dosage needs to be adjusted.

Does that answer your question? I'm sorry if I'm not quite understanding...please let me know!
 
Okay, found some info (from an older post by @Sue and Oliver (GA)...I tag her so that next time she pops in she can see if my info is right to get the SS seen by all). I think you have to choose Share and Share with Anyone. Not sure where that will be located...let me know if you can't find it. I'll have to try to find my SS on google and see if I can remember where it all is! :)
 
Bah! When I first set that up I set access for everyone to see it. Let's see if this works. I restarted my computer earlier and I think it killed the web link.

https://docs.google.com/spreadsheets/d/1w2MGw3E6y_RmqJwhJN14E2iIAXpnsr0krln8j_FYJzE/pubhtml

I was just asking about preloading because I get up at 5 ish in the morning and it would be nice to have one I can just grab and go. It isn't necessary, though.

I definitely understand what you're saying about testing. I just thought some people got on a more regular dose and didn't need to constantly test. In other words I'll be looking at testing twice a day minimum. I was mainly just wondering because my vet was explaining that curves don't need to be done as frequently as most people on here do but it seems like the people on here are more knowledgeable than most vets.
 
Thanks, Rachel. I found the instructions from my first post and just selected publish to the web. That link should work now.
 
It worked!

Okay, I hear you. I'll try to find some info about prefilling syringes and get back to you on that. I hear you about getting up early!

Testing...well..it depends. Some don't need to test as constantly. Some cats find a dose that works and they stick with that. For example, if a cat was on 2 units and that kept them in yellow preshots and getting lovely blue or green nadirs, but any other dose made them either too high or too low...well they might not test as often. Almost anyone on ProZinc will tell you they try to grab a nadir a few times a week at least...even when well regulated. But if you've reached a point where you've been testing for a long time and you know that 2 is what works and your preshots continue to be the same...you might grab nadirs just 2 or 3 times a week to check. A lot of us here are data junkies..but in the end, I suggest getting curves more frequently at first (as you did today) and also when we're having problems figuring out dose so we can see what's going on. Once you've got a lot more data, you can test less. If you check out some other SS's on here you'll see a lot of us test a lot...but these cats are still trying to figure out good doses. And because of the amount of tests, sometimes, we'll suggest taking a day off.

On a side note, it isn't necessary to test every hour for a curve. Every 2 hours is usually fine.

To discuss Nala specifically...since you are using an AT, I have some concerns about that +8. First, that's a pretty late nadir. Second, 80 is where you start worrying about hypo on an AT. I think your preshot was a bounce...and makes me wonder if Nala isn't getting too much insulin. Have we explained bouncing? If so, does it make sense?

Here's what I'd suggest: try to get some more tests in when you can this week...test somewhere around +6 and then again around +8 when you can. Let's see if she just has a late nadir (some do!). I'd also recommend maybe dropping your dose to 1.5. If you drop the dose and get some mid cycle tests (not a curve...just some tests around what the lowest point should be) we can see if that gives her a gentler cycle that may result in lower preshots.

What do you think?
 
I agree with Rachel. The curve was beautiful, gradually dropping and then lasting until the last hour when she bounced. And yes, your green was on the low side for AT so I think I'd reduce the dose a smidge too. Either to 1.5 or a skinny 2 (draw up 2 units and let out a drop or two)

It isn't recommended to pre fill syringes - something about the insulin and the plastic of the syringes being deteriorated.
 
Ok so I checked again this morning and her AMPS was back up to 444. So there might be something about the bounce. It was explained to me somewhat in a prior thread I had posted but I'm not quite sure I understand it completely. Basically what I'm getting from the posts you two made is that it's possible she's still getting too much insulin and her body reacts by over-producing and then her numbers shoot sky high and her next few readings are on the high side. I was just thinking that 2 wasn't going to be high enough. I didn't even consider that 2 might still be too high. After the explanation it does make more sense.

When I did the +8 I was looking at it too and wondering if it was a fluke reading (which I don't know if that can happen or not) or it really was low. My original note in there was that given her trend I was expecting it to have gone slightly up at that point and not dropped. I kept her in my room to test her so I did have my eye on her to make sure she wasn't showing any hypo signs and she was fine.

Since I'm at work during the day what would you suggest for the midday testing? I do live with my dad since I help take care of him but I don't know if he could manage to test her. I could possibly look into leaving early sometime this week but I don't know if I could get the time. This morning she had her dose at 2 units so I will drop her evening to 1.5 as both of you mentioned.
 
Many people work and there are ways to still get the data needed to keep him safe. If you can arrange the shot schedule so you could get a test a few hours after the shot and as soon as you walk in the door at night, those numbers help. A before bed test can also help fill in the picture. And every so often, set the alarm to wake up at night in that 5-7 hour after the shot and get a test then. (If you are of a certain age, you might be up then anyway)

The bounce: Nala's body perceives a lower number than it has been used to. It panics and releases extra glucose to bring that number up. So then, she is higher than "usual" the next test because of the extra glucose in her system
 
Good Morning! (and by that, I mean, I've had some coffee so the morning has become good).

I think of the bouncing as a trampoline. If you jump too hard (giving too much insulin) you are going to bounce much higher (preshot test). If you then increase the amount you jump (insulin) you bounce even higher. However, if you stay the same, without extra jumping, you'll gradually go back down to a safer height of bouncing.

As for working, as Sue said there are ways to get the data. I worked (still do!) when Gypsy was here. I did midday tests on the weekends, did before bed tests whenever I could, and did nighttime testing. Gypsy would sometimes sleep through those nighttime tests!

You just grab those midcycle tests when you can. BTW, wanted to tell you that you're doing great! I know how stressful this is, but you've done research and jumped right in to doing what is needed to take care of Nala. Please do continue to ask questions and let us know what you need.
 
Thanks a bunch for the kind words! I really appreciate it. I totally get the bounce now and I will definitely work on getting some tests even if they're at night! You are all wonderful people.
 
Regarding pre-filling insulin syringes, I have a friend who is a feline vet. She told me she checked with human pharmacist about pre-filling syringes, and the response she got was that it was okay. I have done it a few times - I noticed that the insulin seemed to settle out of solution after about 12 hours (there was a cloudy part in the syringe and a clear part) I don't know if rolling the syringe would help that I'll double check with my friend again about what the pharmacist told her about pre-filling
 
Carol, I have pre-filled a few times before and you're right the solution stopped being cloudy after awhile. Basically it crystallized at the bottom by the plunger. My vet was telling me if you're going to do it, always store the needles with the needle point facing up so the crystals didn't get stuck in the needle. Then you roll it between your fingers and hold it for a few seconds to warm it up and the solution should get cloudy once the crystals re-suspend.
 
It looks like prefilling the syringe could possibly contaminate the insulin since the inside of the syringe has lubricant. It could change the makeup of the insulin I guess. I think @BJM may know more about this...BJ? Any thoughts?
 
Pre-filling is not recommended due to the syringe lubricant which may dissolve into the insulin. In the case of Lantus, the acidic pH will cause the lubricant to dissolve in faster. I'm not sure about ProZinc's effect on that, however it is a suspension and must be rolled which would mix any lubricant into the suspension. Not sure I'd want any extra of that in my cat, though I'm sure it has been tested per FDA.
Rather than pre-filling, making a reference syringe with a colored liquid for visual comparison is helpful.
 
Ok Rachel and Sue, I gave her the 1.5 last night and this morning. I managed to leave work early today. I couldn't get a +6 but I got a +8 just now. Fortunately I have a pretty good job that allows me some flexibility. However her +8 is showing high. Part of me wonders if I shouldn't just go back to a complete starting point and work my way up instead of down.
 
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You could start at one unit and work your way up, but the 2 units looked almost right - just took her a little bit lower than ideal. I think I might stick with 1.5 a few more cycles and see whether she settles in. If she stays high and flat, then maybe we need to look at a dose between 1.5 and 2?

Can you add your spreadsheet to your signature so it comes up each time you post, updated? Go to your Profile, add the link to your spreadsheet and choose submit.
 
BJM said:
Pre-filling is not recommended due to the syringe lubricant which may dissolve into the insulin. In the case of Lantus, the acidic pH will cause the lubricant to dissolve in faster. I'm not sure about ProZinc's effect on that, however it is a suspension and must be rolled which would mix any lubricant into the suspension. Not sure I'd want any extra of that in my cat, though I'm sure it has been tested per FDA.
Rather than pre-filling, making a reference syringe with a colored liquid for visual comparison is helpful.
Click to expand...
does this mean prefilling for any length of time even say 6 hours or so
 
I would suspect that the anount of time affects the rate the lubricant might dissolve.
It is probably a trivial amount, but if your cat is sensitive to it in some way, you could have an adverse reaction - irritaion in that area perhaps.
Note I am guessing here.
Maybe set up a comparison syringe and see how he does.
 
Alright I went ahead and updated my signature to make it easier for you :)
Just tested her PMPS and she's in the black again. I will leave her here and see what happens for now. I don't know how long it takes to settle in but absolutely I'll do whatever is suggested. I was just texting my friend today about how helpful everyone here is.
 
Several of us are riding on the same roller coaster -I thought my cat was finally settled a few days ago, but noooooo
I'm assured that at some point, things settle down hang in there
 
The black is discouraging. It seems unlikely that there is a low hiding somewhere in the cycle that we didn't see......it is a surprise to me that she is higher with just 0.5 less dose.

The protocol says three cycles and then raise, so maybe the first cycle you can get a nadir for, give a fat 1.5 (just a smidge more on the syringe) or 1.75 (if you can eyeball the dose) or 2, if you can monitor carefully? The cycle on 2 units was lovely - just the one green a little lower than you would want - unless you can be around.

The thing is, you can push a little - like giving the 2, testing and if she drops below 80, give her some regular food (or high carb gravy) if she continues to drop. That is the best way to get her into good ranges. But if you can't be around, it is a little easier to be cautious.

But we don't want her sitting in the 400/500s.

What are you thinking?
 
Hmmm. Well, darn. I was hoping the drop would be just enough to even out her cycles, not bring her so high!

I'm with Sue. I doubt there was a low that caused a bounce that day. What do you think about her suggestions?
 
Yeah she was running in the black again this morning and just came in red for PMPS. I think tomorrow Ill bring her up to around a 1.75 for a few cycles and see what happens. If there's no improvement there I can bring her up to 2 on the weekend. I'm around all weekend so I can test her as needed and keep an eye on her to make sure she doesn't go hypo on me.
 
Well given her numbers over the past couple of days it looks like I'll be taking Nala up to 2 again to see how she fares there. Sue is right that the 2 looked perfect for her but I just don't understand why the numbers would come up so high at PMPS if the 2 was working perfectly.
 
The numbers went up at pmps because he bounced. When the body perceives a number lower than it is used to (the 77) it releases extra glucose and raises the number . So his pmps was inflated because of the bounce from the low.
 
There's been something in the air this week with so many cats getting high numbers. I had ever given up hope of seeing a yellow or a blue again and then, Eureka!! they appear miraculously hang in there - maybe try for 1.75?
 
I've been giving her 1.75 for the past 3 days so I guess I'll bring her up to a skinny 2 and see what happens. On a side note, I've noticed something recently and I wanted to know what you guys thought about it affecting her numbers. So my house is open because I have another cat and 2 dogs and my dogs free feed. They never have any issues. However, I noticed that Nala will sometimes steal a couple pieces of dog food and run off with it. It isn't much but I'm honestly wondering if it will affect her and how much. If I see her do it I stop her but I don't know what she's doing when I'm at work. I don't want to lock her in my room all day until I can watch her but that's really the only option I can see to keep her from eating any dog food. I know the dry food is way higher in carbs and not suited for cats but how much would it take to cause her problems? What do I do to stop her?
 
Honestly, it could affect her numbers pretty drastically. It depends on how sensitive Nala is to carbs too. But either way, any dry food (dog or cat) isn't great.

I know it's tough. Any way for the meal feeding like Carol said?
 
Given her SS I'm thinking she's probably pretty sensitive. She was +200 on her numbers over the couple of days I accidentally had her on high carb food before I could switch her off, and that was with her own cat food at 20% carbs. I just looked up the dry dog food that my dogs are on and its coming in at 49% carbs. That would completely explain the crazy numbers I've been getting if she's been sneaking food on me. The dogs do get fed twice a day but they don't eat it all immediately. They're into grazing and my dad will have a fit if I take away their food. They don't get breakfast until around 10am but I can't count on him putting Nala back in my room. I may have to leave her in there just while I'm at work until I come home and keep an eye on her.
 
Eek. I had no idea she was doing that until I was watching a movie last night and looked up and there she was crunching away. I suspect she's been doing it before last night too so I will definitely keep her separated. Thank you. Is there anything I should do as far as her dosage? If she has been snacking then her readings are all off and I don't know where she's really supposed to be at.
 
I think I'd plan to be careful with each shot, but you do that anyway. It is likely that she'll drop back down to that nice cycle you had on 10/17. Two units worked good there if you can monitor and feed if necessary. If, in a cycle or two, you see the preshots dropping, reduce the dose, maybe back to 1.5
 
My dogs were free fed too. While I was transitioning all the cats to wet food, I found they were sneaking the dog food. One of my poor dogs was getting stressed out too because she felt that she needed to keep watch on her food all the time and chase those kitty offenders away. When the cats were free feeding on their dry food, they didn't visit the dog dish. So now, the dogs just get fed twice a day (the same time as the kitties) and they are doing just fine (no free feed). I still have to watch a little as Merlin will try to sneak a bite or find a dropped kibble. When he has found a kibble (just one), his numbers easily go up at least 150 points! I hate to see Nala locked up in the room too so maybe the dogs won't mine eating twice a day. Good luck.
 
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