More dosing advice please

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Andy had been overdosed so we started over. He had been bouncing until I took him back to .8u. But he was still in the 300's so have been taking him up to 1u again. Last pm he was 308, this am up to 401. He is underweight and eating abt 240 calories but according to the food formula, should be getting 178 calories to weigh abt 8lbs. His calories are divided up into 2 meals and 2 snacks. Should I have stayed with the .8u longer? It seems like 1u is too much?? Thanks for any guidance.


Update: I just found out he got into a bag of dry cat food overnight so that could be the reason for his high of 401. However, we just tested at 3+ and he is already down to 247 . Does that drop seem too soon?
 
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Good monring Yvonne. Any chance this weekend you can get some mid-cycle tests? In order to tell what is a good dose for Andy with Prozinc, you need to know the pre-shots and lowest point in the cycle. Since you switched to 1u, I can't tell what the insulin is taking him.

Oh one more thing. Since the nadir test is so important, sometimes if we work during the week, we try and take tests in the middle of the night. I know that doesn't sound like a good idea but that would help a lot more too.
 
Good monring Yvonne. Any chance this weekend you can get some mid-cycle tests? In order to tell what is a good dose for Andy with Prozinc, you need to know the pre-shots and lowest point in the cycle. Since you switched to 1u, I can't tell what the insulin is taking him.

Oh one more thing. Since the nadir test is so important, sometimes if we work during the week, we try and take tests in the middle of the night. I know that doesn't sound like a good idea but that would help a lot more too.
Yes, I plan to do that - I will post later - fortunately I am retired but still may need to check overnight :) - thank you for your response.
 
Good monring Yvonne. Any chance this weekend you can get some mid-cycle tests? In order to tell what is a good dose for Andy with Prozinc, you need to know the pre-shots and lowest point in the cycle. Since you switched to 1u, I can't tell what the insulin is taking him.

Oh one more thing. Since the nadir test is so important, sometimes if we work during the week, we try and take tests in the middle of the night. I know that doesn't sound like a good idea but that would help a lot more too.
I noticed you have 13/11 schedule - what does that mean? We are feeding/dosing abt 7am and 5-6pm. How much could our timing affect his numbers with PZI? Also, you have sliding scale - is that diff doses because of the 13/11? It's been years since I had a diabetic kitty so I am a bit rusty yet!
 
Good monring Yvonne. Any chance this weekend you can get some mid-cycle tests? In order to tell what is a good dose for Andy with Prozinc, you need to know the pre-shots and lowest point in the cycle. Since you switched to 1u, I can't tell what the insulin is taking him.

Oh one more thing. Since the nadir test is so important, sometimes if we work during the week, we try and take tests in the middle of the night. I know that doesn't sound like a good idea but that would help a lot more too.
Scratch that mini curve this am - he got into some dry food overnight and this am. Will try this pm.
 
I noticed you have 13/11 schedule - what does that mean? We are feeding/dosing abt 7am and 5-6pm. How much could our timing affect his numbers with PZI? Also, you have sliding scale - is that diff doses because of the 13/11? It's been years since I had a diabetic kitty so I am a bit rusty yet!
I saw your posting on another thread about the sliding scale - that interests me - I have a "sliding scale type" chart from the vet but it is based on once a day testing and if I used it "as is" would definitely be overdosing Andy again due to his bouncing, so I put that aside. I am not sure I have enough reliable numbers for him yet to try this but it is definitely something to think about.
 
Narrowing in on the relationship of dose to amount of drop:
On 10/23, you got a drop of 391 mg/dL for 2 units. This suggests that about 1 unit could drop him about 195 mg/dL or so.
On 10/26, you got a drop of 261 mg/dL for 1 unit.
Thus, 1 unit may drop him anywhere between 195 to 261 mg/dL. Other factors play into this, of course - food, stress, activity levels, etc.

You may find it useful to check around +10 to +11 to see how long the insulin is lasting for him, too. For some cats, the PZI may wear off a bit early, and avoiding food in the last 4-6 hours of the cycle may help with that.
 
I noticed you have 13/11 schedule - what does that mean? We are feeding/dosing abt 7am and 5-6pm. How much could our timing affect his numbers with PZI? Also, you have sliding scale - is that diff doses because of the 13/11? It's been years since I had a diabetic kitty so I am a bit rusty yet!

Merlin is on a 13/11 or 12.5/11.5 schedule. Currently, Merlin is on the later. You can use this type of schedule when you are on an "in and out" type insulin like Prozinc. So, once you have plenty of data, you may start to see a pattern that one of your pre-shot numbers, the majority of the time, is higher than the other. For example, Merlin's AMPS are generally high and his PMPS are low. So in order to balance it out a little or catch the AM shot before it gets too high, I shorten the time to shoot; hence the 11.5 or 11 hours between shots at night. Prior to this new schedule, we were even having discussion on this site to try shooting TID. Ugh, I really didn't want to do that. Prozinc typically lasts 12 hours but for some reason, Merlin's shots lasts longer in the day and shorter in the night. A great example is when I was gone for two months starting in March through April. You can easily see his high numbers in the AM. He was on a 12 hour schedule during that time. I believe that most cats do very well with a 12 hour schedule. Oh, and you asked about if the sliding scale is used due to a 13/11 schedule....no it is not. Sliding scales can be used with a 12 hour schedule.

I saw your posting on another thread about the sliding scale - that interests me - I have a "sliding scale type" chart from the vet but it is based on once a day testing and if I used it "as is" would definitely be overdosing Andy again due to his bouncing, so I put that aside. I am not sure I have enough reliable numbers for him yet to try this but it is definitely something to think about.

When Merlin was first dx, I did find that consistent dosing helped with his bouncing. Merlin would bounce for days and eventually, his bounces started to decrease both with time and intensity. Today, he hardly ever bounces and when he does (usually from a very low number), it is only for that next shot. So for him, the sliding scale works very well. My goal is to get to a safe, green number with each cycle. It really takes a lot of time to hone in on a successful, sliding scale, i.e. there is a lot of adjustment that goes on. The success of a sliding scale is knowing what his low number will be with any given dose, so sometimes in order to know that, consistent dosing helps you understand that number and dose.

I have a "sliding scale type" chart from the vet but it is based on once a day testing

In order to figure out a proper dose with Prozinc, you need to know the AMPS number, PMPS number and nadir. There is no way to figure out a dose based on one test per day. That is why I asked if you couldn't get some mid-cycle tests along with your AMPS and PMPS numbers for you 1u dose. Without that combination, it is impossible to figure out what the dose should be. It is hard to suggest a dose when one of those key tests are not available and it is hard to suggest a dose for a sliding scale when there is only a few days of those key elements. When ever I have a new dose that I am giving, I always make sure that I can check at least at +4 to see where that new dose is taking him.

You still may want to consider a 12 hour schedule and maybe 3-4 cycles of consistent dosing (unless Andy throws you a weird number) just to see where that dose gets you at nadir and within that 12 hours. That way you can test at +10 or +11 to see when the insulin is wearing off just like BJM suggested. You may find that you do not have to change your 12 hour schedule. If you decide to go to a sliding scale, testing at AM, PM and nadir will be crucial for you in creating one. Periodically, I go back and re-read the Prozinc protocol just to make sure that I am making decisions based on that proven information. Along with the awesome folks here and the protocol, it has helped me and Merlin immensely.

Again, you are so awesome for bringing Andy into your home. Andy is a very lucky boy. Also, great job in your testing and all your questions. Hope this info helps and holler if you have more questions.
 
Merlin is on a 13/11 or 12.5/11.5 schedule. Currently, Merlin is on the later. You can use this type of schedule when you are on an "in and out" type insulin like Prozinc. So, once you have plenty of data, you may start to see a pattern that one of your pre-shot numbers, the majority of the time, is higher than the other. For example, Merlin's AMPS are generally high and his PMPS are low. So in order to balance it out a little or catch the AM shot before it gets too high, I shorten the time to shoot; hence the 11.5 or 11 hours between shots at night. Prior to this new schedule, we were even having discussion on this site to try shooting TID. Ugh, I really didn't want to do that. Prozinc typically lasts 12 hours but for some reason, Merlin's shots lasts longer in the day and shorter in the night. A great example is when I was gone for two months starting in March through April. You can easily see his high numbers in the AM. He was on a 12 hour schedule during that time. I believe that most cats do very well with a 12 hour schedule. Oh, and you asked about if the sliding scale is used due to a 13/11 schedule....no it is not. Sliding scales can be used with a 12 hour schedule.



When Merlin was first dx, I did find that consistent dosing helped with his bouncing. Merlin would bounce for days and eventually, his bounces started to decrease both with time and intensity. Today, he hardly ever bounces and when he does (usually from a very low number), it is only for that next shot. So for him, the sliding scale works very well. My goal is to get to a safe, green number with each cycle. It really takes a lot of time to hone in on a successful, sliding scale, i.e. there is a lot of adjustment that goes on. The success of a sliding scale is knowing what his low number will be with any given dose, so sometimes in order to know that, consistent dosing helps you understand that number and dose.



In order to figure out a proper dose with Prozinc, you need to know the AMPS number, PMPS number and nadir. There is no way to figure out a dose based on one test per day. That is why I asked if you couldn't get some mid-cycle tests along with your AMPS and PMPS numbers for you 1u dose. Without that combination, it is impossible to figure out what the dose should be. It is hard to suggest a dose when one of those key tests are not available and it is hard to suggest a dose for a sliding scale when there is only a few days of those key elements. When ever I have a new dose that I am giving, I always make sure that I can check at least at +4 to see where that new dose is taking him.

You still may want to consider a 12 hour schedule and maybe 3-4 cycles of consistent dosing (unless Andy throws you a weird number) just to see where that dose gets you at nadir and within that 12 hours. That way you can test at +10 or +11 to see when the insulin is wearing off just like BJM suggested. You may find that you do not have to change your 12 hour schedule. If you decide to go to a sliding scale, testing at AM, PM and nadir will be crucial for you in creating one. Periodically, I go back and re-read the Prozinc protocol just to make sure that I am making decisions based on that proven information. Along with the awesome folks here and the protocol, it has helped me and Merlin immensely.

Again, you are so awesome for bringing Andy into your home. Andy is a very lucky boy. Also, great job in your testing and all your questions. Hope this info helps and holler if you have more questions.
Thanks for this great detailed info - I printed it off to study more! One other question (for now) - do you always feed when you test/shoot or do you only test/shoot at the 12hr period? I.e., are you also feeding on 12.5/11.5 schedule? I have many other "furbabies" that we have been regularly feeding 7am and 5-6pm. I need to have them on the same schedule - will I be able to do this with Andy and still get him regulated?
 
I test, feed and then shoot all in about 10 minutes. I make sure that he has not had anything to eat two hours before I test. So whatever schedule I follow, I test, feed and shoot pretty much at the same time. All cats are on the same schedule. Merlin is always hungry and so are the other cats. So I have tried a few times feeding their dinner two hours before his shot. Example: Currently, his shot times are 6am and 6:30pm. They all get fed their breakfast and dinner at that time. Merlin also gets fed 2-3 snacks during the day which basically is about a tablespoon of food each time. A few weeks ago, I was shooting later so I tried feeding their dinners two hour before shoot times. Then at the late shot time, Merlin had almost like a snack (tablespoon). That worked out ok too. Just have to make sure that they are done with their food two hours prior to shot times so the food won't influence the BG numbers.
 
Looking forward to seeing his numbers. If there is any way to block his access to the high carb food, that would make your life a lot easier. Otherwise, anytime he gets a high number, you'll be wondering "Is he really bouncing or really high on too little insulin or did he get into some dry?" Makes it really hard to get the right dose....

Cindi has some great ideas on scheduling and food. Whatever you can figure out....
 
Looking forward to seeing his numbers. If there is any way to block his access to the high carb food, that would make your life a lot easier. Otherwise, anytime he gets a high number, you'll be wondering "Is he really bouncing or really high on too little insulin or did he get into some dry?" Makes it really hard to get the right dose....

Cindi has some great ideas on scheduling and food. Whatever you can figure out....
This was my mistake. I had just bought a bag of dry for my other older cats and had it on a high shelf. I forgot I had Andy :( He is very resourceful! He ate into the back of the bag overnight and I did not see it until the next day when I caught him jumping up for another "snack."

Tomorrow I will try to get some more testing done. Today's numbers were a bit better.
 
Looking forward to seeing his numbers. If there is any way to block his access to the high carb food, that would make your life a lot easier. Otherwise, anytime he gets a high number, you'll be wondering "Is he really bouncing or really high on too little insulin or did he get into some dry?" Makes it really hard to get the right dose....

Cindi has some great ideas on scheduling and food. Whatever you can figure out....
I tested today - amps 401, gave 1.2u, +3 182, +5 236, ff snack, +7 417 He dropped 219 in 3 hrs w breakfast - could he have gone too low at +4 and bounced again??
 
Wow - looked like you were going to have a great cycle and then...bam. Well you probably are right. Andy may not be used to the lower numbers and especially since he dropped so fast. It appears that every time he has received a blue, he gives you a red at pre-shot time except for 10/30. Hang in there, otherwise, good data. It will be interesting to see the PMPS. Hopefully he will stay flat or maybe catch a second nadir.
 
Wow - looked like you were going to have a great cycle and then...bam. Well you probably are right. Andy may not be used to the lower numbers and especially since he dropped so fast. It appears that every time he has received a blue, he gives you a red at pre-shot time except for 10/30. Hang in there, otherwise, good data. It will be interesting to see the PMPS. Hopefully he will stay flat or maybe catch a second nadir.
I am thinking the 1.2u was too much again. Maybe overnight was a drop also - look at the 29th - +6 was 136 w .8u.........................
 
I am thinking the 1.2u was too much again. Maybe overnight was a drop also - look at the 29th - +6 was 136 w .8u.........................

Hmmmm...maybe, but I don't think he went too low today specifically at +4. On 10/25, 416, you dosed a 1.5u and had a nice blue mid-cycle. It looks to me that most all if not all of your 400's at pre-shots could be from previous lower numbers and I am not saying that the lower numbers are bad or too low; it could be just a blue number and Andy is just not used to being that low yet. Since he went low or hypo'd earlier, his body is going to be very protective and guard him against another low number. I think right now, the key is to get him to a nice blue and for him to gently come up for pre-shot and to learn that it is ok to get those lower numbers.
 
Hmmmm...maybe, but I don't think he went too low today specifically at +4. On 10/25, 416, you dosed a 1.5u and had a nice blue mid-cycle. It looks to me that most all if not all of your 400's at pre-shots could be from previous lower numbers and I am not saying that the lower numbers are bad or too low; it could be just a blue number and Andy is just not used to being that low yet. Since he went low or hypo'd earlier, his body is going to be very protective and guard him against another low number. I think right now, the key is to get him to a nice blue and for him to gently come up for pre-shot and to learn that it is ok to get those lower numbers.
He was 381 at PMPS - I gave 1u. I think what you said may be the key. How does his body learn not to bounce ? I have been giving a snack around +5 and +4. Would you stick w the 1.2u and 1u for a while to see if he levels out some?
 
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