Baco on ProZinc part 2

[Ruby&Baco]

Hello everybody, I've created a new thread (part 2)
I will keep you updated this week how Baco's # are doing.

 

[Sue and Oliver (GA)]

Hope the vomiting this am resolves. It is frustrated not to know whether it was food or hairball or? Hard to know why this am is a little higher. Maybe upset tummy, maybe a lower number/bounce later last night. Glad BF will keep an eye on her. We'll regroup tonight if you want dose help,

 

[Ruby&Baco]

I think she ate to quickly, she was hungry and was 'crying' that she wanted some food haha poor baby. So she just ate to quickly and then usually she vomits.. I find it more frustrating that her # are all over the place, there is no straight line in it (yet??) I know you said it's a marathon not a sprint.. but it's so frustrating that you see her drop in # and that's a really good thing, and a day later she is really high again in #. And I'm like "why?" i'm trying to find a pattern in her dosis and # and food combination, but I still can't seem to find one. I'm anxious to know how she is doing right now, and to see her # later today.. I can't call my BF right now due to my work, they're not that fine with making a private phone call, soooo. I will hear it later when I get home I guess.

 

[Sue and Oliver (GA)]

Bouncing is usually the culprit. Nice numbers one day, high and flat the next or a high preshot as a reaction to the low.

Sometimes spreading the food out all over the plate slows them down and stops "scarf and barf"

 

[Ruby&Baco]

But there will be a point in time that the # will be in a pattern right? That she will stay mostly the same? Thanks for the tip i will try to do that with her food tonight!

 

[Robin&BB]

Hard to know why this am is a little higher. Maybe upset tummy, maybe a lower number/bounce later last night.

So she just ate to quickly and then usually she vomits..

Sue's right: Yes, it could be a bounce; or could be that Baco's BG spiked more just from vomiting (that's always kind of stressful anyway). I used to have quite a time with Bat-Bat being a "scarf & barf" cat, Ruby. Two things I do that helped stop that problem:

1) I've raised her food dish up off the floor (a shoebox works well for this) so that she's not eating with her head down at floor level;
2) When she's about halfway through her AMPS or PMPS meal, I pick up the dish and make her take a little 5-minute "rest" from eating, then I allow her to continue after that little time-out!

I know that others have some good tricks, too - like placing a small drinking glass, upside down, in the center of the food dish so that kitty has to eat around it (slows her down a bit).

 

[Ruby&Baco]

I will try that also thank you. Well good news (i guess) I tested her right now and she is at 133. I just came home, so I have to shot her (normally) at 7:00PM. I will test her again in 30 minutes but I don't think she will be going up really high before eating.. soooooo don't give her a shot this evening?

 

[Robin&BB]

I don't think she will be going up really high before eating.. soooooo don't give her a shot this evening?

If she doesn't make it up to 200, you'll just need to skip that shot. And it's possible that we may be looking at yet another reduction at the next shot time, Ruby. Remember: We're going for two shootable #s per day, and this super-low PMPS tonight may be an indication that she needs even less insulin.

 

[Sue and Oliver (GA)]

Try stalling. Test, wait 20 minutes without feeding and retest. If she is rising and nearer 200 (even 180 or so) you could think about a reduced dose and plan to get a before bed test. You could pull up 0.5 and let out a few drops. But no, I wouldn't shoot below 180.


And tomorrow, maybe reduce again to 0.5. We are trying for two shootable preshots a day. Skipping is the least desirable choice because you end up with a higher amps.

On a day when you don't have to work, you can consider "chasing" the level. So, say you had tomorrow off, you could feed her tonight, test in 2 hours and if she is 200 shoot a little less than normal. Then tomorrow, wait until she is high enough to shoot again (probably later than normal test time as you want her at least 11 hours or so from the previous shot). It throws you off 12/12 but is often the way people do it when their cat is headed to remission (anti jinx) and is on tiny doses. Sometimes they do it on the weekend when they have the time to shoot off schedule. Does that make sense? Just another tool for your tool box as PZI is flexible.

 

[Ruby&Baco]

Thanks Robin for your quick reply. So I'll let you know if I give her a shot tonight (I don't bet on it)
Yes I know we are going for 2 shots a day, but if she is this low in # I can't give it to her
So what will you recommend if I don't give her a shot today? what do I give her tomorrow morning? 0.5 instead of 0,75?

@Sue and Oliver (GA) I don't get everything you are saying (sorry, some english terms are a little hard for me).
I'm scared to give her a reduced dose of a few drops at 180...
and I really don't know how to give her a few drops either...

On a day when you don't have to work, you can consider "chasing" the level. So, say you had tomorrow off, you could feed her tonight, test in 2 hours and if she is 200 shoot a little less than normal. Then tomorrow, wait until she is high enough to shoot again (probably later than normal test time as you want her at least 11 hours or so from the previous shot). It throws you off 12/12 but is often the way people do it when their cat is headed to remission (anti jinx) and is on tiny doses. Sometimes they do it on the weekend when they have the time to shoot off schedule. Does that make sense? Just another tool for your tool box as PZI is flexible.

I don't fully get what you're saying. so what do you mean with chasing the level?
I feed her tonight, then don't give her a shot if she's below 200 (that I get) then tomorrow i normally shoot her at 7:00AM but you say that I have to wait, say an hour longer to give her her shot (if she isn't high enough)?
but I understand from ProZinc that I have to shoot her every 12 hours, but I can have a margin of +/- 30 minutes... so what if i give her her shot at say 09:00AM than give her a shot at 09:30PM and the next day I go to work and HAVE to give her a shot at 07:00AM? that's not good right?

 

[Robin&BB]

Try stalling. Test, wait 20 minutes without feeding and retest. If she is rising and nearer 200 (even 180 or so) you could think about a reduced dose and plan to get a before bed test. You could pull up 0.5 and let out a few drops. But no, I wouldn't shoot below 180.

And tomorrow, maybe reduce again to 0.5. We are trying for two shootable preshots a day. Skipping is the least desirable choice because you end up with a higher amps.

@Sue and Oliver (GA) - Glad you're here today, Quick-Draw! My check-the-cat-NOW alarm went off before I could finish my last post to Ruby and ... you read my mind!

 

[Nederland]

Thankfully, tomorrow we (almost) all have a day off due to King's Day (the King's birthday).....

I think I understand what Sue is saying: not shooting at the regular time, but following up the level for some time and shoot when she's high enough BUT a lower dose than normal (0.5). Then tomorrow morning the same: follow up the level and shoot when it's high enough. Kind of postponing the shot until the level is high enough, but less than the normal dose.

Did I understand correctly?

 

[Ruby&Baco]

Yes, that makes sense.. She is now at 166 before eating so i'm not going to give her a shot now. and if she is at 11mmol /200MG or a little bit higher, then I give her 0.5 tonight? i'm a little bit scared that that will be to much, maybe 0.25 is better?
but Jennie, what do I do when I will chase the level, then give her a shot, etc but when I do that this week, (because i'm free until sunday) and then Monday I give her a shot on time again, isn't that going to be a problem then?

 

[Nederland]

Maybe she will be back on her normal schedule by that time. But I'm wondering, too, and I'm curious about what will be said.

If she's back to 200, it's save to shoot 0,5 unit. And I think tomorrow morning you will again have to check her level at 7 AM, your normal time. I think, mind you, I'm not sure. If too low, try again later.

 

[Ruby&Baco]

I'm sorry for all the questions, but I'm still not used to 'what i do in some situations' i'm still learning a lot from you all!

 

[Robin&BB]

Did I understand correctly?

Yes, that's essentially correct ... however, it may not always be practical for someone who is working full-time and does not have that kind of flexibility in the schedule.

but Jennie, what do I do when I will chase the level, then give her a shot, etc but when I do that this week, (because i'm free until sunday) and then Monday I give her a shot on time again, isn't that going to be a problem then?

Ruby's question here illustrates my point above, so ... decisions need to be made as the numbers reveal themselves over time. Early in treatment (where you are with Baco right now, Ruby) we recommend not shooting below 200 for safety's sake: There just isn't enough of a history - meaning lots and lots of #s on the spreadsheet - to justify shooting the insulin at numbers lower than that. But in your case, what Sue was saying is that you can conceivably shoot a little less insulin rather than skipping the shot altogeter if after stalling for a little while, Baco had made it up to 180 or so tonight - is better to do that when you can be around (or have your BF around) to monitor her BG #s to make sure she does not go too low unexpectedly.

This is why we call treating diabetes a "sugar dance" - based on the history that accumulates in your kitty's spreadsheet, as her patterns emerge you can determine more easily and confidently what to do in terms of adjusting her doses, etc. (It would be great, for example, if we could get a few more mid-cycle #s in during the daytime cycles during the week, but this is not always possible for working people.)

 

[Robin&BB]

I will chase the level, then give her a shot, etc but when I do that this week, (because i'm free until sunday)

Ruby, are you saying you're off work all this week until Sunday?

 

[Ruby&Baco]

yes that is correct, so I can do whatever you are telling me to do
tonight I will chase her levels, and if she's high enough in maybe 2 or 3 hours I will give her a shot, if not I will skip it because I'm scared that if I go to sleep tonight she will get to low #.

 

[Robin&BB]

What was her BG# the very last time you checked before you fed her tonight?

 

[Ruby&Baco]

166

 

[Robin&BB]

tonight I will chase her levels, and if she's high enough in maybe 2 or 3 hours I will give her a shot, if not I will skip it because I'm scared that if I go to sleep tonight she will get to low #.

Giving her a token dose of less than 0.5 IF she has risen to about 200 within two hours of feeding may be ok, but otherwise I'd say skip it and get some sleep tonight. Tomorrow is another day, and once she's high enough to shoot, I'd recommend going to 0.5U for the morning dose - perhaps that will be the next good dose. (Ha, maybe Baco is just getting more and more eager to be off insulin altogether - and sooner than expected. Wouldn't that be something!)

 

[Bobbie And Bubba]

Ruby, this is very exciting to watch how well Baco is responding to the insulin ,her new diet and the absence of steroids.

 

[Ruby&Baco]

She's now at 259 13,5+ right now (didn't get her PS just yet. what should I do? 0.5 now? or wait until tomorrow?

 

[Robin&BB]

Oops, sorry! It's been an hour and a half, is that correct?

 

[Ruby&Baco]

7:00PM so that's about +/- 1,5 hours ago.

 

[Ruby&Baco]

yes @Robin&BB

 

[Robin&BB]

You could give her just a little less than 0.5 now (it's entirely up to you), but I would get a test about 3 hours after you give that shot, just to see how she's doing.

 

[Ruby&Baco]

what is a little less? between 0.25 and 0.50? sorry for the questions, I'm just a little scared (hihi)

 

[Robin&BB]

Make that 2 to 3 hours after you give the shot. (Remember, the more BG# data we have, the better.)

 

[Ruby&Baco]

okay, I will give her between 0,25 and 0,50 now. I will keep you updated at +2 and +3.
BTW, how am I supposed to fill in my SS ? because I already filled the PMPS and that was low, how am I supposed to count everything?

 

[Robin&BB]

between 0.25 and 0.50?

Yes, I think you'll feel safer if you do that, especially since you're shooting based on a # that has risen after feeding. (Just a little would be better than skipping altogether, since you are around to monitor.)

 

[Ruby&Baco]

okay, I gave her a shot just now between 0,25 and 0,50. hope she is going to take it well. I will test her in +1 +2 +3.

especially since you're shooting based on a # that has risen after feeding.

Yes I was thinking the same, she is higher because she was eating just now.

 

[Robin&BB]

how am I supposed to count everything?

Make sure you note everything in the remarks section at far right on your SS. (Such as "Dosed at +13.5 or +13.75, whichever it is.) Others here may be able to advise you how to best note this on your SS (I'm afraid I'm not very good at spreadsheet technology myself!) And count (for purposes of your BG tests, from the time you have given the dose). Ok?

 

[Robin&BB]

I will test her in +1 +2 +3.

Very good!!! That's the way to do it.

 

[Ruby&Baco]

I will count from 9PM and just fill in the second half of the sheet (after PMPS) and yes I put it in the remakers sections
I'm so happy Baco is doing sooo well

 

[Sue and Oliver (GA)]

Thankfully, tomorrow we (almost) all have a day off due to King's Day (the King's birthday).....

I think I understand what Sue is saying: not shooting at the regular time, but following up the level for some time and shoot when she's high enough BUT a lower dose than normal (0.5). Then tomorrow morning the same: follow up the level and shoot when it's high enough. Kind of postponing the shot until the level is high enough, but less than the normal dose.

Did I understand correctly?

Yes. Here it is presented a little differently:

When your cat is consistently in numbers too low to shoot at shot time and in numbers in the 100 range and below during the cycle, you can consider micro dosing. This process should be guided on the forum by experienced members and will require more frequent testing. You may be shooting at times other than the 12/12 schedule, when the blood glucose levels rise enough to require a small dose of insulin. You will need to pick a number somewhere near the 150 range at which you will plan to shoot, being sure that the number is indeed rising. The dose at these low numbers will vary with each cat and its patterns, so advice should be solicited. But you may be considering doses below .25 and even considering a “drop” of insulin. At this point, U100 needles and the conversion chart will be necessary. It is important during this period to offer small frequent meals. You may want to experiment with the lowest carb foods to help bring down the numbers, staying away from seafood more than once or twice a week.

You may want to up the range to 180 or even 200. We usually don't suggest this till the kitty has been on insulin awhile, has data and is on tiny doses, headed toward remission.. But Paco is on tiny doses and you are fighting to give two shots a day so it may be useful. And you can try it while you will be around to test, see what changes and then we work on something else for the work week.

Looks like you went ahead and dosed tonight. I think testing is wise - the food throws a variable in the mix because we don't know how much of the rise was because of the food and how much was just a normal rise.

It is wonderful and scary when they start to react well to the insulin. You are learning new info to fit her new levels - just when you had figured out how to work with normal issues. But it is all good news - she is heading in the right direction.

 

[Robin&BB]

I feel compelled to repeat/reiterate two VERY important points that Sue @Sue and Oliver (GA) made above (italics within Sue's original comments are mine):
#1:

Looks like you went ahead and dosed tonight. I think testing is wise - the food throws a variable in the mix because we don't know how much of the rise was because of the food and how much was just a normal rise.

#2:

You may want to up the range to 180 or even 200. We usually don't suggest this till the kitty has been on insulin awhile, has data and is on tiny doses, headed toward remission..

And here's why I am stressing Sue's points yet again: I would not want your forum's participants (since ProZinc is only just now available in the Netherlands) to take what is happening in your individual case with Baco and "run with it" - meaning that I would hate for them to get the impression that "chasing the numbers" is something we would normally/usually tell someone who is new at treating their cat's diabetes to go ahead and do.

Your situation with Baco is a little on the "unusual" side because she has (as indicated by the BG tests you've been doing) very quickly shown us that she needs a very small dose of insulin. (Less than 1.0U.) It is - in my opinion, at least - highly likely that what Baco is experiencing is "transient diabetes" - the kind brought on by a short course of prednisone (steroid) therapy. And now that she is no longer on that steroid, she is responding exceptionally well to the ProZinc. (Which is what we'd hope for in every case, but more often than not this process takes considerably longer.) Also in your case, you are able to be home from work with Baco for this entire week (very lucky that you happen to be able to be home right at this point in her treatment) - most people who are working full-time are not able to arrange that. And even for those who are at home all the time, as a general rule for the vast majority of people with a newly diagnosed cat, we would not recommend chasing the numbers/ or adjusting the dose more often than every few cycles until such time as there are lots of numbers already in the cat's spreadsheet (in other words, a very clear pattern showing that this rather advanced technique is appropriate - and that does not normally happen just 10 days into treatment).

Again - in Baco's case - your cat has responded unusually quickly to the insulin, making much smaller doses a necessity very early on. And another fortunate aspect of Baco's case: She has no other medical complications.

Ruby, I would strongly recommend that you switch over to the U100 syringes straight away and - using the conversion table - thereby help ensure that your very-small doses for Baco are as accurate as can be.

One more thing: Making the decision about whether to skip a dose altogether because of a too-low pre-shot BG #, or to do as you did tonight (waiting one to two hours after the meal for blood glucose to rise to at least 200, then giving a much smaller "token" dose) can be a difficult one. As Sue noted above, there's the problem of not really knowing how much of that rise in blood glucose was "normal" for your cat or how much of that rise was influenced by the food eaten. So even when it's just a token dose given, is still very important that the cat's blood glucose be monitored (as you have been doing tonight). I will caution you, however, that it is possible - because Baco appears to be responding so rapidly to insulin therapy - that in the morning you could see him bounce to a higher AMPS # --- even from that token dose of .35U tonight. Conversely, the pre-shot # you get in the morning could again be one that is too low to shoot. Will be interesting to see which way Baco's number goes tomorrow! (You may even want to do a curve tomorrow or the next day, testing every two hours throughout Baco's daytime cycle.)

I hope what I've had to say here doesn't seem too redundant; I just wanted you and the other members of your forum over there to be very aware: "Chasing the numbers" while on ProZinc is really something we consider a more advanced technique that - in the vast majority of new cases - we would not recommend for someone who is new at treatment of their diabetic kitty.(Ha! Baco apparently does not want to be the "average" diabetic kitty!)

P.S. You are doing a great job with Baco, Ruby. You jumped on that learning curve with great enthusiasm!

 

[Ruby&Baco]

Hi Robin, thank you for the tips. The syringes is not something i will change right now, that's more because i just bought a box of 100 pieces from the u40 ones and id spend so much money in this last month, so i have to stick to the u40 for a little while right now... Maybe next month it is possible for me.

Okay I will 'chase' her these couple of days untill sunday.
Btw she is high in her # right now, 355. So i think i give her 0,5 right now?
Just like was intended yesterday to give her. I think the 0,35 was a little too less due to the fact that she was rising yesterday after pmps at +1 +2 +3..

 

[Robin&BB]

So i think i give her 0,5 right now?

Yes, I would give her to 0.5 now.

 

[Robin&BB]

I think the 0,35 was a little too less due to the fact that she was rising yesterday after pmps at +1 +2 +3

Well, yes it may have been a bit too little - but you were better off safe overnight, so no problem. We will see how she does this cycle on the 0.5. Try to get a +2 in addition to some mid-cycle tests so that we can see what her body is doing with the insulin at this dose, ok?

 

[Ruby&Baco]

Thanks! So that was a good feeling I had about it. See, i'm learing
Well just a couple questions, due to the time difference and that I will chase Baco's # this week i would like to know what i should do if I can't reach you quick enough.
Can you help me with that?
So now she is around 355 (the purple #) so the best is then to give her 0,5. But what if she is pmps in the yellow numbers or even at 200 (standard give her 0,35?)... I would like to have some guide lines because this chasing is totally new for me. And I don't know what to do if I can't reach you guys. Isn't it better to give her 0,5 this evening although she is in her lower numbers (but above 200)? So i can see what is will do? Or do you recommend 0,35?
In the night (my time) it's not that hard to reach you because you are all awake then, i think is midday for you.. But in the (my) morning it is late at night for you... So that's tricky.

 

[Ruby&Baco]

Yes i will test her at +2 +4 + 6 +8 today.

 

[Robin&BB]

But in the (my) morning it is late at night for you... So that's tricky.

Ha, is lucky that I had to wake up at midnight my time to test my cat's +5!

About chasing #s ... I would prefer to see you hold that dose of 0.5 for a few cycles as long as Baco's AMPS/PMPS # is in the 180-200 range right before her usual shot time. (As you will be around to monitor her BG #s, right?) IF it has not risen to at least that 180-200 range, then I would say do the "stall & withhold food" method for 20 minutes, then test again to see if she's risen enough. If she still has not, repeat the "withhold food/stall" and check her BG # yet again. Usually within about an hour or so of doing this, a cat's BG # wil rise enough to safely shoot.

I think this is the better way for you to handle it for now - let's see if that does it, ok? The only reason we really had you do that "token" dose of less-than 0.5 last night was because she was so very low that shooting a little something later was probably a better choice than skipping altogether. But, in general, is better (especially since you can be a little more flexible, at least until you have to go back to work) that you use the "withhold food, stall, then recheck blood glucose" method - even if you have to do this repeatedly until she rises enough.

Here is why I am suggesting this: If Baco keeps showing us too-low-to-shoot #s every 12 hours*, it is quite possible that it is her body's way of indicating that the dose will need to be further reduced. But if we were to keep shifting the doses and times she gets dosed (both simultaneously), it makes it that much harder for us to determine what is the correct dose for her. Does this make sense now?

*Or even if she's showing a too-low-to-shoot # every other cycle it can mean the dose would need to be reduced ...

 

[Robin&BB]

Ruby, I must get to bed very soon, as it is almost 1:00 a.m. my time, and I will need to get up again in another 5.25 hrs. But I will check in on you and Baco's SS as soon as I am awake again and having my coffee - which will be way before your next pre-shot test time. Ok? (And I know the others will be around to weigh in, too.)

Just so you know, I will most likely be awake until close to this same time most of this week, as I am having to monitor Bat-Bat very closely for a while (although I would rather be sleeping). So I hope that gives you some reassurance that at least one of us is up kind of late over here.

 

[Ruby&Baco]

I will hold the 0.5 dosis for now because I think it's also better to stick to the 0.5 for a few cycles. I can 'chase' her untill saterday because sunday I have to build the hours a little lower because monday I have to work again..
Well thank you for your information! it's really very helpfull. Sleep well and I will talk to you in a couple of hours She is at +2 right now and is at 257 so that # makes me happy already

 

[Rachel]

Yep, I just wanted to jump in and echo what Robin said. Chasing the numbers isn't something that we recommend very often. Many folks here never even get to the point where they do that. So, just for the other folks on your forum, we want to be sure that you know we suggested it here because your situation is very different from most situations.

I'm hoping that your numbers will even out for preshot times. We definitely want to hit those 2 shootable preshots. This is a good week, since we have time to really review your numbers and see what is happening!

 

[Ruby&Baco]

Quick question, I gave her a shot at 9am, can i then give her a second shot at 8pm? There has to be a minimum between the shots of 11 hours right?

 

[Sue and Oliver (GA)]

That should work - as long as she is sure rising, not falling. That usually takes 2 tests to determine, spaced at least 15 minutes apart.

 

[Sue and Oliver (GA)]

And that she is sure above your target number - 180/200 whatever your gut says, and depending on whether you can monitor some at night.

 

[Ruby&Baco]

Well she is in her yellow numbers still, and now going up i see.. So there is going to be a second shot today i guess. And a higher PMPS. So what do you think about her numbers today ?