? Switching from vetsulin to prozinc- Part 2

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I LOVE that blue last night, Lisa! There might be some rubber-like activity today but you're definitely getting results. Is Smoky eating better, etc.?
 
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I was worried about higher numbers and now I'm worried about his numbers being too low.o_O He was 352 in am today. The Cerenia seems to be helping with the nausea. He has been eating a lot lately but don't know how much nutrition he is actually getting. I'm glad to see the lower numbers, just not used to them.:)
 
I was worried about higher numbers and now I'm worried about his numbers being too low.o_O He was 352 in am today. The Cerenia seems to be helping with the nausea. He has been eating a lot lately but don't know how much nutrition he is actually getting. I'm glad to see the lower numbers, just not used to them.:)
Seeing the nice blue is scary but in a good way. You'll get used to it! Meanwhile I think the 3.5 u is a good dose. Let's see what his PMPS is.

Eating a lot is great news, given what Smoky has been through. He'll get more nutrition from his food when his numbers are down more consistently.
 
Smoky PMPS was 194 so gave him a reduced dose of 1.5 units. Thank you @Kris & Teasel for all your help earlier.
Smoky was 393 at +2 so his BG went up a bit. I'll check him again at +4 to see if he goes up more or starts dropping.
 
OK so I thought insulin was supposed to bring BG down not up. I'm learning that regulated means that the cat goes up and down, I think?:rolleyes:
 
OK so I thought insulin was supposed to bring BG down not up. I'm learning that regulated means that the cat goes up and down, I think?:rolleyes:
It depends. If the dose is too low (likely the case here but it was done to keep him safe) the BG will rise. Sometimes there'll be a food spike after dosing, often around +2. Your SS tells me that Smoky doesn't tend to spike at +2 so it's more likely from the low "token" dose you gave him.

Regulated means that a kitty's AM/PMPSs will be in the mid 200s and the nadir in the low 100s or high double digits consistently over time when a particular dose is given. In reality, many kitties need the dose tweaked slightly over time to keep them in those numbers.
 
I'm getting ready to test him for a +4 soon.
I'm curious if his BG will continue to go up and cause higher numbers foe AMPS
 
I'm getting ready to test him for a +4 soon.
I'm curious if his BG will continue to go up and cause higher numbers foe AMPS
The lower dose might well put him higher at AMPS. As you get more experience dosing at lower PSs, your no shot number will probably come down and you'll be able to try larger doses at low-ish numbers with more confidence.
 
AMPS 314, back to the drawing board and the 3.5 unit dose I think. I hope this doesn't set him back too much. I guess the mini curve will have to wait.o_O
 
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AMPS 331, back to the drawing board and the 3.5 unit dose I think. I hope this doesn't set him back too much. I guess the mini curve will have to wait.o_O
This is to be expected, Lisa. You had to lower the dose on last night's low-ish PS because you have no data to tell you whether you can shoot a larger dose at this number. That's why we call it a token dose, meant to get a little insulin into him even knowing it's not enough. A no shot might have set him back further. Next time this happens, you can try the stall for 20 minutes and retest technique until he gets over 200 and then shoot a dose that's only slightly reduced.

These dicey situations are the ones that teach you a lot about dosing and your kitty's responses. Once numbers begin to come down dosing becomes an art as well as a science. Yes, you can get it wrong sometimes but if you have data from previous experiences, know your kitty's general trends and err on the side of caution you can do it more confidently.

I agree that your mini curve should wait.
 
I'm trying to figure out how to dose. I heard you base it on his nadir, is that accurate? I can't get too many mid day tests in during the work week so how do I know what to give him?
 
I'm trying to figure out how to dose. I heard you base it on his nadir, is that accurate? I can't get too many mid day tests in during the work week so how do I know what to give him?
With ProZinc, dosing decisions are made on the basis of both PSs and the nadir. However, if you have a bouncy cat, the PSs are often inflated from bouncing so more weight should be given to the nadir. Smoky doesn't seem to be particularly bouncy and that's a good thing.

Deciding on doses can be a bit of a mystery until you have lots of SS data and more FD miles under your belt - ie., experience. You can always post here to ask for input until you feel more confident in your own decisions. If you can't test mid day then a before bed test at +4, say, gives good info about how a given dose is working.

Here are some of the questions you'll learn to ask yourself:
  1. My PSs are high. I wonder how low he went on this dose? (evening +4 might give a hint but high PS can mean dose is too low)
  2. My PSs are really nice. Should I keep this dose? (check +4 in evening or sacrifice a little sleep to set your alarm for a +6 test)
  3. How did he react in the past when I gave this dose at this BG?
  4. What dose did I give in the past at this BG that turned out to be OK?
  5. Am I in the correct dosing range for now? (look at SS trends and patterns)
There are lots of others but this gives you an idea of the thought processes involved.
 
My before bed test would be more of a +3 but I take meds to help me sleep. I can't get up in the middle of the night. How can you tell if a cat is bouncy?
 
My before bed test would be more of a +3 but I take meds to help me sleep. I can't get up in the middle of the night. How can you tell if a cat is bouncy?
Whatever evening tests you can get are good data. A bouncy cat might go from a yellow AMPS to a low blue nadir then up to a red or black PMPS. That's an example.
 
I was thinking the same about Smoky, have to check him for PMPS in 30 minutes. I'm inspired by all the stories I've read on here about cats going into remission after a few months time. I don't know if smoky will get there, he has various other health issues.:facepalm:
 
I was thinking the same about Smoky, have to check him for PMPS in 30 minutes. I'm inspired by all the stories I've read on here about cats going into remission after a few months time. I don't know if smoky will get there, he has various other health issues.:facepalm:
All I'm hoping for with Teasel is some degree of regulation. He's one tough customer and I've been labouring at this since the end of January 2016.
 
Wow! so you are still trying to get Teasel regulated? I just did Smokys PMPS and it actually went down a little from +6 reading. 143,down to 137. guessing I shld stall before feeding and test again?
 
Wow! so you are still trying to get Teasel regulated? I just did Smokys PMPS and it actually went down a little from +6 reading. 143,down to 137. guessing I shld stall before feeding and test again?
Yes, stall for 20 minutes and retest. No food. If needed repeat the stall. If after 1 hour he's still under 200 you'd be safest giving a token dose again. Then thought needs to be given to lowering the AM dose in the hope of getting shootable AM and PMPS.

BTW, don't assume that Teasel's case is typical. He's an outlier for sure - breaks all the rules, is almost totally unpredictable, bounces like a rubber ball, and on and on ... You're already getting a better response to ProZinc from Smoky and more easily than was ever the case with Teasel. I'm used to it now and I don't let it get me down. :)
 
+30 minutes after pmps 178
Give it another 20 minutes, Lisa, and I think you'll be at a number where you can give more than just a token dose. He'll be close to an hour late for his PM dose but that's not a problem with ProZinc. You'll still be able to dose at your normal AM time.

I'll watch for your next test result.
 
Went down a little, 173 now.
I was thinking about giving him two units tonight
I think that's a good choice for this number. It'll give you more data to use in future. Now you know two techniques for dealing with a low PS - 1. stall and retest or 2. token dose. It'll be interesting to see tomorrow's AMPS.
 
The higher BG is because of the lowered PM dose. What I see, Lisa, is that Smoky reacts very consistently to dose changes: when you gave the token PM dose of 1.5 u, he had a 393 and a 331 in the evening. Last night a token 2 u gave you a 257. He's higher this AM because of a reduced dose last night. This is a really good thing! As you get more data to verify this you'll be able to predict the effect of a dose pretty well. :)
 
He was 351 for AMPS and I gave him the 3.5 units. I slept 4 hours last night so need to try and grab a few more hours sleep. I plan on testing him at +6 just to see how he is doing.
 
He was 351 for AMPS and I gave him the 3.5 units. I slept 4 hours last night so need to try and grab a few more hours sleep. I plan on testing him at +6 just to see how he is doing.
Good dose this AM. Data today will (hopefully) validate what I said about him being consistent in his responses. :)
 
Things are looking good, Lisa. It's great that Kris is helping you figure out your doses and your choices are working really well. Hope it feels good that you are getting the hang of the dance steps in this sugar dance, and that his numbers are better.
 
Trying not to panic...:nailbiting: just took smokys BG at +6.5 and it was 82. I waited about a minute and checked again and it was 74!
Isn't that a rather big drop from am. (351). I just gave him his lunch now. Should I be worried?
 
Trying not to panic...:nailbiting: just took smokys BG at +6.5 and it was 82. I waited about a minute and checked again and it was 74!
Isn't that a rather big drop from am. (351). I just gave him his lunch now. Should I be worried?
Yes, it is a big drop but he now has food on board and you're getting past ProZinc's usual peak action time period. I suggest monitoring at +8 and +10 or more often if you wish. His PMPS will be important in determining his next dose. The +6.5 BG alone tells me that 3.5 u is now too high. We need the PMPS to make a decision on the next dose.

He's doing really well on ProZinc! :)
 
I shudder when I think what would have happened if I followed my old vets advice to bump him from 3.25 units right to 4.
His current vet said to try between 3.25 and 3.5 so at least she is a little more cautious
 
Does this mean he needs less insulin right now than he did if the 3.5 appears to have been too much?
Yes, his good dose is likely lower now that he's responding well to the ProZinc. You switched him about 3 weeks ago and he'd been high for quite a while from his UTI, etc. Staying high can make them less responsive to insulin because the excessive BG affects the ability of the cells to behave normally. It can be called glucose toxicity. His UTI has been dealt with and switching insulins has, over time, remedied the problem so he responds well to the ProZinc now.

With FD, it's rare to find THE dose right away and that stays as the best dose going forward. Kitties who have spent lots of time in high numbers often need higher doses to get them moving down. Their cells are sluggish in their response to insulin. As numbers come down and stay down doses often have to be reduced because the cells become more sensitive to insulin and it takes less to keep BG under control.

That's a simple (perhaps too simple) explanation of why doses often need to be lowered.
 
Should I get him some high carb food with gravy? He ate the rest of it earlier as a snack before lunch. I might have to skip his shot tonight if his numbers don't go up a little bit by PMPS. I have to work tomorrow and not sure at this point if I can run home at lunchtime and check him.
 
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