Clueless since insulin switch..?

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Great posts here Monica and we are all saying the same thing so believe it! It's only natural to feel tearful and frustrated, FD is such a tricky thing, but keep going and meanwhile remember to look after yourself properly as well... we would hate to see you, Mrs Cheerful & Positive, let all this get the better of you. As I know you say yourself, everything happens for a reason, and maybe treating Josie atm is something you will learn from and take forward in the future in some way.
So take all the hugs and good advice here - and eat more cake!!!
Diana xx
 
Oh now look what you girls have done.
I just sat down to catch up on here after another night of like 4 hours sleep and you guys are just so nice and kind that you are making me cry all over again!
I think you are right Rachel I probably do need some rest! This is so not me.
The saddest thing is that I am following a newbie here struggling with her numbers being all over the place and losing faith, I've been supporting her to stay positive and I wanted to write her something positive yesterday to tell her to hang in there as she's getting really down by it all. I was sitting here thinking what to say but suddenly I realised that I had nothing to offer her.. I just could not find anything positive within me to take from to pass on.. And that was really sad.

As for holding the dose for so long Rachel yes in hindsight I do have some regrets over the dosing of Caninsulin but Josie was so unwell so often with her pancreatitis flare ups that I was afraid to increase the dosage most of the time throughout those times. She also responded the same way to a lower dosage as well as a higher one so did not make much sense to increase at the time.

Djamila I'm sorry to hear you also shed some tears over your kitty's numbers, you know I think these tears show how much we care.
Hopefully we will be able to turn things around and we'll be shedding happy tears of joy soon:)

Yes I will try to get some rest and not to get too hung up on the numbers.

Although we have made no progress whatsoever on the SS since we started this journey months ago we made a massive progress with kitty herself looking and eating so well, no symptoms of any illness being happy, cuddly and extra fluffy:cat:

And thank you so much for your virtual hugs as well they were very well received and very very much appreciated xx
 
Hi Monica! Wanted to check in on you though I hope you're fast asleep! Looks like Josie is kind of bouncy today...but that was a nice blue to see!

How are you feeling today?
 
Hi Monica! Wanted to check in on you though I hope you're fast asleep! Looks like Josie is kind of bouncy today...but that was a nice blue to see!

How are you feeling today?
Hi Rachel, I'm doing well today thank you for checking on me. Went to bed early and kept away from the BG monitor..
I've decided not to be so hung up on the numbers anymore. Also gave up trying to make sense of it all and just let all my frustration go.
These are just numbers..:banghead:

I even got a little poem out of it..


Boo for red, yay for blue
The cat is happy so I should be too:cat:
 
I love your poem Monica, I know how frustrated you feel, this is such a hard thing to get to grips with...I'm at the stage where I'm almost tearing my hair out with all the up and down numbers...and feel exhausted with it...but we will get there, I'm sure of that x
 
I love your poem Monica, I know how frustrated you feel, this is such a hard thing to get to grips with...I'm at the stage where I'm almost tearing my hair out with all the up and down numbers...and feel exhausted with it...but we will get there, I'm sure of that x

Thank you Sue and Djamila, I am quite proud of my little poem as well!:cat:

You know Sue the person I mentioned above that I wanted to give my support to the other day was actually you!
I can so relate to your frustration and it just really got me down the other night.. but I think I bounced back from it.
I suppose even if we can't help to fix each other's issues at least it might make us feel a little bit better that there is someone else tearing their hair out at the same time somewhere else over the same thing!:banghead:
So let's hang in there together Bounce Buddy!:):bighug:
 
Thank you Sue and Djamila, I am quite proud of my little poem as well!:cat:

You know Sue the person I mentioned above that I wanted to give my support to the other day was actually you!
I can so relate to your frustration and it just really got me down the other night.. but I think I bounced back from it.
I suppose even if we can't help to fix each other's issues at least it might make us feel a little bit better that there is someone else tearing their hair out at the same time somewhere else over the same thing!:banghead:
So let's hang in there together Bounce Buddy!:):bighug:
Monica, I'm usually around if you ever wanna chat, not that i can offer much guidance with all this shooting BG tests etc, when I so obviously have no clue myself, but just know that I'm here when you need some support....we are definitely in the same boat here my bounce buddy xxx
 
Monica, I'm usually around if you ever wanna chat, not that i can offer much guidance with all this shooting BG tests etc, when I so obviously have no clue myself, but just know that I'm here when you need some support....we are definitely in the same boat here my bounce buddy xxx
Thank you Sue, I just replied to you on your own thread.. xx
 
@JanetNJ thank you for your suggestion, thought about it as well but I’m actually in two minds about a dosage increase at this point.
Probably should keep going to break the insulin resistance but the difference is so big with numbers being 10.7 at +7 then jumping up to 23.8 at pmps that it’s making me a bit nervous and concerned what would happen if increased the dosage further..?
Must admit I still haven’t figured out fully how ProZinc works so I might be wrong but such big difference in ps and mid-cycle numbers and big dive curve surely can’t be good for kitty, can it?
Any thoughts if you don’t mind please -
@Djamila @Elizabeth and Bertie @Rachel @Yong @Diana&Tom
Thanks so much everyone!
 
@JanetNJ thank you for your suggestion, thought about it as well but I’m actually in two minds about a dosage increase at this point.
Probably should keep going to break the insulin resistance but the difference is so big with numbers being 10.7 at +7 then jumping up to 23.8 at pmps that it’s making me a bit nervous and concerned what would happen if increased the dosage further..?
Must admit I still haven’t figured out fully how ProZinc works so I might be wrong but such big difference in ps and mid-cycle numbers and big dive curve surely can’t be good for kitty, can it?
Any thoughts if you don’t mind please -
@Djamila @Elizabeth and Bertie @Rachel @Yong @Diana&Tom
Thanks so much everyone!
Completely understand your dilemma, Monica, and only wish I had some answers... hope the Prozinc experts will have something helpful to say. The good thing is that the insulin is working fine - just not for as long as we'd like. So duration is the issue and how to address that dose-wise is the dilemma. I'm sure you're not the only one to experience this! Hang in there ..,
 
For some reason I'm not seeing a post from Janet, so I'm not sure what you're referencing. From your post though it sounds like you're asking for thoughts on dosing?

I think it would be helpful if you look at the change from PS to nadir, instead of from nadir to PMPS. Here's the difference: the first part shows you the response to the insulin, and you really want to see a 50% drop at this point. The second part, the change from nadir to PMPS, just shows you that the insulin has worn off, so that change doesn't really give you much info that's helpful - of course it wears off.

Right now you aren't getting a 50% drop. You are getting close, but still need to nudge the nadir down further, so I would suggest another increase.

I think you still have a ways to go on the increases. I would encourage you to try to increase every six cycles if you aren't getting there. It's not good to linger at an insufficient dose.
 
For some reason I'm not seeing a post from Janet, so I'm not sure what you're referencing. From your post though it sounds like you're asking for thoughts on dosing?

I think it would be helpful if you look at the change from PS to nadir, instead of from nadir to PMPS. Here's the difference: the first part shows you the response to the insulin, and you really want to see a 50% drop at this point. The second part, the change from nadir to PMPS, just shows you that the insulin has worn off, so that change doesn't really give you much info that's helpful - of course it wears off.

Right now you aren't getting a 50% drop. You are getting close, but still need to nudge the nadir down further, so I would suggest another increase.

I think you still have a ways to go on the increases. I would encourage you to try to increase every six cycles if you aren't getting there. It's not good to linger at an insufficient dose.
Thanks Djamila for explaining it further!
Yes Janet suggested it was time for another increase on the thread I posted the other day when Josie had a low pmps - I just replied here on the wrong thread..
As for the 50% drop from amps to nadir that we’re looking for - a few days ago from amps 23.9 she’s gone down to 10.3. That is more than 50% though isn’t it?
 
Thanks Djamila for explaining it further!
Yes Janet suggested it was time for another increase on the thread I posted the other day when Josie had a low pmps - I just replied here on the wrong thread..
As for the 50% drop from amps to nadir that we’re looking for - a few days ago from amps 23.9 she’s gone down to 10.3. That is more than 50% though isn’t it?
Yes, that drop was +50% but the fact that the nadir was still high-ish says a little more insulin is needed. You have to look at the relative size of the PS and nadir numbers as well as what they actually are. So - a 50% drop and a nadir that's in the 4 to 7 range (approximately) is a good goal.
 
Thank you all!
So does this mean that the preshot numbers will not actually be coming down? I thought they would and then once they do we would increase the dose to push the nadir even lower..
But it looks like the preshot number is staying around 20-24.. so we would still be pushing for the nadir to go down below 10 regardless? Is that correct? Does it not matter that it creates an even bigger drop from preshot to nadir?
I apologise for all the questions I just want to get this right.
Thanks so much for your time and input!
 
I do understand your concern about nadir numbers dropping even more steeply on a bigger dose, Monica, and I wonder if the experts here could add a little info so we can all add to our knowledge! I don't really know how Prozinc works but it must have a different action from Caninsulin so presumably its advantage is that it is gentler and gives better duration rather than being used up fast... if that's the case, would I be right in thinking that a slightly bigger dose could mean that Josie might stay in the blues for longer in the cycle so is not zooming up so high as she nears pre-shot and therefore you'd be shooting at a lower than usual number? That's my logic but it may be incorrect of course - would be very interested to see what @Djamila @Rachel @Kris & Teasel say about this.

Hang in there Monica! I don't think you're too far off... maybe will take a bit more courage on the dosing and careful monitoring, but the ladies here are giving you great advice and I'm sure will hold your hand every step of the way!
 
I do understand your concern about nadir numbers dropping even more steeply on a bigger dose, Monica, and I wonder if the experts here could add a little info so we can all add to our knowledge! I don't really know how Prozinc works but it must have a different action from Caninsulin so presumably its advantage is that it is gentler and gives better duration rather than being used up fast... if that's the case, would I be right in thinking that a slightly bigger dose could mean that Josie might stay in the blues for longer in the cycle so is not zooming up so high as she nears pre-shot and therefore you'd be shooting at a lower than usual number? That's my logic but it may be incorrect of course - would be very interested to see what @Djamila @Rachel @Kris & Teasel say about this.

Hang in there Monica! I don't think you're too far off... maybe will take a bit more courage on the dosing and careful monitoring, but the ladies here are giving you great advice and I'm sure will hold your hand every step of the way!
Thank you Diana!
Yes I’ve been learning a lot about ProZinc as we go along, hopefully I’ll get to understand it better with the guidance of the very supportive ladies here!
 
@Diana&Tom, you explained that exactly right! Prozinc tends to flatten along the bottom of the curve instead of diving as deeply as Caninsulin. But like anything around here, Every Cat Is Different (ECID). Monica will need to raise the dose and collect the data to know for sure how Josie is going to progress. And Monica, to be blunt, the pre-shots aren't going to come down if you won't raise the dose. If you're happy with the numbers you're seeing, then continue with the current dose. If you want her in better numbers, then you are simply going to have to start moving the dose up.
 
@Diana&Tom, you explained that exactly right! Prozinc tends to flatten along the bottom of the curve instead of diving as deeply as Caninsulin. But like anything around here, Every Cat Is Different (ECID). Monica will need to raise the dose and collect the data to know for sure how Josie is going to progress. And Monica, to be blunt, the pre-shots aren't going to come down if you won't raise the dose. If you're happy with the numbers you're seeing, then continue with the current dose. If you want her in better numbers, then you are simply going to have to start moving the dose up.

This makes absolute sense, Monica - Djamila has said it like it is! If you want to see better numbers you are going to have to up the dose. Your worry, I know - it would be mine too - is that a higher dose could (and probably would) drop Josie into lower numbers than you're used to seeing. I think we have all been there too - happy to get the occasional blue and somehow more relaxed when our kitty is mostly in the yellows... obviously well out of hypo range, which is what we fear above all else. I know you say Josie is looking and acting as well as she ever has at the moment and that's great but it would benefit her to be a little lower as far as her bg is concerned. I think you might have to take a deep breath and try a small increase one day when you're at home to monitor. Then, if you start seeing lower numbers, you'd have to get used to that and be aware when she's likely to drop a little too low for comfort, and reduce the dose a tad if necessary.

So the decision is yours - we as care-givers can only do what we're comfortable with, but as much as anything it's a case of getting used to a slightly higher dose again. You've gone through other increases and got your head round those, this is just the next step. If you can even get those pre-shot numbers down from the reds, I think you'd be happier...

No-one here would put any pressure on you to do anything but think about it, and come back and ask more questions. You have a great bunch of people here who really know their stuff (not me, obvs!) so take advantage of their knowledge and do what feels right for you in your own good time.
 
Monica, I apologize if my post was too harsh. Diana is exactly right, I would never want to pressure someone to do something they aren't comfortable with. My intent was to be clear and concise since sometimes I ramble on a bit in my explanations, but I think it just came across as kind of mean and commanding. I'm really sorry about that. Diana said it much better!
 
Monica, I apologize if my post was too harsh. Diana is exactly right, I would never want to pressure someone to do something they aren't comfortable with. My intent was to be clear and concise since sometimes I ramble on a bit in my explanations, but I think it just came across as kind of mean and commanding. I'm really sorry about that. Diana said it much better!
I don't think you were harsh, Djamila - clear and concise, yes, which is what's needed when someone is trying to make sense of something. If anything mine was the post that rambled on a bit! Hopefully between us though, Monica will see the point being made and decide what to do for the best for both her and Josie.
 
Monica, I apologize if my post was too harsh. Diana is exactly right, I would never want to pressure someone to do something they aren't comfortable with. My intent was to be clear and concise since sometimes I ramble on a bit in my explanations, but I think it just came across as kind of mean and commanding. I'm really sorry about that. Diana said it much better!
Thank you Djamila, that's ok don't worry I totally understand. I suppose it just shows that you are 100% sure that raising the dose further should be the way forward!

And Diana I don't mind seeing lower numbers, in fact the Lord knows I am ready for it!

My only concern as said before is that with the dosage increase the nadir has been dropping deeper and steeper but the preshot numbers aren't..?!:banghead:

You guys say that the dosage increase should lower the preshot numbers as well but we started ProZinc 4 weeks ago and went from 0.75 to 1.5u ( double of the starting dose ) yet still the preshot numbers are still quite random varying between 14-27 and don't seem to be 'coming down'..??

Could it be because we haven't reached the right dose yet?

Just tested her at +7 and it was a nice blue 10 going down from preshot 23.6! Which is a lot more than 50%..
You say that ProZinc is less harsh compared to Caninsulin and generally produces a more gentle curve but she's been dropping quite low from the starting preshot numbers which seems like a quite steep drop..

My vet emailed me a couple of days ago that she had a look at the SS, it's looking good and she would keep Josie on current 1.5u dose for a little longer..:(
But you are the ProZinc experts here and I respect and value your opinion.

It's just that steep gap that's concerning me thinking it's only gonna dive in deeper if I increased the dose as looking at the past 4 weeks we haven't really made any progress regarding the PS numbers and it doesn't look like those numbers are going to come down any day soon..
Do you see my dilemma here?
But if you say that I shouldn't be concerned about such big dives and it's ok for kitty without causing damage then of course I'm willing to go along with the increase. I just needed some sort of a reassurance that these big gaps are ok as normally big drops in mid cycle and fluctuating numbers are not ideal for kitties..

Many thanks everyone as always, I really appreciate that you are giving me your time to help!
 
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Hi Monica
I will leave it to Djamila and co to answer your concerns properly, but I'd just say two things: one, the drop from 23.6 to 10 isn't that much more than 50%... 50% of 24 is 12 so 10 is only a little under. And without more data we don't actually know when and what nadir was, do we?
And two, what I was trying to suggest earlier is IF you increase dose, it should last longer so when Josie starts rising later in the cycle , theoretically you would catch the rise earlier when it's not as high as you've been seeing.
I know it's tough, believe me! Fluctuating numbers aren't ideal but nor are consistently high ones.

I don't want to muddy the waters by posting too much as I respect the opinion of the others here who have a lot of experience with Prozinc. Let's see what they say.
 
Hi Monica
I will leave it to Djamila and co to answer your concerns properly, but I'd just say two things: one, the drop from 23.6 to 10 isn't that much more than 50%... 50% of 24 is 12 so 10 is only a little under. And without more data we don't actually know when and what nadir was, do we?
And two, what I was trying to suggest earlier is IF you increase dose, it should last longer so when Josie starts rising later in the cycle , theoretically you would catch the rise earlier when it's not as high as you've been seeing.
I know it's tough, believe me! Fluctuating numbers aren't ideal but nor are consistently high ones.

I don't want to muddy the waters by posting too much as I respect the opinion of the others here who have a lot of experience with Prozinc. Let's see what they say.
Thank you Diana!
Yes it is true about the nadir, I know I was thinking the same that it would really help to do a proper curve to see just how low she actually goes.?
it’s just so tricky as we made such an amazing progress with her willingness to test her since we started but she still gets a bit funny sometimes and fussy if I’m testing her too often so I just don’t really wanna rock the boat..
 
Thank you Diana!
Yes it is true about the nadir, I know I was thinking the same that it would really help to do a proper curve to see just how low she actually goes.?
it’s just so tricky as we made such an amazing progress with her willingness to test her since we started but she still gets a bit funny sometimes and fussy if I’m testing her too often so I just don’t really wanna rock the boat..
Sigh... it's a toughie! If you want to give an increase a go, maybe just try a fat 1.5u next time you're home to test... see if you get slightly better duration from that?
 
So sorry we weren't here earlier Monica! It's been a busy day...

Yes, the reason you aren't seeing lower preshots could be that you haven't gotten the right dose yet. With Prozinc, you aren't going to see as flat of a curve as with the L insulins...which isn't bad, it's just different. So you'll see more of a smile curve. We've found that as you move up the dose consistently, you'll get to the lower presots. Sometimes it takes a bit of time, but it DOES happen. Take a look at some spreadsheets around here and that might help you see what we're talking about more. :)
 
So sorry we weren't here earlier Monica! It's been a busy day...

Yes, the reason you aren't seeing lower preshots could be that you haven't gotten the right dose yet. With Prozinc, you aren't going to see as flat of a curve as with the L insulins...which isn't bad, it's just different. So you'll see more of a smile curve. We've found that as you move up the dose consistently, you'll get to the lower presots. Sometimes it takes a bit of time, but it DOES happen. Take a look at some spreadsheets around here and that might help you see what we're talking about more. :)
Hi Rachel,
not to worry, I understand we all have busy lives and I am always grateful for your time whenever it may be.

Managed to handle the situation, although must say it took me by surprise getting such low pmps then 45 mins later jump back again..
Still not sure if I should've waited and check again later like I did or give lower dosage on lower preshot numbers?
Would you be able to advise in case it happens again what's the best approach?
Could it be that that's how long the 1.5u dose lasted?

Re. Prozinc curve and dosage, yes thank you that makes sense.
Josie was looking a bit low this morning and wasn't keen on eating but all being well I will aim to increase the dose tomorrow morning then, I should be around later on to monitor..

And thank you for suggesting, I will have a look at other SS to get a better idea - should be very useful!
 
Hi Monica - you did exactly the right thing by stalling and doing the second test to see the rise. That last hour before the shot many cats have pretty dramatic rises like that. So if we test even a few minutes early, we can get a lower number, or sometimes the insulin will last just a bit longer than usual and at shot time we'll see that lower number, but waiting 20-30 minutes it will be much higher. The reason the stall is important is that if we just see the lower number and reduce the dose or skip the dose, then the kitty doesn't get enough insulin for that cycle, and not enough insulin can lead to DKA. So you managed that 12.2 perfectly by retesting and then giving the full dose. That was the best way to keep Josie safe.

And speaking of ketones, you mentioned that Josie wasn't eating and was a bit lethargic this morning. It would be a good idea to grab a ketone test whenever you notice those symptoms.
 
Hi Monica - you did exactly the right thing by stalling and doing the second test to see the rise. That last hour before the shot many cats have pretty dramatic rises like that. So if we test even a few minutes early, we can get a lower number, or sometimes the insulin will last just a bit longer than usual and at shot time we'll see that lower number, but waiting 20-30 minutes it will be much higher. The reason the stall is important is that if we just see the lower number and reduce the dose or skip the dose, then the kitty doesn't get enough insulin for that cycle, and not enough insulin can lead to DKA. So you managed that 12.2 perfectly by retesting and then giving the full dose. That was the best way to keep Josie safe.

And speaking of ketones, you mentioned that Josie wasn't eating and was a bit lethargic this morning. It would be a good idea to grab a ketone test whenever you notice those symptoms.
Hi Djamila, not wanting to hijack Monica's post but I value your comments here because I'm learning a lot!! Could I ask - what would be your thoughts about Monica giving the usual 1.5u dose at usual shot time when Josie was 12.2? She was rising (had been 10 at +7 I think) so would a shot then have prevented such a steep climb or would it have been ill-advised because bg was so much lower than usual? Just another possibility to add to the mix? Thank you!
 
Hi Monica - you did exactly the right thing by stalling and doing the second test to see the rise. That last hour before the shot many cats have pretty dramatic rises like that. So if we test even a few minutes early, we can get a lower number, or sometimes the insulin will last just a bit longer than usual and at shot time we'll see that lower number, but waiting 20-30 minutes it will be much higher. The reason the stall is important is that if we just see the lower number and reduce the dose or skip the dose, then the kitty doesn't get enough insulin for that cycle, and not enough insulin can lead to DKA. So you managed that 12.2 perfectly by retesting and then giving the full dose. That was the best way to keep Josie safe.

And speaking of ketones, you mentioned that Josie wasn't eating and was a bit lethargic this morning. It would be a good idea to grab a ketone test whenever you notice those symptoms.
Oh brilliant, I'm glad I made the right call then. I learnt it from you guys last time!:cat:

Josie seem to be back to normal now and eating well again so it was just early morning when she wasn't interested in any food.
Happened before and she was eating well later on but still a bit odd.

Ketone tests are tricky as she has no litter tray and always goes outside through her cat flap to do her business under the bushes all her life. Tried litter tray before and locking her in but she just would not do it. Also tried to follow to catch her mid flow but that didn't go down well either..o_O
She usually recovers quickly by lunchtime so fingers crossed we'll be ok without ketone tests..
Was looking into a blood monitor that does ketone tests as well but not found a decent one so far that was affordable for us at the moment..

Thanks so much for your feedback and support, I'm really glad to have you on board!:)
 
Hopefully her appetite will be back by lunch. I do really worry about DKA with our kitties in higher numbers, but I understand how expensive those meters can be!

@Diana&Tom, I wasn't totally clear on when the 12.2 happened. It's on the spreadsheet at +11, so I thought it was a bit before the usual shot time? If it was 12.2 at shot time, then yes, she would have been fine to give the dose at that number. When someone is nervous about dosing though, sometimes waiting to see the rise makes them feel safer about giving the full dose. For new folks who aren't quite sure about getting BG tests during the mid-cycle, we say the cut-off on a human meter is 11.2/200. However, once someone is comfortable with getting mid-cycle tests, they can and should shoot below that number. And especially when you have a cat who still has a nadir as high as Josie's. There is a big enough cushion that she could shoot that low and keep her safe. Prozinc is much more stable than Caninsulin.

If she shot on a lower number, it might hold the numbers down throughout the cycle, however given how high Josie is right now, more likely she would spike during the two hours before onset and it wouldn't make much difference just yet. Once she starts getting into some better numbers in general, then you are exactly right that shooting on the lower PS numbers is how you hold the whole cycle down. So shooting the lower numbers (with monitoring) becomes a very very important part of making progress with all of this.

Great question! Thanks for asking!

And just to clarify for anyone lurking: by "lower number" I mean "lower than usual number". I'm not suggesting she give a shot if her kitty is in the greens!
 
Hopefully her appetite will be back by lunch. I do really worry about DKA with our kitties in higher numbers, but I understand how expensive those meters can be!

@Diana&Tom, I wasn't totally clear on when the 12.2 happened. It's on the spreadsheet at +11, so I thought it was a bit before the usual shot time? If it was 12.2 at shot time, then yes, she would have been fine to give the dose at that number. When someone is nervous about dosing though, sometimes waiting to see the rise makes them feel safer about giving the full dose. For new folks who aren't quite sure about getting BG tests during the mid-cycle, we say the cut-off on a human meter is 11.2/200. However, once someone is comfortable with getting mid-cycle tests, they can and should shoot below that number. And especially when you have a cat who still has a nadir as high as Josie's. There is a big enough cushion that she could shoot that low and keep her safe. Prozinc is much more stable than Caninsulin.

If she shot on a lower number, it might hold the numbers down throughout the cycle, however given how high Josie is right now, more likely she would spike during the two hours before onset and it wouldn't make much difference just yet. Once she starts getting into some better numbers in general, then you are exactly right that shooting on the lower PS numbers is how you hold the whole cycle down. So shooting the lower numbers (with monitoring) becomes a very very important part of making progress with all of this.

Great question! Thanks for asking!

And just to clarify for anyone lurking: by "lower number" I mean "lower than usual number". I'm not suggesting she give a shot if her kitty is in the greens!
Brilliant answer, Djamila, many thanks!
 
Hopefully her appetite will be back by lunch. I do really worry about DKA with our kitties in higher numbers, but I understand how expensive those meters can be!

@Diana&Tom, I wasn't totally clear on when the 12.2 happened. It's on the spreadsheet at +11, so I thought it was a bit before the usual shot time? If it was 12.2 at shot time, then yes, she would have been fine to give the dose at that number. When someone is nervous about dosing though, sometimes waiting to see the rise makes them feel safer about giving the full dose. For new folks who aren't quite sure about getting BG tests during the mid-cycle, we say the cut-off on a human meter is 11.2/200. However, once someone is comfortable with getting mid-cycle tests, they can and should shoot below that number. And especially when you have a cat who still has a nadir as high as Josie's. There is a big enough cushion that she could shoot that low and keep her safe. Prozinc is much more stable than Caninsulin.

If she shot on a lower number, it might hold the numbers down throughout the cycle, however given how high Josie is right now, more likely she would spike during the two hours before onset and it wouldn't make much difference just yet. Once she starts getting into some better numbers in general, then you are exactly right that shooting on the lower PS numbers is how you hold the whole cycle down. So shooting the lower numbers (with monitoring) becomes a very very important part of making progress with all of this.

Great question! Thanks for asking!

And just to clarify for anyone lurking: by "lower number" I mean "lower than usual number". I'm not suggesting she give a shot if her kitty is in the greens!
Brilliant explanation, thanks so much Djamila! Really!

Josie's appetite was back to normal by lunchtime.
We increased the dose to 1.75u this morning. I'll be interested to see how our WonderKitty responds..:)
 
Hi everyone,
I messaged my vet with a quick update this morning that we are increasing her dose as this morning and this is what she replied..
Any thoughts please?
I don’t want to go against her advice as she is sensible and very caring towards Josie but she told me on Monday to hold the 1.5u dose longer and doesn’t seem happy about the increase..?

Many thanks!

Hi Monica,
A higher dose won't give a longer duration, it will just push the blood
glucose levels down further. It is the animal's individual metabolism that
determines the length of action really. I guess you have to be careful
you're not just pushing her into a Somogyi over swing because although you
might be getting low levels at the nadir, she seems to be bouncing back high
at the end of the effect of the insulin. The flattish line is becoming a
curve which is not what we want! Bear with it a few more days but if the
levels are still high at the beginning and end of the day, you'll need to go
down not up.
Let me know if there are any questions
All the best, have a great weekend!
 
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Oh dear! I do sympathise, Monica. The vet wants you to stick with the dose a while longer and our friends here say increase... this is one of the hardest decisions, working out which way to go. I guess the proof of the pudding is in the eating so as you've given 1.75u this morning we might have a different pattern of numbers today, and that would be at least a starting point. I think though I'd want to ask the vet what she actually thinks of Josie's recent numbers, ie what is her interpretation? She's not really giving you much info, is she, just commenting on your message ref increase.

Sorry I don't have any insight but hopefully others will...
 
Oh dear! I do sympathise, Monica. The vet wants you to stick with the dose a while longer and our friends here say increase... this is one of the hardest decisions, working out which way to go. I guess the proof of the pudding is in the eating so as you've given 1.75u this morning we might have a different pattern of numbers today, and that would be at least a starting point. I think though I'd want to ask the vet what she actually thinks of Josie's recent numbers, ie what is her interpretation? She's not really giving you much info, is she, just commenting on your message ref increase.

Sorry I don't have any insight but hopefully others will...
Thanks Diana!

Well last week she said that she checked the SS and it was looking good and not to worry about the occasional high reading as long as the majority was ok.
Also said 'well done for getting some blues'..

Interestingly she raised the same point I was making, that the ps numbers will not go down if we increase the dosage only the mid cycle would go lower which was my way of thinking as well..
But after discussing it above I figured if the experts here are all suggesting that a further dose increase could bring the preshot numbers down as well I was happy to go ahead with the increase and willing hold the 1.75u dose to see if it would make any difference..
We gotta try eh?:)

I was just wondering about the opinions here regarding the Somogyi effect concerns the vet raised..
 
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Yes it has to be worth a try with the 1.75u today - if numbers go too low and/or she shoots back up even higher at ps, at least it might be a clue as to what's best. You don't know until you try so look at today as an experiment if nothing else. It will certainly be interesting to see what happens - and yes, also to hear what people say here about Somogyi.
 
Oh dear...I do understand the stress of trying to decide if you're going to listen to your vet, or to the crazy cat ladies on the internet. It might be helpful to go to the front page of the forum and read through some of the research on a good blood glucose curve for yourself. There are articles out there written by vets and you can see some of the foundational work on which the protocols here were based. It might also be helpful to read through the stickies at the top of the Prozinc forum again to remind yourself of how and why we make the suggestions we do.

I'm afraid I have to run to work this morning, I'm already quite late, but ultimately, I still think the dose increases are needed right now. It may take more than just this morning's dose to see an impact, so I would encourage you to hold it for three cycles (unless of course you suddenly get a lime green!) before making a decision on next steps.

Let us know what questions you have as you read through the information.
 
Oh dear...I do understand the stress of trying to decide if you're going to listen to your vet, or to the crazy cat ladies on the internet. It might be helpful to go to the front page of the forum and read through some of the research on a good blood glucose curve for yourself. There are articles out there written by vets and you can see some of the foundational work on which the protocols here were based. It might also be helpful to read through the stickies at the top of the Prozinc forum again to remind yourself of how and why we make the suggestions we do.

I'm afraid I have to run to work this morning, I'm already quite late, but ultimately, I still think the dose increases are needed right now. It may take more than just this morning's dose to see an impact, so I would encourage you to hold it for three cycles (unless of course you suddenly get a lime green!) before making a decision on next steps.

Let us know what questions you have as you read through the information.
Oh yes definitely intended to hold the dose for longer, made a decision of following the ‘crazy cat ladies’ advice of increasing the dose, would be silly and pointless not to see it through now wouldn’t it? Besides I’m pretty sure I’ve become one of them already..:cat:
I’m not even stressed about it.
Was just curious to hear opinions if anyone had any regarding Josie and the possibility of the Somogyi effect?

Yes I already read loads about ProZinc on the board and the internet but will look for more info on front pages about curves and stickies thanks Djamila!

Have a fab wknd my fellow cat nutters!:cat:
 
Hi guys, it's been a while on 1.75u and I am not seeing much change regarding the pre-shot numbers..?

Which way shall we go now?
Would you suggest another increase?
Or maybe decrease as dose could be too much pushing her too low then bounce up again by preshot times?
Could these big gap numbers be the results of the Somogyi effect overswing?
Or are we barking up on the wrong tree completely and maybe ProZinc is not the right insulin for Josie?
Shall we switch insulin again?
Or should I not be so concerned that Josie's preshot numbers are still in the reds almost constantly?

As you advised I read up more stickies, front pages which was very useful and I looked at other PZ spreadsheets but I must admit those spreadsheets vary so much with all the colours and odd doses that I am finding it hard to relate to them or see an actual pattern how ProZinc supposed to work so can't see whether the way Josie has been responding is expected or not..

If you have a little time I would really appreciate if any of you expert eyes could please take a look at Josie's SS and let me know your opinions please?
Thanks so much!!
 
Hi guys, it's been a while on 1.75u and I am not seeing much change regarding the pre-shot numbers..?

Which way shall we go now?
Would you suggest another increase?
Or maybe decrease as dose could be too much pushing her too low then bounce up again by preshot times?
Could these big gap numbers be the results of the Somogyi effect overswing?
Or are we barking up on the wrong tree completely and maybe ProZinc is not the right insulin for Josie?
Shall we switch insulin again?
Or should I not be so concerned that Josie's preshot numbers are still in the reds almost constantly?

As you advised I read up more stickies, front pages which was very useful and I looked at other PZ spreadsheets but I must admit those spreadsheets vary so much with all the colours and odd doses that I am finding it hard to relate to them or see an actual pattern how ProZinc supposed to work so can't see whether the way Josie has been responding is expected or not..

If you have a little time I would really appreciate if any of you expert eyes could please take a look at Josie's SS and let me know your opinions please?
Thanks so much!!
Hi Monica,

When my kitty was on ProZinc I had no success lowering PSs by increasing the dose. As a bouncy cat he just bounced more violently and gave more a lot of red on his SS. I switched him to Lantus and that worked much better to reduce the spread in BG numbers but he didn’t feel really well on Lantus. He’s now on Levemir which is another depot insulin but it doesn’t behave that way for him. His numbers aren’t ideal but he feels good.

Josie might well do better on a depot insulin like Lantus.
 
His numbers aren't erratic at this point, they are quite consistent. They are just consistently too high. Assuming you are staying with prozinc for a bit longer, then yes, increase to 2u. At some point he will likely start bouncing all over the place, but right now it just looks like too little insulin still. Also, Sam and Josie are now at the same dose, so we can start a little club. ;):cat::cat::)

You could certainly consider another insulin change. The "rules" for Lantus/Levemir are quite strict and defined, so you may feel more comfortable with that. It's a bit less guess work and a bit more "if this, then that". We've also seen several cats who weren't making a lot of progress on one insulin do much better on the next. Sam started on prozinc, then went to Lantus, then Levemir, and now we're back on Prozinc, so if one doesn't work after some time, you can always switch again. It really is just finding the right match for your cat, and the right match for you.
 
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