Dosing Advice

[Adam Flowers]

Hello all. I just switched Mogee over to wet food (he had been free fed dry since he was a kitten) last Wednesday night.

Instantly his BG dropped the next day with the wet. I assumed it would and dropped his dose from 6 units twice a day to 3 units twice a day. To my shock, I came home the first morning at the 3 units, and Mogee was already at 62 @ +3. That freaked me out as his prior lowest BG was 111 on the dry and that was after a month+ on insulin.

Since then, I have noticed he runs higher at night and lower in the morning which is the exact opposite of how he used to run before the switch to the wet.

Since his numbers have dropped, inhale reduced his dose to 2 units in the morning but he seems to still be dropping really fast and it worries me as I cannot come home each morning to test and don't want him to hypo.

At the same time though, if I don't give more than 2 units at night (I've been giving 2.25), then he won't drop very low. He stays in the high 200s with only 2 units at night.

Does anyone have any advice on what they believe I should put his dose to? Can he have to different dosages (one for am and one for pm)?

I am still new to all this so all and any advice is helpful! You guys have been great!

 

[Djamila]

Yes, he can have different am/pm doses, and that’s not uncommon with Prozinc since many cats run differently during the two cycles. It looks like his insulin needs are going to change rapidly right now, so we’ll just need to follow his lead for a bit. It’s especially hard when we have to be at work all day!

Speaking of work, I’m there now, so I’ll try to look at the spreadsheet more carefully this evening, or hopefully someone else is around who can suggest doses.

But hooray for falling numbers!!! He’s looking great!

 

[Djamila]

Okay, first of all, these numbers really do look great. Hooray for food changes! It really does make a huge difference for our kitties.

It looks like the +4 test is your most important one right now. He's surfing after that, not diving, which is good. Cats on a consistent, low carb diet, and a steady dosing plan will usually do that. Any increase in carbs will make things go wonky though, so make sure that kibble is sealed tightly in a place where he can't sneak any. See what happens this evening. If he holds steady in safe greens, then I would say to hold the dose for a bit longer. It is a little nerve-wracking, but you want to pull those PS numbers down by holding the nadir steady fi you can. However....if he goes into the low 50's (or below) tonight, then I would say to go ahead and give a reduction in the morning to 1.75u. The greens are stressful at first, but you have some good data showing that he surfs, so try not to be too scared of them. Easier said than done, I realize.

 

[Adam Flowers]

Okay, first of all, these numbers really do look great. Hooray for food changes! It really does make a huge difference for our kitties.

It looks like the +4 test is your most important one right now. He's surfing after that, not diving, which is good. Cats on a consistent, low carb diet, and a steady dosing plan will usually do that. Any increase in carbs will make things go wonky though, so make sure that kibble is sealed tightly in a place where he can't sneak any. See what happens this evening. If he holds steady in safe greens, then I would say to hold the dose for a bit longer. It is a little nerve-wracking, but you want to pull those PS numbers down by holding the nadir steady fi you can. However....if he goes into the low 50's (or below) tonight, then I would say to go ahead and give a reduction in the morning to 1.75u. The greens are stressful at first, but you have some good data showing that he surfs, so try not to be too scared of them. Easier said than done, I realize.

Thank you for taking the time to look through his spreadsheet. He seems to have really high PMPS still. Do you believe it is because he is going so low during the day? He was 208 @ +8 and by PMPS he was near 400. I only gave the 2 units tonight just to see what it does with his numbers.

If he is below 300 @ AMPS tomorrow, I will probably only give 1.75 units. It is just so hard to work while wondering how low he is going at home by himself.

As for the PM, I will see what the 2 units does with the high PMPS. I know you mentioned that I could do two separate doses. Does this affect the next round then? Like how I've been doing higher at night, is that making him be lower in the morning and when I dose lower in the morning, does that make him go up faster towards PMPS?

Just don't want to make things worse by changing his dose constantly..

 

[Djamila]

Thank you for taking the time to look through his spreadsheet. He seems to have really high PMPS still. Do you believe it is because he is going so low during the day? He was 208 @ +8 and by PMPS he was near 400. I only gave the 2 units tonight just to see what it does with his numbers.

If he is below 300 @ AMPS tomorrow, I will probably only give 1.75 units. It is just so hard to work while wondering how low he is going at home by himself.

As for the PM, I will see what the 2 units does with the high PMPS. I know you mentioned that I could do two separate doses. Does this affect the next round then? Like how I've been doing higher at night, is that making him be lower in the morning and when I dose lower in the morning, does that make him go up faster towards PMPS?

Just don't want to make things worse by changing his dose constantly..

Well done! Yes to all of that. Yes, his high PMPS tonight is more likely from the greens. It could also just be that his duration was slightly shorter today. Maybe he played more? Maybe the test was a few minutes later than normal? Maybe he saw a squirrel?Given the variation in meter accuracy (+/- 20%), it really isn't all that different than the other pinks he's had. Try not to worry too much about the PS just yet. Once the nadirs get into good ranges, the PS numbers will usually start to wiggle down. It just takes cats a little while to adjust to the lower numbers.

And yes, giving a lower AM dose causes the higher PM numbers. And the higher PM dose causes the lower AM numbers. And round and round. Most people around here who haven't used prozinc say that it's an "in-and-out" insulin, but it isn't exactly. At least not the way that Vetsulin is. One cycle does carry over and impact the next cycle, so it's often helpful to look at 3-6 cycles at a time to find the patterns, not just one individual cycle. However, given the AM numbers that you have, I wouldn't raise the dose for that cycle. And given the PM numbers you have, I wouldn't lower the dose. I think you'll just have to ignore those PS numbers for now and really focus on the nadirs. I suspect that as his body adjusts even more to the world of low-carb wet food that you'll see his insulin needs reduce and his PS numbers get into better ranges.

 

[Adam Flowers]

Well done! Yes to all of that. Yes, his high PMPS tonight is more likely from the greens. It could also just be that his duration was slightly shorter today. Maybe he played more? Maybe the test was a few minutes later than normal? Maybe he saw a squirrel?Given the variation in meter accuracy (+/- 20%), it really isn't all that different than the other pinks he's had. Try not to worry too much about the PS just yet. Once the nadirs get into good ranges, the PS numbers will usually start to wiggle down. It just takes cats a little while to adjust to the lower numbers.

And yes, giving a lower AM dose causes the higher PM numbers. And the higher PM dose causes the lower AM numbers. And round and round. Most people around here who haven't used prozinc say that it's an "in-and-out" insulin, but it isn't exactly. At least not the way that Vetsulin is. One cycle does carry over and impact the next cycle, so it's often helpful to look at 3-6 cycles at a time to find the patterns, not just one individual cycle. However, given the AM numbers that you have, I wouldn't raise the dose for that cycle. And given the PM numbers you have, I wouldn't lower the dose. I think you'll just have to ignore those PS numbers for now and really focus on the nadirs. I suspect that as his body adjusts even more to the world of low-carb wet food that you'll see his insulin needs reduce and his PS numbers get into better ranges.

Awesome. You've been great. Love the help!

I should have given his 2.25 units this evening instead of just the 2 units. Shucks. Hopefully he doesn't stay too high tonight.

I will not increase his AM dose, if anything I was considering reducing it to 1.75, regardless of his AMPS, since he has been dropping so low, so fast in the AM and I get too worried at work about him.

I am hoping that we are just around the corner to having this dosing all figured out. Everyone here has been more than helpful and I am just glad I finally listened and switched him to the FF and got him off the dry!

 

[Djamila]

Awesome. You've been great. Love the help!

I should have given his 2.25 units this evening instead of just the 2 units. Shucks. Hopefully he doesn't stay too high tonight.

Don't worry about it - he's still adjusting himself right now, so he may surprise you with a nice green nadir anyway. It will be quite a bit of guessing over the next week or so while his body figures out the new food.

And as for the help - we all were helped by other folks when we first got here and just pay it forward now. This forum saved my cat's life when he was first diagnosed!

 

[Adam Flowers]

Don't worry about it - he's still adjusting himself right now, so he may surprise you with a nice green nadir anyway. It will be quite a bit of guessing over the next week or so while his body figures out the new food.

And as for the help - we all were helped by other folks when we first got here and just pay it forward now. This forum saved my cat's life when he was first diagnosed!

I appreciate all of you!

Looking at your spreadsheet, your numbers look amazing. I am curious though, why did you have to change insulin from Prozinc to Lantus and then to Levemir and then back to Prozinc again. To me all the numbers from Prozinc looked great until the change and even Lantus looked good until the Levemir, which was the only one that looked to not work.

Thanks again for all your help

 

[Djamila]

Great question! Brace yourself, it's a long story....

Hindsight being 20/20, I really wish I had never changed his insulin. He was doing really well on Prozinc, but had been in the same numbers and the same dose for a couple of months and was just stuck there. Lantus has a higher remission rate than Prozinc, so I decided to try switching to see if it would finally kick him into remission. Unfortunately, I switched just as he started having a dental problem, so right away, his numbers and dose climbed. The teeth were removed and he settled back down, although never to as low of a dose as he had been on Prozinc. Plus, he was lethargic and biting at the injection site. I gave it a couple of months hoping he would adjust, but finally decided that he seemed to feel so lousy that I needed to get him off of Lantus. Well, I had already tried Prozinc and that didn't get him into remission, and Lantus didn't agree with him, so Levemir seemed like the next logical thing to try. Well again, the timing was lousy: I switched him to Levemir right as some mysterious health issue has emerged. Levemir doesn't allow the dose to be changed as quickly as Prozinc does, and I didn't feel like it was safe to leave him in those high pinks and reds while I waited for the insulin to catch up, so I dumped Levemir before it even had a chance and moved back to Prozinc so that I could move the dose more rapidly and put the breaks on the rising numbers. It did help, but that was a lot to put his little body through - being on three different insulin types in a matter of two weeks.

In hindsight, I should have kept him on Levemir and added a fast acting insulin like Novolin, but honestly, I have only rarely seen people use that around here and didn't know enough about it to go that route alone.

For the record, the vast majority of cats do really well on Lantus, so if you ever decide you want to switch, please know that Sam's experience is extremely unusual.

And now I'm still clueless as to what is causing him to sit up in these higher numbers after months and months of blues and greens. He's been to the vet for a thorough exam and blood work, and nothing really showed up. But numbers only do this if there is some infection or inflammation, so something is going on with him. It's just not something with any obvious symptoms so for now it's a matter of waiting and watching and hoping something becomes apparent. And just trying to keep his dose at a level that will hold his numbers in the least-damaging range possible.

 

[Adam Flowers]

Well, I only gave 1.75 units this morning and his numbers went nowhere.

I am so confused that 2 units will make him almost hypo (near 60) but only 1.75 seems to not do anything? Ugh. Can't give him 2 units and worry while at work but less doesn't do anything.

* What I also found weird is that on Tuesday his numbers are the same as today but on Tuesday I did give the full 2 units. What's the difference between the two units Tuesday that he didn't move down on and Wednesdays two, which he went way down on?

 

[FurBabiesMama]

Don't expect this to always make sense or you will be very disappointed.

My two cents.. for what it's worth.. is that staying at the same dose for a few cycles might help things level out. (The Prozinc info on this site recommends at least three cycles.) There are a lot of factors that impact blood glucose.. food, activity level, stress, excitement, etc...so things fluctuate. Changing his dose almost every cycle adds another constantly changing variable. Prozinc is a long-lasting 'in and out' insulin (does not build up depot and stay in the system like Lantus), but there is definitely a difference in impact of being on a dose one cycle versus several. For one thing, their little systems have to adjust, and that can take a few cycles. When doses are different am and pm, as you have already figured out, it can cause them to be higher after the lower dose and lower after the higher dose. The point of feeding them at about the same times each day is so that food's impact on their glucose is kept level/consistent - so, it makes sense that there is also value in keeping the insulin level consistent, at least when you are still just trying to get them regulated.

 

[Adam Flowers]

Don't expect this to always make sense or you will be very disappointed.

My two cents.. for what it's worth.. is that staying at the same dose for a few cycles might help things level out. (The Prozinc info on this site recommends at least three cycles.) There are a lot of factors that impact blood glucose.. food, activity level, stress, excitement, etc...so things fluctuate. Changing his dose almost every cycle adds another constantly changing variable. Prozinc is a long-lasting 'in and out' insulin (does not build up depot and stay in the system like Lantus), but there is definitely a difference in impact of being on a dose one cycle versus several. For one thing, their little systems have to adjust, and that can take a few cycles. When doses are different am and pm, as you have already figured out, it can cause them to be higher after the lower dose and lower after the higher dose. The point of feeding them at about the same times each day is so that food's impact on their glucose is kept level/consistent - so, it makes sense that there is also value in keeping the insulin level consistent, at least when you are still just trying to get them regulated.

Okay. Do you believe I should give him 2 units then? Or should I do the 1.75 for both injections?

Then only reason I have been going lower in the AM is because of the low readings at +3 with 2 units. But 1.75 does nothing to his PM dose.

Isn't it better to be safe than sorry and go with that lower dose for a few days to see what it Does?

As always, thanks for all the help

 

[FurBabiesMama]

Since the 2 concerns you, yeah, staying with the 1.75 might be a good idea. You already gave it one cycle so maybe if you can stand to stay with it for two or three more, you can at least see if things level out any. At that point, you can decide where to go from there. I don't know if your schedule allows you to monitor him more on the weekend, but if so, Sat morning might be a good time to step up to 2 for a few cycles - provided, of course that it looks like an increase to 2 is needed. He is doing so good, who knows, he may start hitting greens with 1.75. (Oh, and I wanted to mention that if you still end up feeling like 1.75 is not enough and 2 is too much, you could go in between and do a 'fat' 2.)

You know, it's been a while.. we need another photo

(PS Those 2 cycles looked pretty nice to me, but I get that you are scared, so better safe than scared. )

 

[Adam Flowers]

Yes, I am able to test all the time during the weekends. I think I will try the 2 units..

Which two cycles are you talking about? The AM greens? Is it normal to drop that fast at +3? I mean, I didn't give any high carb food or anything just tested and made sure the numbers went back up. Is 62 and 65 low at +3? He acts completely normal, in fact more active and is out more during those numbers. I just get worried since it is close to that 50 mark.

* We never put up our tree until after Thanksgiving but given that the tree is Mogee's favorite thing and that he was recently diagnosed, we felt it was only right to give him more time with it this year

 

[FurBabiesMama]

He is such a big, pretty boy. I want to hug him. He looks 'plush'.

Sorry, I meant the cycles at 2u. Seeing pink PS go to blue nadir and yellow PS go to green nadir looks lovely to me - something I would love to see right now. (Hey, I just got a blue.. woo hoo! For us, right now, that is very exciting. Hoping the dental next Tuesday turns things around for us.) 257 to 65 is a big drop which probably is not ideal, but at least he does not appear to be prone to doing any extreme bouncing. As far as when the nadir happens, that can vary. I have seen it anywhere from +4 to +8 with Mia. Even if he hits it early, he 'surfs' in good numbers for quite awhile after, so who cares! Staying in the blues/greens for hours is so wonderful.