? Need dosing advice after BIG drop

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fatcat

fatcat

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Help, what dose do I give now? My cat, Tige, BG is 450 AMPS this morning. He had a big drop last night from 410 to 125 on 4 units of PZ. I changed his food last night. What dose do I give him this morning? 4 again?
 
No, I'd reduce to no more than 3 u this AM. The food change can have a big influence on his BG level. Test again at +2 to see where he might be headed. If that +2 test shows a big drop (100+ points on the US sheet) be prepared to test again at +3 and so on until you see if he's likely to reach the "take action" number (50 on a human meter or 68 on a pet meter like the AlphaTrak). If the +2 is about the same as PS he might not drop too much but another test or two is a good idea. If +2 is higher it won't likely be an active cycle where you have to keep testing and perhaps intervene with food.

This is from the "Protocol for ProZinc" yellow info sticky (http://www.felinediabetes.com/FDMB/threads/protocol-for-prozinc-pzi.165103/)

CHANGING THE DOSE
Changing the dose will depend on both the pre shot levels and the nadir (lowest point of the cycle, usually 5-7 hours after the shot.) During this initial period, especially if wet low carb food is replacing higher carb dry, monitoring is very important. Insulin plus a diet change can result in sudden low numbers, or in a gradual lowering of numbers overall, depending on the cat.
When adjusting the dose, it is wise to check with your vet and with forum members for guidance. In general, the following guidelines can be used. Be cognizant of the over riding principle for ProZinc/PZI : Every Cat is Different (ECID)

If the cat is in the 250+ range at pre shot and does not drop 50% or more for nadir, a small adjustment could be considered, if monitoring is possible. A small adjustment is likely to be 0.25 units per shot.
If the cat is in the 250+ range(or higher) at pre shot and drops below 50% at nadir, bouncing is a possibility.
Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, releases glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". (Adapted from the Lantus sticky by Jill)

If bouncing is suspected, any increases in dose should be tiny and monitored carefully.

If the cat is high and flat during the entire cycle, the dose could be raised by 0.5 units, as long as monitoring if possible.
Doses are best held at least 3 cycles, unless the nadir is too low. In that case, it should be adjusted down. NOTE: A cycle is 12 hours. So, when we say 3 cycles, we mean (3) 12 hour cycles.
 
It would be helpful if you add the type of glucose meter you're using to your signature text. It's important for us to know that when we give advice.
 
From the spreadsheet, it looks like you dropped to 2u. Kris' suggestion of 3u was good, but don't worry about that now. This is all a learning process and it takes time, and some trial and error along the way. The 2u may be a bit low, but considering the food change, there's really no way to know until you collect the data on it today. It could turn out that 2u was perfect.

Along with some monitoring during the cycle today, try to test about 30 minutes before shot time this evening and post so there is time for folks to see and respond before you need to do the injection. Remember that you have about an hour of flexibility on shot time, so it's okay to wait a bit for folks to respond.

Great job getting him onto some low carb food. Hopefully that will really help his numbers going forward!
 
Hi there! The good news is that the blues you saw last night weren't dangerous, as Jenna mentioned to you in your other post. They were just what we like to see! That food change is probably part of what's causing this...and this morning's number is almost certainly a bounce. That's pretty normal after those lower than expected numbers last night. 2 units should certainly keep him safe, but I'd try to get whatever mid cycle tests you can today...the more data you can get at the earlier stages of this, the better our advice can be!

I love Djamila's suggestion about tonight! What time do you shoot and what time zone are you in? That helps us know when to check in. :)
 
I am in the Mountain Time Zone. I usually test between 6 and 7 p.m. and then feed after. About the bounce -- should I have kept him at 4 units?
 
fatcat said:
I am in the Mountain Time Zone. I usually test between 6 and 7 p.m. and then feed after. About the bounce -- should I have kept him at 4 units?
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The food change requires extra caution. It's wise to err on the side of a (maybe) slightly too low dose and work up from that if needed instead of leaving him at a higher dose that was supported by higher carb food. Safety is always the number one concern. Dropping to 2 u wasn't a mistake, it was an experiment. Let's see how he does with that on the low carb food. Don't be surprised if he rockets back up to high numbers from bouncing.

This is something I wrote about bouncing a long time ago:
  1. BG goes low OR lower than usual OR drops too quickly.
  2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
  3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
  4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
  5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
  6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.
 
fatcat said:
I am in the Mountain Time Zone. I usually test between 6 and 7 p.m. and then feed after. About the bounce -- should I have kept him at 4 units?
Click to expand...

Nope! With the food change, Kris gave you excellent advice above. Reducing was a good choice because the lower carbs will cause lower glucose levels. The bouncing is just something that explains why you might be seeing a higher number this morning...but that large drop plus the lower carbs in the food indicate that you needed a lower dose to make sure he stays safe.
 
This is great...I think we have all the North American times zones covered now! ;)

(And one of my best friends went to Carleton!! This is a very strange coincidence for such a little college!)

@fatcat Could you put that you’re on Mountain time in your sig block and/or in your profile?
 
Hey, that cat is not fat. I know this because I used to live in St. Albert. At the bottom of the hill, where the Dairy Queen used to be, (that's always a big help isn't it?) that was the only set of lights in town. Do the RCMP still terrorize the local long-hairs? My uncle lives in Edmonton and when I asked about the green belt between St. Albert and Edmonton he couldn't stop laughing. Apparently there is some kind of expressway where the old seminary used to be!
Please tell me you still have a Safeway. I think I read the last one on the planet closed in BC a few years ago. We live in Ontario now but NOT in Toronto, you can stop holding your nose.
 
Noah & me (GA) said:
Hey, that cat is not fat. I know this because I used to live in St. Albert. At the bottom of the hill, where the Dairy Queen used to be, (that's always a big help isn't it?) that was the only set of lights in town. Do the RCMP still terrorize the local long-hairs? My uncle lives in Edmonton and when I asked about the green belt between St. Albert and Edmonton he couldn't stop laughing. Apparently there is some kind of expressway where the old seminary used to be!
Please tell me you still have a Safeway. I think I read the last one on the planet closed in BC a few years ago. We live in Ontario now but NOT in Toronto, you can stop holding your nose.
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He WAS fat. He was 25 pounds when we got him. He is now at about 16. He's just big-boned. LOL. Yes, we have 2 Safeways now. They are still around in the West. Please tell me it gets easier dealing with all this dosing and poking stuff. I feel for my poor Tige, he is so patient. It seems like I will never get him regulated. :(
 
I promise it will get easier. Noah is our second sugar cat and because of migraines etc. it's not a figure of speech that I can practically do this in the dark. What seems like small talk for the rest of us was at one time all of us running in circles and tearing our hair out. "Is he dead or just sleeping? Oh dear God how did this happen?".
Just remember to test at home no matter what any vet tells you, there is no such thing as a stupid question here, get educated on the main emergency you may face one day, a HYPO episode. You're in the best place on Earth now. It's not Facebook so we don't care about your new shoes and nobody will un-friend you. We care about your cat and by extension you. Remember you have to be healthy yourself to take care of what was a sick cat.
 
All this dosing and poking stuff gets easier. No, really, it does!!! I promise. Remember, you JUST switched the food and look at the blues that got you! That tells you that he CAN and WILL come down and that this new food is helping. Now today, he is staying high. Why? Could be that 2 units wasn't enough insulin (but that doesn't mean that was a bad choice...it was safe). Possibly 3 would have brought him lower. Possibly it wouldn't have. All data is good data! But it could also be some bouncing...after a bounce from lower than expected numbers, often kitties will have a higher, flat cycle.

The GOOD news is that you got some action today. Your +4 was a drop of 150 points. Sure, that's not great, but it IS a drop. With the food change, you've got to kind of play around to figure out what the right dose for Tige is. We can help with that for sure. Finding the right dose takes some finagling and that dose changes over time usually. But it does exist, and you will find it with time and work. Just remember, this is a marathon, not a sprint.

Here's a little something that might give you a smile: Dear Mom. It was written by someone a long time before I arrived here, but it's helped me a few times...and given me something to smile about!
 
Thank you Rachel. FatCat's mom, that one piece of paper set our whole world back on it's axis. It's not the end of the world, your cat just needs some maintenance. Don't all cats need that?
 
Rachel said:
All this dosing and poking stuff gets easier. No, really, it does!!! I promise. Remember, you JUST switched the food and look at the blues that got you! That tells you that he CAN and WILL come down and that this new food is helping. Now today, he is staying high. Why? Could be that 2 units wasn't enough insulin (but that doesn't mean that was a bad choice...it was safe). Possibly 3 would have brought him lower. Possibly it wouldn't have. All data is good data! But it could also be some bouncing...after a bounce from lower than expected numbers, often kitties will have a higher, flat cycle.

The GOOD news is that you got some action today. Your +4 was a drop of 150 points. Sure, that's not great, but it IS a drop. With the food change, you've got to kind of play around to figure out what the right dose for Tige is. We can help with that for sure. Finding the right dose takes some finagling and that dose changes over time usually. But it does exist, and you will find it with time and work. Just remember, this is a marathon, not a sprint.

Here's a little something that might give you a smile: Dear Mom. It was written by someone a long time before I arrived here, but it's helped me a few times...and given me something to smile about!
Click to expand...
Dear Mom is just what I needed. :) Tige is bugging for food, following me around and meowing, and I need to wait for another hour and a half before I can test him for his PMPS.
 
Hey everyone, WOW! I just did Tige's BG and it's at 225. That's 11 hours after he got his insulin of 2 units. How do I dose him tonight, please? He was at 450 this morning and 300 at 4+.more
 
OK, well, I did some research on the forum and the sticky on prozinc protocol and stayed with 2 units. He ate all his food and I will do another test in about 4 or 5 hours.
 
I’m so sorry no one was here! I think you made a very good call with that PM dose. Looks like the food is bringing him down fairly quickly. Yay!
 
You did good. When I showed my wife Dear Mom she almost burst into tears. We must have printed 100 pages and used up a hi-liter before we came across that.
 
Aw, I'm sorry we weren't here last night! I'm an early to bed girl (because I'm up early for work...not by choice!). You made a great decision though. 2 seems to have given you a nice cycle last night! I definitely wouldn't go any higher than that this morning. I'll try to check in later and most likely some other folks will be around too when your AMPS comes around. Great job!
 
@Rachel It didn't hurt having our vet on the phone with us twice a day for the first two weeks giving advice. All I could do for her was bake cookies, money never entered the picture. Binky's Page seems like a hundred years ago now.
 
Noah & me (GA) said:
@Rachel It didn't hurt having our vet on the phone with us twice a day for the first two weeks giving advice. All I could do for her was bake cookies, money never entered the picture. Binky's Page seems like a hundred years ago now.
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Sounds like you have a great vet! Mine, I can't even talk to her. When we took Tige in because I thought he might have diabetes, she took blood and said if there was anything serious, they'd call right away. This was a Saturday. I called Monday, she didn't return my call. I called Tuesday and she didn't return my call. I called Wednesday and finally got ahold of her. Yes, he has diabetes. What? Isn't that serious and warrant a phone call asap? She never explained why. And she hasn't talked to me since. It's always the techs. I'm thinking of changing vets.
 
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