ProZinc dose advice please

SpotsMom said:
Oh my! C.C. found her breakthrough dose and added a dose of drama! 33 is a scary number but you are doing all the right things to keep her safe. As long as she keeps eating that’s a good sign!
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Not going to lie that 33 freaking scared the **** out of me. If I didn't see improvement quick I was going to throw her into a carrier and rush to the er.
 
Djamila said:
I'm really concerned about how much it sounds like you're feeding her. I understand you are feeling anxious about this, but too many carbs really can make her sick - not just vomiting but feeling awful. If she gets over full or starts to feel nauseous it will be much harder to help her over the next few hours. It takes awhile for what she's already eaten to show up in her BG, so please be careful how much you're giving her. Let her body have some time to catch up with what she's already consumed.
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Chris and China once recommended to us to squeeze out just the gravy part by popping the lid and the putting it over the food and pressing down, to get the carbs without filling them up.
 
Summary:
PMPS 186 - 7.5units dosed
+4 hr = 43, + high carb food
+4.25 hr = 33, + honey and half can gravy food
+4.5 hr = 4.5, + honey and carb food
+4.45 hr = 68

...Yes, that 33 is a very scary number. Any lower and there is not much to work with. I'm really glad you were testing. You are looking for 1 hour of stable or rising BG at this point, after the last food/honey.
 
Djamila said:
I'm really concerned about how much it sounds like you're feeding her. I understand you are feeling anxious about this, but too many carbs really can make her sick - not just vomiting but feeling awful. If she gets over full or starts to feel nauseous it will be much harder to help her over the next few hours. It takes awhile for what she's already eaten to show up in her BG, so please be careful how much you're giving her. Let her body have some time to catch up with what she's already consumed.
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She's not eating right now. She's chilling under the coffee table. She thinks this is the best night ever. Lol
 
She only ate a total of maybe 3/4 a can of food. She would be eating something this time of night anyway. Maybe not with gravy and honey in it of course. Lol
 
114@+5. I'll leave her alone for a half hour... No food and test again.

Thanks for sticking around with me tonight everyone. I'll take down the 911 now so I don't give anyone a heart attack.
 
Heck, I just came here originally to post "looking good on C.C.'s progress", then it turned into a hypo thread. I'm glad you were ready Janet. At least it is not a school night. C.C. will wonder where all the party treats are tomorrow.
 
JeffJ said:
Heck, I just came here originally to post "looking good on C.C.'s progress", then it turned into a hypo thread. I'm glad you were ready Janet. At least it is not a school night. C.C. will wonder where all the party treats are tomorrow.
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Yeah right! This is my last night of no school tomorrow. Start back on Tues.
 
Ok so not sure what to dose tomorrow. Last time she had a big hypo like this in January she was very insulin sensitive for a week.
 
JanetNJ said:
Ok so not sure what to dose tomorrow. Last time she had a big hypo like this in January she was very insulin sensitive for a week.
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That’s a tough one. It seems like she hit her breakthrough dose and is now on the way back down, but you don’t want to lower so much that she loses momentum. Since you’ll be home tomorrow, you can afford to be a little more aggressive, but for Tuesday you’ll need a good conservative safe dose. If it was Spot, I’d drop .25-.5u .. but that’s also a 25-50% reduction for him. I don’t think 5u would be a bad choice for tomorrow... I’d be interested to hear other opinions on that though....
 
The last dose was 7.5. I noticed C.C. was responsive on 8/25 to 7.0 units. You might consider dropping to 5.0 or 5.5. Then ramping up slowly from there.

Has C.C. been tested for Acro yet? It seems like 7.0 units is pretty high, and acro could be contributing to some of this insulin demand.
 
JeffJ said:
The last dose was 7.5. I noticed C.C. was responsive on 8/25 to 7.0 units. You might consider dropping to 5.0 or 5.5. Then ramping up slowly from there.

Has C.C. been tested for Acro yet? It seems like 7.0 units is pretty high, and acro could be contributing to some of this insulin demand.
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I don't think she's acro... Up until may she was doing OK on 1-3 units. I think she just had stubborn insulin resistance. Her numbers went up with her dental problems and we're stuck there for a couple months and they just didn't want to come back down. She was also stuck in a cycle of steep curves with vetsulin which just wasnt lasting long enough. Then my vet tried the failed experiment of dropping the dose for a couple of weeks before she was willing to switch insulins.
 
Since you are going to be home tomorrow, you could try a smaller reduction - to 6.5. Then testing. I am one of the more conservative members on the forum. I keep Leo's numbers just a little higher. He tends to hypo easily once he crosses a threshold. Since C.C. just crossed a similar threshold, as you observed, more diligence is needed.

It did not take very long to ramp C.C. on Prozinc. If ketones are not a huge concern, you could try the lower dose and a slower increase to avoid future hypos.
 
JeffJ said:
Since you are going to be home tomorrow, you could try a smaller reduction - to 6.5. Then testing. I am one of the more conservative members on the forum. I keep Leo's numbers just a little higher. He tends to hypo easily once he crosses a threshold. Since C.C. just crossed a similar threshold, as you observed, more diligence is needed.

It did not take very long to ramp C.C. on Prozinc. If ketones are not a huge concern, you could try the lower dose and a slower increase to avoid future hypos.
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I was thinking 6.5 as well.
 
Kris & Teasel said:
Time will tell but it does look like you cracked the insulin resistance. Stressful, though. :eek:
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Cracked? I'd say she blew it up! Thank God I set an alarm for a+4. I considered setting it for a +5 but changed it. If I had waited it could have been deadly. 30 on an Alphatrak is VERY scary. HUGE bounce this morning. I lowered to 7 this morning. I'm afraid to go back to work. :(
 
JanetNJ said:
Cracked? I'd say she blew it up! Thank God I set an alarm for a+4. I considered setting it for a +5 but changed it. If I had waited it could have been deadly. 30 on an Alphatrak is VERY scary. HUGE bounce this morning. I lowered to 7 this morning. I'm afraid to go back to work. :(
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You always have the option of lowering the dose by more than is necessary and carefully increasing. Trust a cat to do this at the worst time, though. Was she showing any visible hypo symptoms when she was that low? Some cats seem to tolerate low BG better than others. Teasel has bottomed out a number of times but never appeared to feel weird - hungry though.
 
Kris & Teasel said:
You always have the option of lowering the dose by more than is necessary and carefully increasing. Trust a cat to do this at the worst time, though. Was she showing any visible hypo symptoms when she was that low? Some cats seem to tolerate low BG better than others. Teasel has bottomed out a number of times but never appeared to feel weird - hungry though.
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Hard to say. She may have been a little unsteady on her feet... although with her arthritis she’s often stiff when she first stands up after laying. I would say a little more unsteady then usual. Her eyes were dialated .... but it was also dark in the living room before I went in there so not sure if it was related to that or low bg. She was hungry for sure. Thank god no seizures or hiding. She was under the coffee table but not under a bed or in the closet. I think I will lower for when I'm not home. I would feel awful if something happened to her while I was gone. I work 30 min away so I can't really come home at lunch and get back on time. The traffic is too unpredictable in nj.
 
Oh my goodness, what a scary night! So glad you were able to steer, but she really took her time coming up! I'm sorry you have to go back to work tomorrow, especially with CC finally showing you some greens. Cats really have awful timing, don't they?? Hugs to you and some scritches for CC!
 
This is where your patience gets tested more than normal with C.C. Since the bounce-back was big into the black, you can't over compensate. I would hold the new dose longer and see if C.C. will come down at that level.

We just had a similar problem with a relatively new patient Tucker. Patty followed our advise and carefully brought Tucker up slowly. Then he had 3 days of hypos, so we went back to half the dose. Yes it is levemir, but she wanted to be careful. Now Tucker is responsive at 4.5, where we had brought him up to 5.5. Latest thread
is here <<-- link
 
JeffJ said:
This is where your patience gets tested more than normal with C.C. Since the bounce-back was big into the black, you can't over compensate. I would hold the new dose longer and see if C.C. will come down at that level.

We just had a similar problem with a relatively new patient Tucker. Patty followed our advise and carefully brought Tucker up slowly. Then he had 3 days of hypos, so we went back to half the dose. Yes it is levemir, but she wanted to be careful. Now Tucker is responsive at 4.5, where we had brought him up to 5.5. Latest thread
is here <<-- link
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I may lower tomorrow but didn’t want to go down too much with this high bounce. I have to be more conservative when I am not home. Man I wish this happened two weeks ago. Ah well
 
What does your schedule look like once you go back? Are you still able to get tests in the PM cycle?
 
The nice thing about Prozinc protocol, and Prozinc is that you can adjust doses fairly quickly. Levemir and Lantus require must slower changes because of the depot effect.
 
Hey Janet...I was out of it yesterday, so I just now caught up. Looks like I was wrong! How's CC doing today? You're going back today, right?
 
JanetNJ said:
Ty. I am in school now (students start Thurs). I was so anxious last night. Second night in a row of 3 hours of sleep. Zzzzz. I just have to pray and trust God that she will be ok today.
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Thank heavens for no students today if you're sleep deprived ... :confused:
 
Rachel said:
Hey Janet...I was out of it yesterday, so I just now caught up. Looks like I was wrong! How's CC doing today? You're going back today, right?
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Ok I guess. She was Lethargic yesterday. Seems more alert this morning.
 
That is a relief to see that 90 on the chart. Let's hope C.C. decides to level out at this dose and not play any more hypo tricks.
 
JeffJ said:
That is a relief to see that 90 on the chart. Let's hope C.C. decides to level out at this dose and not play any more hypo tricks.
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She'll be fine tonight. She actually had a little pep in her step and looked happy. May go to 6.75 tomorrow for when in not home though. :) nice to see the dose going down instead of up for a change.
 
It will be interesting to see C.C.'s nadirs this weekend. That was a high PMPS today.
 
Unfortunate rise to the black. I hope the updated dose gives C.C. some relief. There were good nadirs over the weekend.
 
I know that's disappointing Janet, but you have seen that CC can do it! Hopefully this dose will bring her back down. It's tougher when you have to work during the time she wants to get good numbers, I know!
 
C.C.'s chart is looking decent. It is sure frustrating to not get those daytime nadirs. Reminds me of the first diabetic year with Leo - when I was working a 1 hour round trip at a software company.

The evening post-PMPS numbers aren't too bad. It's hard to tell if C.C. is going lower at +6 or +8.
 
JeffJ said:
C.C.'s chart is looking decent. It is sure frustrating to not get those daytime nadirs. Reminds me of the first diabetic year with Leo - when I was working a 1 hour round trip at a software company.

The evening post-PMPS numbers aren't too bad. It's hard to tell if C.C. is going lower at +6 or +8.
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I'll get extra readings this weekend for sure. It really stinks not being able to monitor during the week.
 
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