Give dose early?

AlysonE

AlysonE

Member
I am new to ProZinc and new-ish to feline diabetes in general. Since April I was just shooting 2u twice daily ( as directed by Vet) and Emmitt was fine, but then he started to drink and pee more, so now I need to figure out regulation much more proactively than I had been.

I have recently switched to ProZinc after a disastrous experience with Novolin N, and Im trying to get him regulated. His Novolin ride has left him in pretty rough shape.

My question is, when I have done a curve and know his insulin is rising and he is ~4 hours before his next shot, can I give the shot early to prevent him going into the high (400+) BG range? He is at 329 right now and starting to look a little rough. I think I need to up his dose a little, ( he got a fat 2u, I think he needs a solid 2.5u next time.)

Im still learning, and appreciate any advice on early shots. Another motive for the earlier shot is now that I understand the curve better, if I switch to the earlier time, I can be home to feed at the low spot on the curve instead of feeding only at the shot time. I gather that will help regulate him better.
 
It's so hard to see our kitties not feeling well!

In general, it's not a good idea to give a shot off-schedule because you end up with competing nadirs (I can explain that more later), however, if you're wanting to change the shot time altogether, we can help you get that sorted out.

Could you set up a spreadsheet and share it so we can see whatever data you've collected so far? (and by the way, great job home testing!). Once we can see the data, we'll be better able to help you move the shot time and figure out if you could have shot a little early today.

Link to the spreadsheet: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Sorry no one was around when you asked the question. :oops:
 
It's easier overall to stick to shots at 12 hour intervals unless you have to alter that by an hour one way or the other because of some other commitment. I wouldn't chase the BG and try to intervene earlier because it's on the upswing. Altering dosing intervals too much can lead to overlaps in doses and more erratic BG levels. Stability is key. If you want to move to a new shot time a few hours different that what you do now you can skip a shot and just give the next one at the new time.

We can help you get better control of your kitty's BGs. Would you be willing to set up the spreadsheet we use here? That data is what we rely on to figure out dosing. It meshes with the basic testing routine we recommend:
  1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
  2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
  3. do extra tests on days off to fill in the response picture
  4. if indicated by consistently high numbers on your spreadsheet, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
  5. post here for advice whenever you're confused or unsure of what to do.
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
 
Thank you guys for the info on the spreadsheet. I have one in my signature now, and am reading on how to fill it in. I really appreciate the help.
 
Okay. I have today's curve inputted. Im going to take readings until I go to bed every hour to try and get as good a picture as possible. Emmitt hates the shot much more than the testing.
BTW I think his dose last night was actually closer to 2.5u, which contributed to his nice morning numbers. I backed off a little to be safe for the curve, but I am guessing I should give the 2.5? The 2.1 is just 2 units "fat" with the plunger on the long side of 2 units.
 
Good morning! Sorry we're often not around too late at night. I'm the early bird (during the week at least). Yes, it looks like a dose increase is on order. On that 2.1, the numbers just went up throughout the day. I'd probably try 2.25 (just eyeball it the best you can) for the next few cycles, and then if that doesn't work, go up to 2.5. We like to try dose increases by .25 when we can so we can avoid skipping over a good dose. Emmit isn't in too high numbers, so I think doing the small increase for 3-4 cycles would be good (a lot of people prefer to increase only during the day so they can keep an eye on things, which is fine)
 
I should have checked here first. I actually went up quite a bit, to 2.9, just under 3 because the "Hi" following the whole bad day of numbers scared me. I am off today and can stay home and check him every hour or so. At his age and after fighting these kind of numbers for a few weeks on Novolin N, (until I could convince his vet it just wasnt going to work and get him to change it to ProZinc) I am pretty desperate to get him under control asap.

I am curious what you meant by him not being in too high of numbers. My meter reads up to 599, so anything over that reads as "Hi." On the Novolin, we had solid days in the 400, 500, and Hi readings. He would stagger, and looked confused and eat and drink and pee constantly.

While I have not achieved regulation on ProZinc yet, the first day on 2u I got nice numbers, in the 200's at the highest and lows above 100. But they didnt stay there on that dose, which is why I started moving above 2u, but unfortunately, I went up to 2.5ish then got nervous I was going to fast and went back to 2.1. Now I've jumped way ahead. :(

Im a bit stressed and getting panic-y and need to calm down. I keep thinking "these numbers are killing him!" but if you are saying, "it isnt that bad" then perhaps I can calm down a bit. I read other things on your threads that even being over for a short while is damaging, and he has been high for around two months or better now at this point.
 
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AlysonE said:
I should have checked here first. I actually went up quite a bit, to 2.9, just under 3 because the "Hi" following the whole bad day of numbers scared me. I am off today and can stay home and check him every hour or so. At his age and after fighting these kind of numbers for a few weeks on Novolin N, (until I could convince his vet it just wasnt going to work and get him to change it to ProZinc) I am pretty desperate to get him under control asap.
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Unfortunately you can't really rush the process. Increasing the dose by more than 0.25 u can result in you missing a good dose for that point in time. It can also set off a big bounce. If you can follow the testing routine I outlined in my post #3 above and increase by only small amounts I think you'll find that he'll settle eventually.

The fastest routine would be to give a dose for three cycles and if you don't see blues appearing on your SS, increase by 0.25 u. Give that three cycles and increase again by 0.25 u, and so on. Eventually you will get to a dose that gives you some better numbers and you can slow the rate of dose increases. Instead of thinking of it as undoing the damage done by Novolin, think of it as moving forward to better control with ProZinc. :)

Here's a description of the rebound phenomenon we call bouncing:
  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.
 
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Insulin is quite powerful. It's not something you want to be impulsive/reactive with. When considering a dose, we look at patterns over several cycles or days, not just at one number on one day. Bodies are complex, and there will be good days, bad days, and "normal" days. On Novolin you react to each number. On Prozinc and other long acting insulins, you have to look at trends and patterns and ignore outliers.

As Kris said, you can't rush this. And trying to do so will cause more harm than good. I know it's so so so hard to see our kitties sick. Just keep reminding yourself that rapid or dramatic changes to the dose can cause more trouble and actually slow down progress. The opposite of what you are hoping for. Slow and steady wins the race around here.

Go ahead and test today (every two hours is enough data, it doesn't need to be every hour). Let's see how he does. Then post again before it's time for the next injection. It may be best to keep the dose you gave this morning instead of going up and down, but we'll need to see the numbers from today to get a sense of that.

Do you have any data from before yesterday? Anything you can add to the spreadsheet would be helpful. It doesn't have to be full curves. Any numbers are good.
 
I do not have much coherent going on in terms of numbers on the ProZinc. Just random readings. I had been panicking for a month on the Novolin N and fighting with my vet for a week over switching him off it. I did some bad things though. Shots early, shots late, his vet says to move in 1unit increments as he thinks the smaller changes are a waste of time, we backed him back to 1 unit after a 188 pre-shot reading, and his BG shot back up. I went back to 2 units, and just never got any control.

I just need to calm down and have good advice. And sadly I do not think my vet is giving it. He wanted to keep trying with Novolin even though his numbers were sky high on that. As bad as his number are now, at least I can see the glimmer of hope of getting him under control.

My work schedule is horrific. I work some mornings and some nights in the same week. The only way I can keep him on a schedule is to have his shots at 10am and 10pm. There will be times when he is off by an hour, as to make the 10am shots some days I have to drive home on my lunch break and I cannot always get away at a precise time. (It takes a half an hour drive each way, so I run in, test, shoot and run out.)

Trust me, his diabetes coupled with my schedule and the trauma it wrecks upon my own sleep and eating is really destroying my calm and sanity. Please try not to judge my stupidity too harshly. I am really dedicated to keeping him well, I just have had no real idea what I am doing.

I know I have done things that are not ideal. Bad even, now that I have read more of this website, now that I am talking to you all I am confident I can get sorted out. I know I need help, and that is a good first step. I will listen to advice, too,
 
It looks like the good numbers I got I got because of overlapping doses. (Shooting early to try and get my timing back to something better. I had not yet read your advice to skip a dose to get that result) So, I am not certain, but it looks to me that his high numbers are not bounces, just places where he is only getting 2 or less units.
 
What started this whole mess in the first place was that his control on his Lantus was going south. He had had a honeymoon once, maybe two months after being on Lantus and I almost killed him because I was just giving him his doses and not testing everyday. (Per his vets instructions) One day I noticed he was lethargic and tested and he was at 32. Gave syrup and food and got him back to normal and then tried to have him off insulin for a while, didnt work, bg went back up, so long story short he eventually went back to 2u 2x daily.

Then, I noticed his drinking and peeing increasing. So started checking his numbers again, (His vet does NOT recommend home testing, just shoot the dose 2x a day) and found he was having numbers in the 300+ range. I assumed my Lantus might be going bad, the bottle was almost empty, and could not afford a new one, so asked Vet to switch. My vet actually LIKES Novolin N, and swears it works almost as well as Lantus, but starting with Novolin N Emmitt just spiraled out of control quickly. (I had to ask for Lantus in the first place, because I had read it was the one most likely to offer remission. I knew I couldnt afford it long term, but I hoped remission would set in before the bottle ran out.)

We started off the Novolin N with 1unit and numbers were in the 400 and 500 range, numbers I had never seen with him before. So upped to 2 and still, just crazy high numbers. I was giving many days at same dose, to allow him to adapt at that point.

At that point I started begging his doctor for a new insulin, and fought with him for around 2 weeks before I finally got this one.

I am panicking now because it has been a couple of months at numbers I have never seen him at before, and he is looking rough. At 18yo Emmitt has great weight and muscle tone, good liver and kidney numbers, still very able to walk, jump, (just not as high) but now after a couple months of being out of control he is losing weight and just acting so not himself.

So, that is how this all came about. If there is a bounce going on, it COULD be that what I interpreted as his Lantus going bad was actually him bouncing from a second remission I never noticed?

Edit to add: Emmitt originally became diabetic in April after an infection. He had been bitten by another cat, (while at work not sure how that happened.) Prior to that Emmitt had never really had bad health, was not over weight, and ate wet food almost exclusively. (He had bad teeth and lost most of them at a relatively young age.)
 
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AlysonE said:
So, that is how this all came about. If there is a bounce going on, it COULD be that what I interpreted as his Lantus going bad was actually him bouncing from a second remission I never noticed?
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It's possible. If you were rarely testing and changing dose in whole units any number of undetected things could have been happening. Don't beat yourself up - water under the bridge. You were trying to follow an animal care professional's advice. We've all been there ...

You're now doing things differently. Try the testing routine we recommend. Change doses only when needed and only in 0.25 u fractions. Ask as many questions as you need. We can help.
 
Kris & Teasel said:
We can help.
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Thank you, and I believe that. I absolutely see the competence and experience you have accumulated and I am so grateful that so many of you have generously decided to share your time and expertise with others.

I don't know if you have had a chance, but if you do get an opportunity to look at Emmitts numbers for today, should I stay with the 2.9 (skinny 3) for a couple days? He didnt drop too terribly, but I was home and timed his food to help soften the drop a little so as not to shock his system too much with those low numbers he hasnt seen in a while.
 
So you mentioned you softened the drop with food at specific times...when on your SS were those times that you fed? And did you just give regular food during those times?
 
That was a lovely curve today, but I second Rachel's questions - if you could give some details about when you fed, what food you gave him, and about how much (just a rough estimate is fine), it would help us think about tonight's dose. Also, was the food you gave today different than his normal eating schedule, and does he have food out overnight? Sorry, I know that's a lot of questions :)
 
Djamila said:
That was a lovely curve today, but I second Rachel's questions - if you could give some details about when you fed, what food you gave him, and about how much (just a rough estimate is fine), it would help us think about tonight's dose. Also, was the food you gave today different than his normal eating schedule, and does he have food out overnight? Sorry, I know that's a lot of questions :)
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Okay, the main thing I did differently was I gave Emmitt his food as I knew he was dropping. I allowed him a little bit with the shot, because he was hungry, but not a lot. Just enough to hold him over a while. He got about a heaping tablespoon of Gerber ham babyfood. (He and my other elderly cat Percival like that, I supplement it with Taurine.) When I knew he was dropping, (around +2) I opened up his packet of "Delectables" also sprinkled with a little extra taurine and also with broccoli added. He gets the whole packet.

When he was nearing the bottom, I opened him another packet and added a bit of sweet potato. (around +4) He ate slightly more than half of that.

He actually started hunting around for food as he was rising, so I let him have some Fancy feast canned.

I have not let him eat the two hours leading up to his pre-shot.

His diet is his normal diet, just with the timing more strategic and the added sweet potato at the bottom because I was a little worried I might have given too much and was trying to prevent to sharp a dip. I dont think I needed to do that. He didnt go as low as I feared.

His normal diet is two packets of Delectables (morning and night, with supplements to make them a better food,) and Gerber baby food, baked chicken, salmon, etc. as and when it happens. The Fancy Feast (canned) is usually left out through the day for the other kitties, but he has access.

He occasionally has gotten into dry food which is around the house for pets, but that isnt like him. He normally does not eat dry, that was due to extreme hunger when his sugar was sky high. When he is more controlled, he doesnt care for it at all. Ive made certain he cannot get into it for now while he is being regulated.

I am not sure of his weight at the moment, but Emmitt has never been fat, he is a very heavy muscled cat. (A little thinner now because of being starved by his out of control diabetes.)


I do plan to leave some food out overnight, just one can of FF.

To be clear, the extra packet of delectables at the bottom with extra carbs and the delay on his first big meal was the big difference.
 
Are those the Natural Balance Delectables?

It looks like maybe a little less tonight might help you be more comfortable for a few cycles. Maybe try 2.75.

As far as the kibble, even just a piece or two can impact their glucose quite a lot, so do everything you can to keep him away from it - if possible you might consider changing everyone to a low carb diet - it will help keep Emmitt safer, and also be good for all of them.

I'm not sure I understood the part about "I allowed a little bit with the shot..." You should feed him a meal at shot time so he has food onboard before the insulin kicks in, but I might be misunderstanding what you were saying there.
 
Djamila said:
Are those the Natural Balance Delectables?


I'm not sure I understood the part about "I allowed a little bit with the shot..." You should feed him a meal at shot time so he has food onboard before the insulin kicks in, but I might be misunderstanding what you were saying there.
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No, you didnt misunderstand, I did delay his normal breakfast until he was already dropping and just gave a snack at shot time. Yesterday I fed with the shot and he really rose before falling. Today he just began a decline. Im guessing you do not think I should do that. :) I wont have it as an option on work days, really, so no worries.

I am glad you suggested a slight decrease. If I hadnt heard back from you I was going in that direction myself.

Thank you so much for your help.

Edit to add, I am going to try harder to cut out the kibble on the others. I live rural and there are some feral "woods cats" that I feed, and I buy the kibble mostly for them but I know my gang eats on it too.

Emmitt is being kept well away from it from now on.
 
I think as long as you're home and monitoring, your feeding plan is fine. But yes, if you're leaving, or just don't want to test so much, do make sure he's had a good meal.

Try to keep his dose steady now for a couple of days so he can adjust. Prozinc works best for most cats with consistency. And please know that it's fine to post whenever you have any questions. There is so much to learn at the beginning! It can feel overwhelming at times. :bighug:
 
Oh and no, they are the Hartz Delectables. Probably not the best food in the world. I dress it up with extra veg and taurine. Percival (who will be 18 in Feb 2019) has an issue with his tummy where he vomits if he eats too much solid textured food. He does best on liquidy foods or, conversely, natural textures like chicken and fish. Hence the babyfood and delectables. He does terrible on pates for some reason. I suspect Percival may have a bezoar, but have no way to prove it that wouldnt be expensive and traumatic for him. Emmitt is just along for the ride on those because he sees them, loves them, and wants them too.

Emmitts main food is and always has been FF pate, seafood flavors, and it is nearly always out for my cats. (Also regular Friskies canned for one of them who prefers it) There has been a parade of kibbles as well over the years but lately I aim grain free high protein for my guys, (Crave atm) but have some regular Friskies for the ferals outside. (And my kitties do get outside during the day, and do get into the junk food. )

Usually Emmitt just wont eat dry because he doesnt like it, but clearly all bets are off when he is starving due to his sugar being way to high. He gets scary hungry and thirsty, meowing loudly, it is pretty dramatic.
 
Djamila said:
ii
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I am planning on upping his next dose by .25 unless someone here thinks it is not a good idea. I really need to get his numbers down. I notice the plantigrade stance this morning.

Also, is it normal to need that many units? I notice most of the spreadsheets show much lower doses. Is it possible he is having somogyi? Or is it fairly common for a cat to get out of control and need higher doses for a while?
 
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You've been on 2.75 for 3 cycles, so you can definitely raise now. I wouldn't ever raise earlier than 3 cycles because you really do need to allow the cat to try a new dose out for a minute. Most of us increase every 3-4 cycles (some like 4 so they can always raise on a cycle during the day).

As for the high dose...it's really not THAT high. A lot of cats go pretty high at first...but we don't start thinking it's a lot of units until around 5 or 6 units. The lower doses often come after the cat has been on insulin for a bit and has started to get better control...and then the dose needs decrease. We don't really subscribe to the Somogyi effect here...bouncing IS fairly common, and that's what I see on your SS. And really, your numbers aren't that bad. Yes, the preshots are high, but you're getting some nice yellows, and that means that you are getting a good effect from the insulin. We just need to help get the preshots down. Look at the dose this way...you had almost a 600 preshot and went down to a 280 nadir...that's over a 50% drop which is good!

Yes some cats need a higher dose for a bit. With Emmitt having been in higher numbers for a bit, he might just need some insulin to get him under control and then the need could decrease. I wouldn't focus on the dose so much. A cat needs what it needs and that is perfectly fine. It's not a big deal if they need more because it isn't a medicine...it's a hormone. This WILL get better. :bighug::bighug::bighug:
 
Look at my spreadsheet. We are very close to 4u and have been for awhile now. Or JanetNJ's spreadsheet - I believe her kitty is around 11u right now. As Rachel said, a cat needs what it needs. As long as you are monitoring the BG, you can see that it's not too much, no matter how much it is. While some cats are on much lower doses, other cats are on much higher doses. Every cat is different.

As Rachel said, if you're getting a 50% drop between pre-shot and nadir, you're getting a nice insulin response. Yes, the numbers are still too high, but it tells you that the insulin is working well for Emmitt. It's just going to take some time. Go ahead and increase to 3u on a cycle when you can monitor by getting a couple of tests mid-cycle.

Holding the dose for 3-4 cycles lets you see how it's working since some cats respond right away to dose changes, and other cats take a day or two. That's why you don't want to increase faster than that. It also gives Emmitt a little time to adjust before the next change.
 
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