? Question about frequency of dosing

Ramon's mom

Ramon's mom

Member
I hope this is not a forbidden type of question: I have done some reading elsewhere and discovered that some people dose every 8 hours for cats on Prozinc. Is anyone here doing that? My cat's numbers do rise @ +8 and in general his cycle doesn't seem to ever go into a normal curve. So I am wondering if I should try dosing every 8 hours. Perhaps this is what is covered in the scale dosing here?
 
ProZinc is meant to be dosed every 12 hours. There are some cases where it is dosed differently but this is rare and normally only after giving the normal dosing ample chance. I don't think 8 hour dosing would be a good idea in your case. There would be too much overlap which would greatly raise the potential for hypos.

This discusses the 'unusual' dosing options: http://www.felinediabetes.com/FDMB/...ion-for-experienced-prozinc-pzi-users.166057/
 
Prozinc can be dosed every 8 hours when a cat gets short duration (typical duration is 10-14 hours). The problem with it is that it narrows your life down so much since you have to be home every eight hours, every single day. Plus monitoring to check the nadirs. It can certainly be done safely, but the constraint is more than most of us are willing to take on. However, if you feel like that suits your schedule and the level of care you want to engage in, it's certainly not forbidden.

This is Ramon's second round of diabetes, and the second round can be tough and persistent. If you want to try a more aggressive approach, and have a schedule that allows you to be consistent with it, you could give it a try. If it doesn't work for him, or if after a few weeks it feels like too much, you can move back to BID dosing.

All that being said, he honestly looks like he's doing really well right now. You're getting a good insulin response, and your duration already looks like it's closer to 14 hours than to 10 hours, which is a good sign. To move to TID dosing you'll need to lower the dose, and monitor quite a bit at first since his duration is long enough to end up with some serious overlap. Moving to TID could give you some nice flat cycles, or it could end up with some unpredictable dives (hence the close monitoring, especially at night). The only way to know which way he goes with that is to try it and collect the data.

If you want to try it, let us know and we can help you think through the starting plan.
 
Djamila said:
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All that being said, he honestly looks like he's doing really well right now. You're getting a good insulin response, and your duration already looks like it's closer to 14 hours than to 10 hours, which is a good sign. .....
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Well today he has terrible numbers. Started @ 235 and now at +5 it has gone up to 259. I really don't feel as if anything is predictable with him and the BG numbers. He has not had a speck of carbs for a few days now (except for the little in the wet food). I thought that would be the solution. But then there are today's numbers. I now have no clue as to why they went back up and what to do about it.
 
Yes, this is a bad cycle. Sometimes those happen. Look at the bigger picture though. The past several cycles he's had more than a 50% drop, he's hitting greens, and he's had blue PS numbers. All of that is really really good. They do have bad days sometimes, but that's why we don't dose based on a single cycle. It's the overall trends that matter. Deep breaths and hang in there. :bighug:
 
Looking over the last few cycles, it looks to me like you might be seeing a tiny bit of bouncing. Bouncing at lower numbers, and not going sky high, but still there. The reason I say this is because you do get some lovely blues and greens, then you seem to hit a cycle or two of just mostly flat yellows throughout. Those flat cycles followed by some nice blue and green cycles is what bouncing usually looks like, though it is often flat pinks and reds than yellows. He might just be a tiny bit bouncy so the rise you're seeing later in the cycle isn't a duration issue, it's the beginning of a bounce. It's hard to be sure, but that's sort of what I'm seeing when I look over your SS.

As Djamila said, trends matter more than one day. I'm not saying TID dosing doesn't work, because it does for some people, but I think in this situation, it wouldn't be the solution I'd go to. It does require a lot of no sleep and some really exhaustive work to keep your kitty safe. I've seen it tried a few times with people and most of them only did it for a little bit to help get their kitty where they needed to be and then went back to BID.
 
Rachel said:
Looking over the last few cycles, it looks to me like you might be seeing a tiny bit of bouncing. Bouncing at lower numbers, and not going sky high, but still there. The reason I say this is because you do get some lovely blues and greens, then you seem to hit a cycle or two of just mostly flat yellows throughout. Those flat cycles followed by some nice blue and green cycles is what bouncing usually looks like, though it is often flat pinks and reds than yellows. He might just be a tiny bit bouncy so the rise you're seeing later in the cycle isn't a duration issue, it's the beginning of a bounce. It's hard to be sure, but that's sort of what I'm seeing when I look over your SS.

As Djamila said, trends matter more than one day. I'm not saying TID dosing doesn't work, because it does for some people, but I think in this situation, it wouldn't be the solution I'd go to. It does require a lot of no sleep and some really exhaustive work to keep your kitty safe. I've seen it tried a few times with people and most of them only did it for a little bit to help get their kitty where they needed to be and then went back to BID.
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Would you recommend I go back to the 1.2 dose or continue with 1 unit doses?
 
I think I'd wait and see what happens tonight. Sometimes those flat yellow cycles precede an active cycle. If that's the case here, then I'd probably stay at 1u tomorrow. However, if Ramon stays flat and icky tonight, I'd probably go back to 1.2u in the morning.
 
+3 - 268 So I guess I didn't get it into him. He clearly doesn't feel well but I can't do anything for him until PMPS. What a horrid disease. The stuff you give them to make them feel better can also kill them.
 
I'm so sorry about the fur shot. I used to do those all the time. There was much cursing and crying at shot time when my little wild child would decide to twist or take off right as I was injecting. Hang in there. It's just one cycle and you'll get him back on track. Sometimes it can take a cycle or two to get back to the green numbers, so be patient. :bighug:
 
I don't know if I should start a new thread or not, but once again I am totally confused about Ramon's numbers and what to do about them. I had tried going up a tiny bit a few days ago but he is bouncing all over the place for no apparent reasons. His diet is good and I stayed with the 12 hour dosing as recommended. Is it normal to never settle down? A particular dose never gives me the same results. Is there some protocol for handling what you guys call "bouncing"? Any advice please?
 
His bouncing isn't too bad. It can take a while for it to calm down - 3 days even. I would have kept the 1 u dose a bit longer because it gave you a very nice 88, just about ideal on an AT meter. Try hard not to jump the gun because of the PSs. Bouncing will happen, let it settle for a few cycles and you might see dark green again.

Bouncing is part of the game with many FD kitties. There's not a lot you can do except to avoid frequent dose changes and too large a dose change. Ramon is actually quite moderate in his responses.
 
Kris & Teasel said:
His bouncing isn't too bad. It can take a while for it to calm down - 3 days even. I would have kept the 1 u dose a bit longer because it gave you a very nice 88, just about ideal on an AT meter. Try hard not to jump the gun because of the PSs. Bouncing will happen, let it settle for a few cycles and you might see dark green again.

Bouncing is part of the game with many FD kitties. There's not a lot you can do except to avoid frequent dose changes and too large a dose change. Ramon is actually quite moderate in his responses.
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Previously I've received suggestions to try 1.2, which I thought might even out his swings and might be important to do to bring down the higher numbers (close to or over 300). It sounds like you think I should just stick with 1 unit except when he goes to low to shoot?

The other problem is that he does not seem like he feels well, and that does not correlate to whether he is high or low. I'd love to know that he will feel well when he gets his insulin, but that is not happening or apparently possible. Today he has been high in the 200's and is refusing to eat (so I have to forcefeed him). I'd be tempted to give 1.2 at PMPS but there is no guarantee that will bring it down, nor make him feel better. And experience seems to suggest that going to 1.2 just starts more bouncing.
 
The one unit had some good carryover the other day (which is what gave you that low PMPS), so for now, I would think 1.2u would be too much. You don't want to be skipping doses because that messes them up for a few days. If that happens again, try stalling for 30 minutes and re-test to see if the number is rising. If it is, you can give the regular dose.

Please get a ketone test asap. When a kitty isn't feeling well and goes off their foods, ketones are the first concern. They can progress quickly. If you don't have ketone strips at home, you can buy them at any pharmacy for about $15, but you need Ramon to pee so you can get the test. If that doesn't seem likely, you can also bring him into the vet and ask them to do a quick blood test for it.
 
When we make a dose recommendation we look at the several days preceding to see what's happened. We focus on the lows, much less on the PSs. It's because of the nice green you got with 1 u and the blue PS later that day that I suggested staying at 1 u for a bit more. I recognized the recent yellows as bounce inflated numbers and looked past them for now. If they continued another couple of cycles I'd suggest an increase to 1.2 u. It's hard but best to avoid reacting to bounce numbers - they aren't a true representation of what a dose can do.
 
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Djamila said:
The one unit had some good carryover the other day (which is what gave you that low PMPS), so for now, I would think 1.2u would be too much. You don't want to be skipping doses because that messes them up for a few days. If that happens again, try stalling for 30 minutes and re-test to see if the number is rising. If it is, you can give the regular dose.

Please get a ketone test asap. When a kitty isn't feeling well and goes off their foods, ketones are the first concern. They can progress quickly. If you don't have ketone strips at home, you can buy them at any pharmacy for about $15, but you need Ramon to pee so you can get the test. If that doesn't seem likely, you can also bring him into the vet and ask them to do a quick blood test for it.
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I do have ketone strips and checked last week and he was normal. I'll try again. Its challenging because I have to be around him when he pees. today i was out working so I haven't seen it so far.

I also never tried the stalling idea. I will do that the next time he is too low and hope it will rise so I can give a dose. As you can see sometimes his numbers go down when you think they should go up and up when you think they should go down.
 
Kris & Teasel said:
When we make a dose recommendation we look at the several days preceding to see what's happened. We focus on the lows, much less on the PSs. It's because of the nice green you got with 1 u and the blue PS later that day that I suggested staying at 1 u for a bit more. I recognized the recent yellows as bounce inflated numbers and looked past them for now. If they continued another couple of cycles I'd suggest an increase to 2 u. It's hard but best to avoid reacting to bounce numbers - they aren't a true representation of what a dose can do.
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Interestingly enough his Internal Medicine specialist sent me a message (in reply to my updating her. I also shared the spreadsheet with her) and she told me I really need to stay consistent with the 1 unit.
 
Ramon's mom said:
Interestingly enough his Internal Medicine specialist sent me a message (in reply to my updating her. I also shared the spreadsheet with her) and she told me I really need to stay consistent with the 1 unit.
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That's interesting! If you have a minute, would you mind updating your SS? :)

BTW - I edited my post #19 to say 1.2 u, not 2 u. That was an error.
 
Sorry. I didn't realize I didn't fill in last night's number. I just updated it and this morning's. I also managed to get a ketone urine strip test in last night. Normal/negative. So far he hasn't ever had ketones either at home or at the vets. My vet responded to me that she wants me to stay with a steady 1 unit and that she was happy if numbers were under 300. In fact she claims the reason the numbers are not being steady is because I am changing the doses. (Its the reverse actually because I have been responding to the changing numbers, though it hasn't done much good). I'm frustrated because that certainly won't get him back to normal anytime soon.
 
Ramon's mom said:
Sorry. I didn't realize I didn't fill in last night's number. I just updated it and this morning's. I also managed to get a ketone urine strip test in last night. Normal/negative. So far he hasn't ever had ketones either at home or at the vets. My vet responded to me that she wants me to stay with a steady 1 unit and that she was happy if numbers were under 300. In fact she claims the reason the numbers are not being steady is because I am changing the doses. (Its the reverse actually because I have been responding to the changing numbers, though it hasn't done much good). I'm frustrated because that certainly won't get him back to normal anytime soon.
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Hurray for no ketones! I will say that the vet's approach in dosing is likely a bit different from ours. We're inclined to change the dose by a small amount if the BG level over several days shows that the middle cycle level is too high. The proof is in the pudding as they say ...
 
Well so far changing the dose has not improved or stabilized his readings. So I am not sure that will work for him. I find it difficult to believe that I won't be able to get it stabilized.
 
Ramon's mom said:
Well so far changing the dose has not improved or stabilized his readings. So I am not sure that will work for him. I find it difficult to believe that I won't be able to get it stabilized.
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What you're after is relative stability in BG levels over time. PSs in the low 200s and nadirs in the high double digits or low 100s are the goal. It's important to know, though, that maintaining this stability usually requires careful dose tweaks at appropriate intervals because the kitty's response to a given dose can and will vary over time for any number of reasons. It's not (or is only very rarely) a situation of find the right dose and "set and forget". It's usually a case of finding a narrow dose range and working within it. Sometimes the kitty will need a dose in the upper part of that narrow range and sometimes in the lower part. Have a look at a bunch of spreadsheets to see what others do.
 
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