Dosing update

[Breanna H]

Hello!
I had posted about 5 days ago asking for new dosing advice for Tigger. I wasn't sure if I should continue in that thread or create a new one so I created a new one. (I'm not the best at using forums haha). I upped him from .75 to 1u of Prozinc on 2/14 in the PM based on advice and numbers. From what I can tell from his numbers, this still doesn't seem to do it for him. Should I increase again to 1.25u for another 6 doses? Suggestions?
He still acts starving, eating anywhere from 3 to 4 cans of Fancy Feast pate a day. I usually give a whole can before shooting, then divide the other one up into one or two snacks during the day or over night. Still peeing a decent amount too but that has improved since diagnosis.
Thank you all once again!

 

[Juls and Billy]

I'm not a dosing expert, but I can tell you what I think until other folks chime in. You are certainly making some progress with the numbers starting to come down. I think you are getting close to a good dose for Tigger. If it were me, I would up to 1.25 for 3 cycles and see how he does. Your preshot tests don't look like bounce to me, so I think the dose increase is warranted.

As long as Tigger isn't very overweight, I would feed him anytime he is hungry. Yes, it seems like a lot of food, but diabetic kitties don't utilize the nutrients in food well, so some of that nutrition is going straight into the litter box. My Billy is fat, but I didn't limit his food at all while we were trying to get him regulated. He ate like the little piggy he is, but didn't gain one ounce. Now that he is off insulin, we are working on his weight problem. It can also help keep Tigger safe to have food available in case his BGL ever gets low. Of course, the feed as much as he wants is my personal opinion. Every cat is different, and you decide what you think is best.

 

[Deb & Wink]

Tigger's blood glucose levels aren't budging much at the 1U dose.
I'd definitely increase to 1.25U

You want to see around a 50% drop between the pre-shot test and the mid-cycle low blood glucose (BG) test.
Tigger is only getting a 20-25% drop.

I would not hold this 1.25U dose for more than 6 cycles, 12 hours being a cycle. Roughly 3 days.
Unless you see some more movement in the mid-cycle tests.

If you are ever up early enough in the morning to get a +11, that could be very useful information. Some cats spike up much higher in the time between the +11 and the pre-shot test. So +11 before AMPS.

Same thing for the +11 before the PMPS. If you are home from work, try to get at +11 before your evening pre-shot test.

What kind of treats is Tigger being fed? For testing times, etc.

 

[Breanna H]

Tigger's blood glucose levels aren't budging much at the 1U dose.
I'd definitely increase to 1.25U

You want to see around a 50% drop between the pre-shot test and the mid-cycle low blood glucose (BG) test.
Tigger is only getting a 20-25% drop.

I would not hold this 1.25U dose for more than 6 cycles, 12 hours being a cycle. Roughly 3 days.
Unless you see some more movement in the mid-cycle tests.

If you are ever up early enough in the morning to get a +11, that could be very useful information. Some cats spike up much higher in the time between the +11 and the pre-shot test. So +11 before AMPS.

Same thing for the +11 before the PMPS. If you are home from work, try to get at +11 before your evening pre-shot test.

What kind of treats is Tigger being fed? For testing times, etc.

Sounds good. I will reevaluate soon as I increased the dose this morning and I will get a +11 in the PM.
Tigger is actually pretty picky about treats. He refuses most low carb ones, like the pure bites. Occasionally he will get some cheese or some cooked chicken but mostly after testing he just gets pets and loving and he's good with that. As long as he's getting his wet food he seems happy.

 

[Deb & Wink]

Pets and loving are treats too. Does not have to be food.
My diabetic cat loved the Halo Liv-a-Little freeze dried chicken breast treats.

I'll look forward to seeing those +11 tests for your Tigger.

 

[Breanna H]

Tigger's blood glucose levels aren't budging much at the 1U dose.
I'd definitely increase to 1.25U

So this weekend was kinda crazy. I planned on doing a better curve than what I got, but I was on call both yesterday and today and, of course, had to go in. So I did what I could. Life in general has been pretty hectic for me so I've been getting numbers when I can. Tigger also seems to be extra mad with me with the increase in testing. He hasn't been liking his pokes as I think his ear is getting sore Still giving him loving though during and after.
Any dosing advice with what I've got as of now? Yesterday's numbers were weird, lower to higher and back down again. Not sure why. I kind of feel like I'm getting no where, but I suppose I'm probably just being impatient as usual.
Thank you!

 

[Deb & Wink]

Breanna, I think you have to keep going up in dose, until you see the blue range numbers again. Or even some greens for Tigger.

So that would up to 1.5U for Tigger.

 

[Breanna H]

Breanna, I think you have to keep going up in dose, until you see the blue range numbers again. Or even some greens for Tigger.

So that would up to 1.5U for Tigger

That's what I was assuming but I wanted to confirm. Thank you!

 

[Deb & Wink]

You're welcome. Keep us posted.

 

[Deb & Wink]

Hi Breanna, I simply wanted to make you aware of this.

All the "Sticky" or pinned posts in the Prozinc forum have been updated and there are a couple of new ones.

Highly recommend that everyone using Prozinc or helping those using Prozinc read them thoroughly.

I'll be doing that myself. Been expecting this for some time. Came about a week before I thought it would.
Thanks Marje, and Robert, and especially Djamila for the Modified Prozinc Method. You folks are FANTASTIC!

 

[Breanna H]

All the "Sticky" or pinned posts in the Prozinc forum have been updated and there are a couple of new ones.

Highly recommend that everyone using Prozinc or helping those using Prozinc read them thoroughly.

Perfect! Thanks! I'll check it out!

 

[Breanna H]

Breanna, I think you have to keep going up in dose, until you see the blue range numbers again. Or even some greens for Tigger.

So that would up to 1.5U for Tigger

Curve is done! Still doesn't seem like enough. Can you explain to me why he goes back into the 300s when he's supposed to be at his lowest? Is it just because he's eating? And then drops again in the two hours with no food? He is eating 3 to 4 whole cans of FF pate a day and still loosing weight.

I'm guessing it's time to go to 1.75u? My problem is I am going away on vacation for a week and I am leaving Friday night. My sister is staying with him at my house. She works 8 hours a day so he will be alone for that time, but I'm giving her instructions to leave him with food before she goes. As long as I see him not dropping too low this week, do you think it would be safe for her to keep this dose for the week while I am away? She will only be testing AM and PM pre shot.

Thank you, as always. I've been feeling rather defeated and worried lately so getting your advice makes me feel like I'm making progress.

 

[Juls and Billy]

Can you explain to me why he goes back into the 300s when he's supposed to be at his lowest?

My best guess is combination of food and insulin wearing off. Which to me, suggests a .25 increase is indeed warranted. ECID. Sometimes the ProZinc lasts longer, sometimes it's shorter, but a slight increase might get it to last a bit longer.

Don't get defeated! Often, pancreases don't heal all at once. Sometimes, they start working for a bit and then decide they need a little more help. It does not mean you aren't making progress.

I'd try the 1.75 for a few cycles and see what happens. You don't go out of town until Friday, so you have time to check it out. Then reevaluate before you leave. You might decide for a lower dose while you are away, or he might be doing great on the 1.75. Will your friend test BGL or only inject? Can you get a timed feeder for wet food before you leave? Otherwise, yes, have her leave extra food and even low carb freeze dried type treats out for him while she's at work.

 

[Deb & Wink]

I'll try to explain, Breanna, I'll surely try.
Give me a bit to gather my thoughts.

First, if Tigger is still losing weight, you need to feed him more.
The 3-4 cans of Fancy Feast a day is not enough. (9-12 ounces per day) Add more. Maybe another 3 ounces a day, if he'll eat it.
If cost is a factor, you could also consider Friskies pates. They are good for a diabetic cat also.
My diabetic boy cat ate 11 ounces a day at first, and for some time after he was regulated.
Unregulated diabetic cats can require twice as much food as a non-diabetic cat.

Yes, having your sister come to take care of Tigger and test at pre-shots and leave him some food will help.
We often suggest a "vacation dose" if someone will be away and there will be no or very limited testing of the blood glucose levels.

That vacation dose depends on what the cat is currently receiving.
You also need contingency plans, such as skipping, stalling, reduced dose if Tigger is too low at pre-shot.
Leave a copy of the hypo symptoms with your hypo tool kit and make sure your sister knows where that is located.

Leave a letter of authorization for her to seek vet care in case of emergency, and make your wishes known. You might not always be available by phone, and she needs to know what you want to happen in an emergency situation. Worst case, she needs to know what you would want to do if the decision is put to sleep, intensive medical care, etc. Discuss with your sister.

p.s. More to come, on the dose. on the higher numbers.

 

[Deb & Wink]

I'm guessing it's time to go to 1.75u?

Yes, it is time to increase the dose to 1.75U.

I've been feeling rather defeated and worried lately so getting your advice makes me feel like I'm making progress.

Don't feel defeated or worried. It takes time to get a diabetic cat regulated. You are making progress. It's just very, very slow.

Do you feed Tigger after +6?

Curve is done! Still doesn't seem like enough. Can you explain to me why he goes back into the 300s when he's supposed to be at his lowest? Is it just because he's eating? And then drops again in the two hours with no food?

When did he eat? After +6?

Basically, the insulin is all used up around mid-cycle, so any food after that point will simply raise the numbers higher later in the cycle. You haven't found the right dose yet, to bring Tigger into the lower BG ranges at mid-cycle. You want to be seeing those blue colors again.

More notes on the SS as to what you feed and at what + hour would be helpful to see.

 

[Breanna H]

The 3-4 cans of Fancy Feast a day is not enough. (9-12 ounces per day) Add more. Maybe another 3 ounces a day, if he'll eat it.

If cost is a factor, you could also consider Friskies pates. They are good for a diabetic cat also.

Oh he will definitely eat it. He has been picky about the Friskies before but I have several in the cabinet. Maybe since he is starving all the time he will be more accepting of trying them now. I'll try to get more in him. He was at 19 in December and at the vet last week he was down to 16. He did go through about a 2 to 3 week picky strike so that didn't help.
Good idea about printing all of the information for her to have. I hadn't really thought about that.

When did he eat? After +6?

He basically has access to food all day. As soon as he runs out of his wet, my husband or I will refill his plate, except for an hour here or there if he is napping or 2 hours before testing. I'll tell my husband to try to keep more of an eye on it during the day to try to get more in him when he runs out when he is home with him.
So chances are very good that he did eat today after +6 since I was home with him all day and kept refilling.

I'll up to 1.75 and get some numbers over the next two days and message back so I can get your advice on what to do while I am gone.

Again, thank you so much!

 

[Breanna H]

We often suggest a "vacation dose" if someone will be away and there will be no or very limited testing of the blood glucose levels

We are leaving tomorrow afternoon (Friday) for vacation for a week, so my sister will be taking over starting at Tigger's PM test and shot.
After upping him, I was only able to get a few numbers before we started dog sitting a family members dog (Tuesday 3/3 in the afternoon). We always keep Tigger separate from him but he still is clearly stressed. He hides in the room and I have been struggling to get him to eat more than a can or two a day for the past two days. Thankfully, the dog leaves when we do tomorrow. But then my sister takes over, so more stress for Tigger, but definitely a lot less.
Okay, back to my main point. Do you think it is safe to keep him at the 1.75u while I am gone? Or should I lower the dose while we were away? Tigger gets tested/fed/shot at 7 & 7. My sister works 10am to 6:30pm. She is going to leave food out for him before she leaves as well. I feel like he will be fine at the 1.75, but I want to make sure what you think.
I felt like Tigger was starting to get better numbers (slowly into the 200s more rather than the 300s) then the dog is screwing it all up! Grr! We haven't had a 400 in a while!
I feel like when I get back he will need to go up to 2u, but we will see when the time comes.

Thank you!!

 

[Deb & Wink]

Do you think it is safe to keep him at the 1.75u while I am gone? Or should I lower the dose while we were away? Tigger gets tested/fed/shot at 7 & 7. My sister works 10am to 6:30pm. She is going to leave food out for him before she leaves as well. I feel like he will be fine at the 1.75, but I want to make sure what you think.

Tigger hasn't been down in the blue range numbers in a long time. So 1.75 is probably a safe vacation dose for your sister to give.

Have a pleasant time away. Hope it's somewhere new for you and fun.

 

[Breanna H]

Tigger hasn't been down in the blue range numbers in a long time. So 1.75 is probably a safe vacation dose for your sister to give.

Have a pleasant time away. Hope it's somewhere new for you and fun.

Thank you. My anxiety is through the roof already. I almost feel like I can't enjoy my vacation. Ugh. And of course, there's already a problem.

I went over testing with my sister multiple times. She's done it with me there watching and has done okay. And of course, as soon as I leave and am not there, Tigger is not cooperating, running away, hiding, ect. Which he never does for me.

If she is is not able to get a successful test in, do you think the 1.75u is safe to give blindly? (I mean I know it's not 100% safe but with his higher consistent numbers he has to have some insulin) I HATE to do this but I am making myself sick and am literally leaving the country. I need to give her instructions for what to do. Or should I tell her to shoot less? She will keep trying to get pre tests but I'm not sure how cooperative Tigger is going to be.

Thank you!

 

[Deb & Wink]

Contingency Planning.

If Tigger can not be tested, give a 1.5U dose.
If Tigger can be tested, give a 1.75U dose.

Doses are dependent on him eating.
If not eating as well, 1.5U dose.
If eating well, 1.75U dose.
Skipping the insulin is not a good idea. Too many incidents of ketones and DKA lately for that to be a good option.

Is there a way that Tigger can have smaller restricted quarters? So there are less places for him to hide from your sister's care?

 

[Breanna H]

Is there a way that Tigger can have smaller restricted quarters? So there are less places for him to hide from your sister's care?

I'll have her stick with the 1.5 if she's not able to get a number.
And getting him to come out isn't the problem really..he can be easily lured out with chicken. Tonight as soon as she picked him up he began growling at her and wriggling to get loose. I know it's just because I'm not there and he isn't used to her (even though I've had her doing the past three checks). But he is eating well. Hopefully after a day or so he gets more used to her and she's able to get more checks.

Thank you again!

 

[Breanna H]

Have a pleasant time away. Hope it's somewhere new for you and fun.

While vacation and time away was nice, I am now home and back to trying to get Tigger regulated.
I upped him to 2u as soon as I got home, and it looks as though it's barely touching him.
Am I still not close to the right dose or could Tigger be insulin resistant? I feel like 2u is getting on the higher side and I still am not even close to a blue let alone a green number. Since it has been 3 doses, should I up him to 2.25 or continue at the 2 for a few more?
Thank you!

 

[Juls and Billy]

I'm not a dosing expert, but if it were me, I'd stick to the 2 unit dose a couple more cycles and try to get a few more mid-cycle tests as your schedule allows. A curve would be a good idea when you can manage it. I think you need a little more test information before you up the dose again.

 

[Deb & Wink]

Since it has been 3 doses, should I up him to 2.25 or continue at the 2 for a few more?

6 cycles is the recommended number of cycles before a dose increase.

Remember, you are looking at the nadirs for those dose adjustments. Not the pre-shot tests.
You need to be getting a regular test every cycle, PM too. More than simply the pre-shot tests for the PM cycle.
If you don't, you are missing half your data.

I feel like 2u is getting on the higher side and I still am not even close to a blue let alone a green number.

2 U of insulin every 12 hours is not a lot.
5-6U of insulin every 12 hours would be a lot. And then you'd want to test Tigger for some high dose conditions, like IAA (Insulin Auto Antibodies) or agromegaly (pituitary gland growth/tumor).

 

[Patty & Teal'c]

With Teal'c it almost always seems it does take 3 to 4 days before either an increase or even a decrease seems to show a change. About the time I think it didn't work then I see a change in his numbers. You've got to give any dose change time to work before you increase or decrease.

 

[Deb & Wink]

Hi Breanna, How are you and Tigger doing?

 

[Breanna H]

Hi Breanna, How are you and Tigger doing?

Hello!
Today is actually Tigger's birthday! (he is officially 9 today).
As far as his diabetes is concerned, we had a blue number the other day at +6, which got me pretty excited, but they haven't continued. I'm doing a curve today, since I will be home all day, for obvious reasons. However, I have a feeling tonight I will be upping him another .25u. Still not where he needs to be.
But he is still eating very well and playing, so no concerns there.

How are you doing? Hopefully staying healthy!

 

[Deb & Wink]

Happy Birthday Tigger!! Some rainbow colored cake, to go along with Tigger's recent BG numbers.
Low carb of course!

However, I have a feeling tonight I will be upping him another .25u. Still not where he needs to be.

No, I agree he needs more insulin. Don't even need a curve to see that.

Doing fine here.

 

[Breanna H]

No, I agree he needs more insulin. Don't even need a curve to see that

Is it safe for me to assume, that until I start seeing some blue numbers, after about 6 doses it is safe to continue upping Tigger .25u at a time? Still no blues.

 

[Deb & Wink]

Is it safe for me to assume, that until I start seeing some blue numbers, after about 6 doses it is safe to continue upping Tigger .25u at a time? Still no blues.

Yes Breanna, that would be a good plan, to keep upping the dose by 0.25U at a time, after that minimum of 6 cycles.

Please print out the Sticky PROZINC DOSING METHODS and review the guidelines for the MPM protocol and see if that is something you can follow with your schedule.

As long as you are doing mid-cycle testing, to catch those low nadirs, you can increase fairly quickly. You need to see some blues before you might slow down on the increases. Even then, unless you are seeing lower blues, <130, I think you'll want to increase Tigger's dose until you do see some blues and some higher greens.

Tigger has been on insulin long enough, without getting good control, you either need to be increasing the Prozinc dose more rapidly and using the MPM (Modified Prozinc Method) protocol. Or consider switching to a different insulin.

How are Tigger's signs and symptoms? Peeing? Pooping? Playing? Preening? Purring? Appetite?

How crazy is your life during this virus outbreak?

 

[Breanna H]

How are Tigger's signs and symptoms? Peeing? Pooping? Playing? Preening? Purring? Appetite?

Tigger is still peeing a lot. Litter box is full every day. I usually empty twice a day. He poops every other day, which is pretty normal for him.
He is acting normal otherwise, playing and purring, wanting pets.
He always acts like he is starving. I am able to get about 4 to 5 cans of Fancy Feast in him a day. He eats small amounts through out the whole day. He dropped from 19 to 16 pounds since diagnosis, but he seems to be holding.
He clearly has some neuropathy. His front legs shake often. I do have him on Zobaline. But I know that until he is regulated, it probably won't help much.

I will start upping more regularly. I am just afraid of dropping him too low, but I know he isn't where he needs to be at all.

I guess I've been doing the start low, go slow method but I will reread about the other method today to get a refresher on it and hopefully give that a try.
I did give 2.5u this AM, and will increase as soon as I see a few mid day tests.

How crazy is your life during this virus outbreak?

I am a nurse so it's been fairly crazy. I am actually going to be off for two weeks starting Saturday (our hospital is switching to a two week on/two week off policy for now) so I will have plenty of time for increasing, testing and monitoring since I will be quarantined.

How about you? Anything crazy?

 

[Deb & Wink]

Doing ok. Treasuring every day.

 

[Breanna H]

Tigger has been on insulin long enough, without getting good control, you either need to be increasing the Prozinc dose more rapidly and using the MPM (Modified Prozinc Method) protocol. Or consider switching to a different insulin.

So after reading the MPM post, it says if you're nadirs are above 200, you should increase .5u at a time. Tonight will be 6 doses at 2.5u, still no blues. Is it safe to increase to 3u starting Saturday? I will be home all day/everyday to monitor. I just want to check before I go ahead and just do it.

Also, if I still can't get blues, do you need a prescription for lantus? Doubt my vet will agree with why I want to switch considering she's telling me to still only be giving 1u and that I shouldn't be increasing how I am.

 

[Noah & me (GA)]

Today is someone else's birthday. Just saying is all.

 

[Deb & Wink]

How fresh is your Prozinc Breanna? Would you please make a prominent row on the SS, to show when you switched to a new bottle. Spread the note across the entire +1 to +11 columns just before the date you opened the new bottle.

Tonight will be 6 doses at 2.5u, still no blues. Is it safe to increase to 3u starting Saturday? I will be home all day/everyday to monitor.

MPM does say increase by 0.5U if nadirs are >200.
As long as you can monitor, go ahead and increase would be my recommendation.

Also, if I still can't get blues, do you need a prescription for lantus?

Yes, a prescription is needed for Lantus.

p.s. Not sick at this point. But I'm high risk and the Boston area is a hot spot for covid-19 right now. I'll stay here as long as possible, but you'll need to start taking control and making the dosing decisions yourself, if I'm not here, or no one else responds to you.

Print out the Prozinc Protocol and make a ton of notes.

For example, notes that I have made on my copy of the Protocol for the MPM version are:
Safeguards: 1. frequent monitoring, 2. feeding frequent meals or access to food with a timed feeder or wet food left out when you are not home. 3. Better to feed low carb vs feeding dry food.

I have a ton more notes, for the SLGS Prozinc protocol. They also apply to MPM protocol. Such as:
1. regulation first with prozinc, then better regulated and maybe remission
2. regulation is BG's in the 200's at nadir; better regulated is nadir's in the 100's or double digits >50
3. 50 or <, hypo territory, pull out the regular low carb food and feed small amounts to bring the numbers back up. Don't overfeed, you need your cat a bit hungry so he/she will eat more if the numbers stay low.
Don't resort to a simple sugar at the beginning of the lows. You'll only cause bouncing.
Pull out the medium carb foods if BG's in the 40's. High carb foods and/or simple sugar for the 30's.
Dry food should be your last resort to bring the BG's up fast, as it takes longer to digest and get into the bloodstream.

Simple sugar wears off fast. You need to monitor and see at least 2 rising numbers. By rising, I don't mean by only meter variance, I mean 15% or more. Until your cat is >80-90.

I have a ton more notes. Maybe I should put them in a document, and attach that.
And a lot of them are general notes, for any insulin and things I've learned over the years and gleamed from reading many threads and looking at many spreadsheets.

A lot of those notes are already in the lantus ISG documents. Look at those.

Print them out, see how they apply to you and Tigger.

 

[Breanna H]

How fresh is your Prozinc Breanna? Would you please make a prominent row on the SS, to show when you switched to a new bottle. Spread the note across the entire +1 to +11 columns just before the date you opened the new bottle.

I got my bottle the day Tigger was diagnosed, so December 18th, 2019. I opened it a few days later. I will add the column.

 

[Breanna H]

p.s. Not sick at this point. But I'm high risk and the Boston area is a hot spot for covid-19 right now. I'll stay here as long as possible, but you'll need to start taking control and making the dosing decisions yourself, if I'm not here, or no one else responds to you.

I hope you stay well! So scary right now!

 

[Deb & Wink]

I got my bottle the day Tigger was diagnosed, so December 18th, 2019. I opened it a few days later. I will add the column.

You may need a new vial of Prozinc. Although some people say they get many months of use out of a vial of Prozinc, that is not always the case.

Prozinc and any suspension type insulin (Vetsulin/Caninsulin, NPH) breaks down faster than a non-suspension insulin once the vial or pen rubber seal is breached. Shelf life, of an unopened vial or pen of Prozinc is a different matter. With correct storage, an unopened vial/pen can be good until the expiration date printed on the vial and accompanying box.

Your prozinc has been open for more than 90 days. Time for a new vial Breanna.

 

[Breanna H]

Your prozinc has been open for more than 90 days. Time for a new vial Breanna.

Just ordered a new vial from Chewy. Let's hope that's it. I was debating getting a new one incase I did make the switch to lantus, but I guess it's something I have to rule out first.

 

[Deb & Wink]

Breanna, I'm starting to feel sick. Slight fever. Not sure how long I'll be able to help here.

Please post on Feline Health, if no response here. Thanks.

 

[Breanna H]

Breanna, I'm starting to feel sick. Slight fever. Not sure how long I'll be able to help here.

Oh no! Hopefully, it will pass with no other symptoms. I'll be thinking of you and hoping for a speedy recovery!

 

[Breanna H]

Breanna, I'm starting to feel sick. Slight fever. Not sure how long I'll be able to help here.

Just thinking of you and hope you're doing well!

 

[Deb & Wink]

Yup, up to 4U tomorrow morning, 4/4/20. Saw on your SS that you forgot. Write yourself a note, and put it in with your testing supplies.

p.s. Hanging in there. Wish it would stop raining so much, so the sinus headaches would stop. Getting very foggy across the road, in the salt marsh.

 

[Breanna H]

Yup, up to 4U tomorrow morning, 4/4/20. Saw on your SS that you forgot. Write yourself a note, and put it in with your testing supplies.

Got my new bottle of Prozinc. I was going to wait a few more doses in hopes that it was just the dose that wasn't high enough but I figured I might as well just find out if it's the bottle that's gone bad. I was going to give a reduced dose with the new bottle, just in case. Would you go with 2u? 3u? Or just stick with my 4u from the new bottle?

Thanks, as always!

 

[Deb & Wink]

Or just stick with my 4u from the new bottle?

I'd suggest sticking with 4U, as long as you can monitor.

Would you go with 2u? 3u?

You certainly do not want to cut the dose by half (2U) or down to 3/4 (3U) of the current dose. Then you are basically starting all over again.

If you are around to monitor, you might consider a 0.25U reduction, to 3.75U.

But Tigger is rarely down in the blues, let alone the greens where you want to see him.
That is why I recommend you stay at the 4U for the new bottle of Prozinc.
Tigger has a long way to go with his BG levels, before he's down below 90 mg/dL. That is when you want to pay attention a bit, more attention if/when his BG's are <70.

I was going to wait a few more doses in hopes that it was just the dose that wasn't high enough but I figured I might as well just find out if it's the bottle that's gone bad.

I think the problem is that the dose is simply not high enough yet.

 

[Breanna H]

Hello! Checking in for some advice as usual. According to the modified method, if nadirs are >200, increase by .5u. However, I've been seeing some more blue numbers so I'm hoping I am finallyyy maybe getting closer to Tigger's right dose. So should I still go to 5.5 since most of his nadirs are still above 200? Starting my new bottle of Prozinc this Saturday since I will be home from work all day just incase the strength of that bottle is better.
Also, do you think Tigger may be bouncing? I'm not sure exactly what that looks like but at +4 last night he was 200, so I'm assuming he did drop lower than that over night. Then this AM he was 425! Would that be a bounce?
Just wondering what you thought on dosing.

Ps. My sister watched him over Easter weekend. Both sides of my family quarantined for 2 weeks straight (we literally all went no where) so we would be able to see each other before I had to return to work for 2 more weeks. Tigger really doesn't like her so his numbers weren't his usual and I adjusted the dose to make sure he was safe.

 

[Deb & Wink]

Tigger's nadirs are coming down to the blue number range (100-199 mg/dL) but then not staying there for long at all.
You want more than a single blue number, in the 3-6 cycles where you hold the dose after an increase.

Yes, that red on AMPS on 4/15 could be a bit of a bounce.
Are you able to get a test in after PMPS this evening?

Time for another 0.5U increase.

 

[Breanna H]

Are you able to get a test in after PMPS this evening?

Yes, I can get one at the usual +4 tonight. Would +6 be better? I can always set an alarm to wake up and get it.

 

[Deb & Wink]

Would it be possible to do both?

 

[Breanna H]

Would it be possible to do both?

Yes I can