Need advice

Celi

Celi

Member Since 2020
Angel was diagnosed almost two months ago and put on 4U twice a day. After I joined this group, I lowered the dose and thought she was doing pretty well until I did our first curve and saw the steep drop - in 2 hours from 199 to 63. Now I am unsure of what dose to give her. I posted her curve and spreadsheet on the FB group site.
 
Hello and welcome. Any chance you can copy that spreadsheet over here? It'll help even more if you can put it in your signature. Here's how and what we need:

“New? How You Can Help Us Help You!"

People here need to see that spreadsheet, I suspect whatever dose you are giving now, may be too high. What food are you feeding? Has that changed lately?
 
I know of at least 5 different facebook groups for feline diabetes, in 3 different languages.
We have no idea which facebook group you belong to, or the name you use there.

Wendy gave you the link for setting up your signature and linking your SS there.

When you get your spreadsheet linked here into your signature, I'd be happy to take a look. Tag me if you want. It's the @ symbol directly followed by my user name. @Celi There I just "tagged" you.

What meter are you using? That's very important to know also. That info goes in your signature too.
 
Celi said:
Angel was diagnosed almost two months ago and put on 4U twice a day. After I joined this group, I lowered the dose and thought she was doing pretty well until I did our first curve and saw the steep drop - in 2 hours from 199 to 63. Now I am unsure of what dose to give her. I posted her curve and spreadsheet on the FB group site.
Click to expand...
 

Attachments

  • A0717D47-3AFF-40AB-B34A-1B783CB4EF22.jpeg
    A0717D47-3AFF-40AB-B34A-1B783CB4EF22.jpeg
    77.5 KB · Views: 197
Ok, I can see some of the spreadsheet, but when I try to zoom, the numbers become blurry. I can see the colors on the SS, but when I try to zoom it to see the actual numbers, they become too blurry to tell if the numbers are low blues, <150 or high blues >150.

The 1U was too much. Our protocols here for Prozinc would have you reduce the dose if your cat's BG's fall under 90 mg/dL.That is using a human meter and the SLGS protocol.

You reduced the dose on 3/24/20 after getting that low green, looks like in the 60's somewhere. Good. I see you also reduced the dose on 3/26/20, after you got another low green, another 60 something. Good.

I would not recommend more than the 0.5U dose you are giving now. You do need to test during the mid-cycle, every day that you can. You also need to test at night, or you are missing half your data. Many cats go lower at night.

What is your life/work/responsibilities like these days?

I have no idea what meter you use, or what protocol you are following. Would you please add some information to your signature, so we know what meter you use. Also, your first name, cat's name age and sex, DX (diagnosis date), insulin used, meter used, protocol used, and any other pertinent info. Also please include the link to the spreadsheet (SS).

Please, please, please give us a bit more info so we can help you better.

Sorry Celi, but that is only a temporary attachment.

If you follow these instructions, it will permanently attach a read-only view of your SS to your User Id "signature".
FDMB Spreadsheet Instructions

Would you please do that?

Thank you.
 
Spreadsheet above. Angel eats mainly wet food weruva chicken cherish and wellness tiny tasters chicken are her current favorites. Also have freechoice out for her and my other cat Young
Again
Celi said:
Angel was diagnosed almost two months ago and put on 4U twice a day. After I joined this group, I lowered the dose and thought she was doing pretty well until I did our first curve and saw the steep drop - in 2 hours from 199 to 63. Now I am unsure of what dose to give her. I posted her curve and spreadsheet on the FB group site.
Click to expand...
Celi said:
Angel was diagnosed almost two months ago and put on 4U twice a day. After I joined this group, I lowered the dose and thought she was doing pretty well until I did our first curve and saw the steep drop - in 2 hours from 199 to 63. Now I am unsure of what dose to give her. I posted her curve and spreadsheet on the FB group site.
Click to expand...
 
Thank you, thank you, thank you, so much for that signature info and the SS link in your signature. It makes a huge difference, when we are short handed and trying to help so many people these days. Covid-19 has hit us here too.

Would you please add you meter to the SS (spreadsheet). Up at the top of the SS, there is a spot that says "Meter:" It's an orange colored box, below the dosing method. So it should say Meter: Alphatrak.

Knowing you use an Alphatrak makes a BIG difference when seeing BG (blood glucose) numbers <100 and in figuring out if you need to increase/decrease the dose.

Angel is bouncing, because you skipped the dose last night. Also, it's very likely that Angel dropped lower at night. A regular before bed test is a good idea, every day. Would you be able to do that PM test?

Are you able to get any BG tests in during the AM cycle today? Please get a BG test this AM as soon as you are able to. I have a feeling that Angel will be dropping too low. You do not want her lower than 68 mg/dL when using an Alphatrak pet specific meter.

I think the 0.75U dose is a bit too much for Angel. Highly recommend reducing that dose to 0.5U for now. You want to find an insulin dose that you can give twice a day.

My recommendation is that you please reduce the dose to 0.5U, Perry.

p.s. Your SS is now a permanent view only link. I'll be able to click on the link in your signature, and open the SS to see what is going on with Angel.
 
Last night 2/28 she was 79 so no insulin. I tested at +3 and she was 144. This morning she was 142. Gave her .5 and at +3 she was 95. I hope we are in the right track.
 
If you are able to test around +5 to +7 timeframe, that could be very useful.
1. To make sure that Angel is not too low.
2. To try and find the nadir, or lowest point this dose of insulin takes her.
 
Good job!

That gives you a bit more information, and helps to see that there were no huge variations in the BG numbers this cycle.

Try to vary that mid-cycle BG test. A +5 one cycle, a +6 the next. Trying to find the nadir or low that Angel gets.
Notes in the Remarks column on the SS can be very helpful. To help interpret the swings in the BG levels during the cycle.
 
Woah! Good thing you gave Angel some food at +5. That 66 is kind of low for an Alphatrak.
Would you please test again, within 30 minutes of that +5?

p.s. Angel has "earned" another dose reduction.
 
These pictures show U100 syringes, and you are using U40 syringes with the Prozinc.
But the concept is the same, of where to position the end of the syringe plunger for those tiny doses.
01unit-1.jpg

025unit-1.jpg


Do you think you can measure out that tiny 0.25U for Angel? Starting with tonight's dose.

p.s. I think Angel may be trying to go OTJ.
 
She was 69 at +5.5 and yes I can reduce to .25 tonight. But what if she is high when I test at +12? Should I reduce anyway?
 
Yes, Absolutely. She "earned" that reduction, by getting that low today.

p.s. Starting to run a fever. Not sure how much I'll be able to help the next few days.

Please post in Feline Health forum if you don't get an answer here, in the Prozinc ISG.
 
So sorry you are not feeling well. Sending good thoughts and prayers! Thank you for all your help. I really appreciate it!
 
Ummmm. That's not a bad "Ummm", it's a good "ummm."

Yes, those numbers are wonderful.
But, if you are using the SLGS (Start Low, Go Slow) prozinc dosing protocol, that 81 today is another "earned" dose reduction.

"Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately."

Not sure that Angel would "Hold" a reduction down to 0 insulin. She has had back to back reductions the last few days. So although the protocol says to reduce by 0.25U again, it may be too soon.
Option 1 would be to hold the dose at 0.25U.

There is a second option. Reduce the dose to 0.1U. Go back up to reply #15, to see the picture of what that would look like in a syringe with half unit markings.

Third option, is to reduce the dose to 0 (zero) and see how Angel does.
Your choice, you hold the syringe.

Worst case, if you reduce to 0 units which is no insulin, then you may need to restart the insulin at some point.
No big deal.
 
Thank you. I will hold the dose at .25 since we just started that and see what happens tomorrow. I hope you are feeling better.
 
Just tested and got a 55. She seems fine and ate a good lunch which will hopefully bring her numbers up. What should I do tonight? Smaller dose? None at all? Or should I wait and see what her numbers are?
 
First, what happened on 4/2/20? No row on the SS for that date.
That 55 with the Alphatrak is another earned reduction for Angel.
So smaller dose. Or none at all.

The next 2 lowest doses you can do, are 0.1U or "Some" insulin. Pictures of those 2 doses are below, shown with U100 syringes, but the concept of plunger placement is the same with U40 syringes.
someinsulin-1.jpg
01unit-1.jpg


Can you test in the PMPS cycle, at +2 and before you go to bed?
I think Angel is trying to go OTJ, into diet controlled remission.
 
I added yesterday’s numbers. I will give the .1 dose tonight and test at +2 or +3. Thanks so much - makes mefeel so much more comfortable knowing I have the support of someone experienced.
 
Some of the rows on the SS seem to be out of order.
3/29, 4/2, 3/30, 3/31, 4/1, 4/2, 4/3 is the current order.

Would you please double check that you have the correct BG date associated with the correct dates?
Also, if you scroll down the SS , at row 69, there is a comment in the +5 column for the PM cycle.
Thanks.
 
Deb & Wink said:
First, what happened on 4/2/20? No row on the SS for that date.
That 55 with the Alphatrak is another earned reduction for Angel.
So smaller dose. Or none at all.

The next 2 lowest doses you can do, are 0.1U or "Some" insulin. Pictures of those 2 doses are below, shown with U100 syringes, but the concept of plunger placement is the same with U40 syringes.
someinsulin-1.jpg
01unit-1.jpg


Can you test in the PMPS cycle, at +2 and before you go to bed?
I think Angel is trying to go OTJ, into diet controlled remission.
Click to expand...

i think I have the SS corrected. I will test tonight.
 
Thank you.

If you have read a reply, if you would click on the "Like", that let's us know you have read it.
In my mind, that is the only useful function for the "Like". Don't care how many people are reading a reply, simply need to know that you have.

Sometimes, I will only click on the "Like" to let you know I've read your post, but have no additional comment.
 
I am excited! 67 at +5 and 117 tonight. We are skipping insulin tonight and we’ll see what tomorrow brings. Fingers crossed!
 
Looking good Angel. Good thing you skipped Perry.

I think that Angel may be ready for an OTJ trial.
Would you like to try that? No insulin for 14 days.

Angel does not strictly meet the criteria, but I think it's worth a shot. I'm suggesting this, since Angel has been having such low mid-cycle numbers and you are giving such a tiny dose. Like that BG of 67 at +5 today, 4/4/20.

Here are the general instructions.

OTJ Trial Guidelines (These are the criteria we use when following an OTJ Trial.)

Here are the instructions for an OTJ trial: If on Lantus or Levimir, depot has to drain first before trial starts, about 3 days or 6 cycles. No depot with in and out type insulins (NPH, Vetsulin/Caninsulin, Prozinc). The trial starts when numbers are in the range of a healthy cat (50 - 80 mg/dL), but under 100 overall... with only occasional readings in the 100 - 120 range. Start the trial on the next green pre shot.

If you are posting in the Lantus/Levimir forum, please start a new thread each day which says ‘[Cat name] OTJ trial Day 1 BG xx’ (where xx is the BG reading for that cycle PM), then day2,3 etc. If you are posting in the Main Forum, we don’t require you or need you to do that separate post for each day. In fact, if you have never posted before over in the Lantus/Levimir forum or use a different insulin, you are fine staying in the Feline Health (Welcome & Main Forum). Or in the specific ISG (Insulin Support Group) for your insulin. We’ll cheer you on!

1. Test at your normal AMPS and PMPS times. Remember, you want a 2 hour fast before those AMPS and PMPS test times. Feed multiple small meals throughout the day as much as possible (small meals are less likely to overwhelm a newly functioning pancreas). The morning test is now called the AMBG. The evening test is now called the PMBG.

2. If your cat is green (0-99 mg/dL human meter, 0-130 mg/dL pet meter, 0-5.5 mmol/L) at your normal test times, no need to test further until the next "PS" time, just feed small meals and go about your day. If the numbers are blue or higher (100-199 human meter, 130-230 petmeter, 5.5-11 mmol/L), feed a small meal and test again after about 3 hours. Food raises BG's. So if the number is lower 3-4 hours after a meal, then the pancreas is working!

3. Your cat may have a sporadic blue number. Don't panic but post before you decide whether to shoot so we can have a discussion.

4. After 2 weeks, 14 full days, if everything is looking good, we have a party!

Sometimes, the trial doesn't work the first time and we have to give a little more support by starting the cat with a tiny dose of insulin again. I had to do that with Wink. We simply start the cat back on a tiny dose of insulin to support the pancreas with healing for a bit longer. Our goal is a strong remission and it's better to be safe now then sorry later that you rushed it. With just a little more time we will probably get that strong remission we are looking for.

Are you ok with trying that OTJ trial Perry?
 
I will give it a try but her numbers preshot are over 100 so if I have to wait for a green number to start, I don't quite understand how that works.
 
Yes, Angel's numbers are over 100 at pre-shot. But the dose you are giving her is so low, at 0.1 unit, there isn't much lower you could go with the dose. You could try doing one drop.

So what I'm saying, is ignore the usual requirements for the pre-shots to be <100 before you start an OTJ trial.
Those mid-cycle tests are so low, close to hypoglycemic numbers, that I think giving any insulin to Angel at this point is endangering her life.

If you would like to try drop dosing instead, I did a write up on that.
 
Drop Dosing

How many drops do you get from your insulin syringes if you draw the liquid up to the first line? Not the first line with a number next to it, or the shorter line that shows half unit markings. The very first line on the syringe. What we think of as the zero mark.
  • Practice, practice, practice to see how many drops you can get out of the syringe.
  • Use some sort of colored clear juice like apple juice or colored water.
  • Mark the syringe well. Painter's tape, duct tape, masking tape at the top of your “practice syringe”. So you don't forget and use that syringe to draw up insulin.
  • Draw the "test liquid" up to the first line on the syringe.
  • After you have drawn up a tiny bit of “test liquid”, point the needle up towards the ceiling and give the syringe a "finger flick. Push out the air bubbles.
  • Slowly “twist” the syringe plunger to push out all the “test liquid.”
  • Then when one small drop of “test liquid” is all that is left on the beveled tip end of the needle, draw the syringe plunger back to "suck" that 1 drop back into the syringe.
  • You are looking for consistency.
  • Try to get evenly sized drops.
  • Practice, practice, practice until you get a consistent number of drops.
Do you think you have the technique down for the drop dose?

Then let me know.

When it’s for real. You’ve practiced and are ready to give a tiny “1 drop” dose.
  • Draw up a tiny bit of insulin, needle pointed up to the ceiling and give the syringe a "finger flick. Push out the air bubbles.
  • Slowly “twist” the syringe plunger to push out all the insulin.
  • Then when one small drop is all that is left on the beveled tip end of the needle, draw the syringe plunger back to "suck" that 1 drop back into the syringe.
"Finger flick” technique - make a circle with thumb and first 2 fingers tucked into first thumb joint. Quickly “snap” those first 2 fingers against the syringe barrel held in your other hand. That will force any air bubbles up to the top of the syringe. Then you can push the air bubble out.

Syringes have a lubricant inside. Before you draw up insulin, moving the syringe plunger up and down a couple of times helps the plunger move more easily.

Give the shot. Monitor.

Later, if you need to, you could increase the number of drops.
 
Deb & Wink said:
Looking good Angel. Good thing you skipped Perry.

I think that Angel may be ready for an OTJ trial.
Would you like to try that? No insulin for 14 days.

Angel does not strictly meet the criteria, but I think it's worth a shot. I'm suggesting this, since Angel has been having such low mid-cycle numbers and you are giving such a tiny dose. Like that BG of 67 at +5 today, 4/4/20.

Here are the general instructions.

OTJ Trial Guidelines (These are the criteria we use when following an OTJ Trial.)

Here are the instructions for an OTJ trial: If on Lantus or Levimir, depot has to drain first before trial starts, about 3 days or 6 cycles. No depot with in and out type insulins (NPH, Vetsulin/Caninsulin, Prozinc). The trial starts when numbers are in the range of a healthy cat (50 - 80 mg/dL), but under 100 overall... with only occasional readings in the 100 - 120 range. Start the trial on the next green pre shot.

If you are posting in the Lantus/Levimir forum, please start a new thread each day which says ‘[Cat name] OTJ trial Day 1 BG xx’ (where xx is the BG reading for that cycle PM), then day2,3 etc. If you are posting in the Main Forum, we don’t require you or need you to do that separate post for each day. In fact, if you have never posted before over in the Lantus/Levimir forum or use a different insulin, you are fine staying in the Feline Health (Welcome & Main Forum). Or in the specific ISG (Insulin Support Group) for your insulin. We’ll cheer you on!

1. Test at your normal AMPS and PMPS times. Remember, you want a 2 hour fast before those AMPS and PMPS test times. Feed multiple small meals throughout the day as much as possible (small meals are less likely to overwhelm a newly functioning pancreas). The morning test is now called the AMBG. The evening test is now called the PMBG.

2. If your cat is green (0-99 mg/dL human meter, 0-130 mg/dL pet meter, 0-5.5 mmol/L) at your normal test times, no need to test further until the next "PS" time, just feed small meals and go about your day. If the numbers are blue or higher (100-199 human meter, 130-230 petmeter, 5.5-11 mmol/L), feed a small meal and test again after about 3 hours. Food raises BG's. So if the number is lower 3-4 hours after a meal, then the pancreas is working!

3. Your cat may have a sporadic blue number. Don't panic but post before you decide whether to shoot so we can have a discussion.

4. After 2 weeks, 14 full days, if everything is looking good, we have a party!

Sometimes, the trial doesn't work the first time and we have to give a little more support by starting the cat with a tiny dose of insulin again. I had to do that with Wink. We simply start the cat back on a tiny dose of insulin to support the pancreas with healing for a bit longer. Our goal is a strong remission and it's better to be safe now then sorry later that you rushed it. With just a little more time we will probably get that strong remission we are looking for.

Are you ok with trying that OTJ trial Perry?
Click to expand...
Deb & Wink said:
Yes, Angel's numbers are over 100 at pre-shot. But the dose you are giving her is so low, at 0.1 unit, there isn't much lower you could go with the dose. You could try doing one drop.

So what I'm saying, is ignore the usual requirements for the pre-shots to be <100 before you start an OTJ trial.
Those mid-cycle tests are so low, close to hypoglycemic numbers, that I think giving any insulin to Angel at this point is endangering her life.

If you would like to try drop dosing instead, I did a write up on that.
Click to expand...
Deb & Wink said:
Yes, Angel's numbers are over 100 at pre-shot. But the dose you are giving her is so low, at 0.1 unit, there isn't much lower you could go with the dose. You could try doing one drop.

So what I'm saying, is ignore the usual requirements for the pre-shots to be <100 before you start an OTJ trial.
Those mid-cycle tests are so low, close to hypoglycemic numbers, that I think giving any insulin to Angel at this point is endangering her life.

If you would like to try drop dosing instead, I did a write up on that.
Click to expand...
Deb & Wink said:
Yes, Angel's numbers are over 100 at pre-shot. But the dose you are giving her is so low, at 0.1 unit, there isn't much lower you could go with the dose. You could try doing one drop.

So what I'm saying, is ignore the usual requirements for the pre-shots to be <100 before you start an OTJ trial.
Those mid-cycle tests are so low, close to hypoglycemic numbers, that I think giving any insulin to Angel at this point is endangering her life.

If you would like to try drop dosing instead, I did a write up on that.
Click to expand...

i will start the trial and see what happens. I don’t want to give insulin if she can make her own. And it is hard enough to measure the .1 dose.
I really thank you for all your help. I am in awe of the expertise I have seen in this group!
 
Angel’s AMBG was 117 this morning! Trying not to get too excited but this is 24 hours without insulin.
 
Awesome! Hope Angel's pancreas can produce some insulin on it's own.

The countdown has started. Go Angel!!!!!

p.s. 117 seems to be her lucky number.
 
Hope it's only a temporary blip higher. Still hopeful.

So remember, when you get those numbers on a pet meter like the Alphatrak, higher blues >130, you want to test again around +3 or +4. To see if the pancreas is working a bit, and is producing insulin on it's own. If it is, that +3 or +4 test should be lower than the pre-shot.

In the meantime, go back up to post #33 and read about drop dosing. Just in case you need to do that, now would be a good time to learn. "Practice makes perfect."
 
Don't fret, Perry. Even if Angel ends up needing a titch of insulin for a while, that doesn't mean she isn't headed for remission. Sometimes a wee bit more is what cements that strong remission. Deb has a great idea about practicing the drop dosing, just in case you need it.
 
Worth a try. Human diabetics are advised to do that sometimes, a before bed snack.

My human diabetic friend tried that and is still a bit high in the morning.
 
My Billy, when he was doing an OTJ trial, did better with one of his small meals before bed. If he didn't eat it for some reason, his morning BGL was always a bit high. So that before bed snack is worth a try.
 
High again this morning at AMBG 163. I will test at +4 and we will carry on from there. Not giving up on the trial yet.
 
Ok, if you get a high AMBG or PMBG, test again right away. Within 5 minutes or so without food. To double check the first test.

Do you have enough test strips to do that?
 
You must log in or register to reply here.
Back
Top