Scared, Confused, Lost, Worried, Part 3

Discussion in 'Prozinc / PZI' started by Irish Pat, Mar 29, 2020.

  1. Irish Pat

    Irish Pat Member

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    http://www.felinediabetes.com/FDMB/threads/scared-confused-lost-worried-part-2.227516/

    Prozinc 1.5 Units

    Hello all its guy Pat again, lol. Well I have been starting to check his BG again just a few times during each cycle. Once again confused. I raise the amount of insulin he is on and its seems his numbers go up. However, after the PMS his numbers go down to a nice level....During the day however, they don't they hang in the mid 300's. We are very pleased with Brady's progress so far as, he isn't drinking that much water at all, urinating normally, eating well (bugs us quite a bit between 1.5 to 2.5 hours before his meals, depends on the day) He is between 17 and 16.5 lbs, which means he should get about 340 calories a day. He pretty much eats 2 cans of Friskies lower carb cans a day, on average a can is about 180 calories or just a little more. He eats just about 3/4 of a can for his AMPS meal and 3/4 of a can before his PMPS meal. He gets the leftover 1/4 from each can, one of them about +6 after his AMS and one of them about +5 hours before I go to bed after his PMS. Just really confused as to why his counts go up even though I raised his insulin. Any input would be helpful. Im really wondering how much his pancreatitis is hanging on and casuing most of this, just don't know. He goes for complete blood work April 15th, guess that will tell us more. Hope all is well with everyone.
     
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  2. JOJI and Kit

    JOJI and Kit Well-Known Member

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    this was similar with kit especially in the beginning and until we got into a rhythm with her "small meals" during the morning and the evening.

    for those hardest times during the 2hrs before a shot when you can't feed, we have taken up different activities to pass the home stretch time.
    some of the time exercise works wonders, other times we set her in front of the "birds and squirrels" channel at one of her window locations far from her feeding spot, and sometimes we just sit with her quietly to meditate away the time.

    also, not to stress you out, but pay attention to brady chewing on non-food stuff that he might find around. we happed upon kit early one morning as she finished a 17" piece of string. thankfully she passed it through without incident. but, yeah, they get creative .... nom. nom.
    ^jw
     
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  3. Irish Pat

    Irish Pat Member

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    Thank you so much for replying, was getting worried nobody was reading my stuff or wanted to give advice....Oh trust me, Brady already has destroyed a few rolls of TP, and we need that...He also got into some plastic, but he is ok...Just have to put everything up....This is so difficult, one day he is just a sweet little boy, the next he has diabetes.

    One of the biggest questions I have and cant seem to find an answer is how much does a cat need to eat before his shot. Some days he eats good, some days he picks, eats maybe half of his meal, so we add crumbled up treats to make him eat more because im so worried about how much he has to eat. I asked the vet and really didn't get a good answer.

    Trust me I understand he didn't get this disease overnight and it will take time to get this under control. Just wish I knew what under control meant, he just seems to jump all over the place. Sometimes I think his BG may be going up because he is stressing from being hungry, I don't know. Today he was at 224 AMPS, knocked him down to 1U today and then he went clean up to 461 PMPS. Had a good number at +5 and then downhill from there, I get so excited at good numbers and then it hits you like a ton of bricks when it jumps up so high again. Guess I should have given him 1.5U again this morning....Im not going to lie, im scared to death of him going hypo, that's the last thing I want to happen to him or us at this point. The vet seems to think he will be fine and to quit worrying.....Worrying is in my blood, not a good thing I know, but its who I am....

    Sorry to go on a rant again, but thank you for answering
     
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  4. Deb & Wink

    Deb & Wink Well-Known Member

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    Brady is bouncing! Big time.

    • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
    Thought I had replied. Guess not. See above and below.

    On 3/27/20, his BG dropped to the blues. Then his body would have dumped sugars and hormones into his body, to compensate and bring those numbers back to what it considers a safe level. Then, that black pre-shot number, on 3/28/20 AM is a bounce from the lows the night before.

    Black = bouncing (or not enough insulin) but more often bouncing, 90% of the time.
    That bounce kept Brady high for the entire AM cycle 3/28.
    Then, another low, during PM cycle on 3/28, caused another bounce to the red numbers for 3/29 AM pre-shot.

    Not sure why you raised the dose back up, from the 1.25U dose to 1.5U.

    I think you need to drop back down to 1.25U, and hold it there for 6 cycles, even if you have higher pre-shots. You need to hold the dose for awhile, so he can clear those bounces.

    Prozinc is not dosed on the pre-shots. Prozinc needs to take those nadirs or lows into consideration when doing dosing changes. Pre-shot tests are given some consideration, but you have to look at the past BG levels and learn to interpret the SS. In waves of action, learning to recognize the see sawing and learning when a low like those blues you had last night mean. A bounce will be happening the next cycle and to hold off on a dose increase.

    Also, you could have fed Brady a bit of food last night, when you got that 105 at +5. That could have evened out the cycle a bit.

    You can't hammer down the BG numbers with more insulin. Slow and steady wins the race with insulin dosing. More consistency in the dosing, instead of dosing on a sliding scale or such frequent dose changes as you are doing will be better for Brady in the long run. Patience my friend.

    p.s. Pat, I'm starting to run a fever. If no replies here, please post over in Feline Health.
     
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  5. Irish Pat

    Irish Pat Member

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    Oh Deb im so sorry to hear about your fever, where are you from? That's way more important and I will pray you are ok.

    I moved his insulin up because the vet is hammering me to go to 2U, I guess I was trying to combine the two ideas, the forums idea and the vets idea, so I met a little in the middle and went 1.5U.

    We guess at the 1.25U's because there is no line for that on his syringe, we pick right in the middle of 1 and 1.5 units. So do you think it would be practical to stay at the 1.5 for a bit longer or drop back down to the 1.25U at this point. Also when you say 6 cycles, how long is that in days?

    We do feed Brady around that +5 point in the evening, just a 1/4 can of Friskies, he usually destroys that portion.

    I truly hope you are ok and feel better soon.
     
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  6. Deb & Wink

    Deb & Wink Well-Known Member

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    A cycle is 12 hours, so 6 cycles is 3 days. Or 3 24 hour periods, because sometimes you change the dose in the middle of a day/24 hour period, so that is why we say 6 cycles instead.;)

    p.s. Massachusetts.
     
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  7. JOJI and Kit

    JOJI and Kit Well-Known Member

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    we went a few rounds w the vet on how much food kit should be getting. early on, we felt it was just too little overall and we "negotiated" for more based on catinfo.org ideal weight and calories. kit wasn't really overweight, so restricting was kind of silly. she now gets like 260-270 calories a day divided equally AM and PM.
    her pre-shot meal is half of either AM or PM total. her next two mini meals are typically quarter, quarter portions. (you can see all the details in our ss. ask questions if it's not clear). also, we stopped "eye-balling" and started weighing her portions. we already had a kitchen scale, so that was an easy call for us.

    so, to your question on the amount before shot. we go with "most" of the shot meal. as we've learned from deb and others, a reasonable target w prozinc for BG, feed and shot all done is a space of 15min. sometimes, kit just doesn't eat quite enough in that time frame for us to feel comfortable with the shot, so it could take us a little bit longer than 15min to get everything done.


    that's a natural response; we tried that at first as well. now, we use the protocol and ask for help here.

    always feel free to hit us w an "at"
    we can't give dosing advice, but hopefully we can help you in other ways.

    ^jw
     
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  8. Irish Pat

    Irish Pat Member

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    @JOJI and Kit

    I was looking at your SS, what does the s2 stand for on your March 30 PMPS mean?
     
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  9. JOJI and Kit

    JOJI and Kit Well-Known Member

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    "skinny 2U"

    i.e. (a little less) dose
     
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  10. Irish Pat

    Irish Pat Member

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    Oh, thank you...wasn't sure what that meant
     
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  11. Deb & Wink

    Deb & Wink Well-Known Member

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    F2.0 or 2.0F would be a Fat dose, or a tiny bit, a smidge more than the 2U "end of the plunger on the line" dose.
     
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  12. Irish Pat

    Irish Pat Member

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    @Deb & Wink @JOJI and Kit

    So let me ask you this then, now that I learned something new today with the F and the S. Is that small amount of insulin really make a big difference. I mean I know a Unit of insulin doesn't appear to be a lot but when you start talking a smidge that gets my curiosity on what kind of difference it makes??

    How you feeling Deb?
     
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  13. Deb & Wink

    Deb & Wink Well-Known Member

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    Well, no way to really tell if the skinny and fat doses do too much. But if the cat is just a tad bit high, not high enough to need a full 0.25U increase, than a "Fat" dose can be tried. Conversely, if the cat is just a tad too low, then, "skinnying" the dose may be enough to squeak through the current cycle and for a couple of cycles more.

    Insulin syringes aren't known for their complete accuracy, as to where the lines are printed on the syringe barrel. It's why some folks measure the dose with digital calipers. Dosing with Calipers

    Someone recently, over in the one of the forums, can't remember which one, mentioned that the syringe manufacturer customer service/sales rep admitted that their syringes could be off by as much as 0.3U. So when dosing such small doses to our cats, and to human children, then your strive for the best you can do, to keep the dose consistent, from one shot to the next.

    Found that thread that talked about the syringe inaccuracy. It was over in the Tresiba ISG group, about a week ago.This one:
    http://www.felinediabetes.com/FDMB/threads/what-should-we-expect.226246/#post-2548099

    Wendy&Neko said "Also very interesting that you got a manufacturer to admit there can be a 0.3 unit fluctuation in the stamped scale on the syringe! I think many of us have found there is easily that much difference on some. Which is why some of us are now using digital calipers to measure the dose. It helps with fattening and skinnying the dose too. More info here if you are interested."

    It's possible to make a "reference syringe" by drawing up some colored liquid in a used syringe, and then trying to match that amount with the actual dose of insulin.

    p.s. Hanging in there. "Hit the wall" and had to nap this afternoon. Could barely keep my eyes open, think I nodded off at the computer.
     
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  14. Irish Pat

    Irish Pat Member

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    So let me ask you guys this, I was thinking about this in bed last night. So, I take Brady to the vets on the 15th to get bloodwork done again. Not sure why im doing that or if it is necessary. Could you guys shed some light? He is eating fine, I take his BG and the vet checks it from time to time. He is not lethargic or vomiting, other than bouncing all over the place with his sugar numbers, I mean he is doing ok. So why would the vet want complete blood work done at this point? She wants to check him again for pancreatitis, but he already had been dx with panc and they really don't have him on anything but cerenia at this point. Since you guys are experienced in this, can you tell me why she wants to do another complete bloodwork one month into his diabetes diagnosis? And what will the results change, he is on insulin, he is on cerenia, what could bloodwork change in his treatment?
     
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  15. Juls and Billy

    Juls and Billy Member

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    I'm guessing she just wants to see if the numbers are improving, maybe get a fructosamine test and check his pancreas. We had Bill in about a month after his diagnosis, but they just did the fructosamine, which was $99. I guess it was good to know, but we already knew he was doing great from his BGL tests. It ended up being just another added expense too soon after his very expensive diagnosis.

    If Brady isn't having any difficulties, you might put it off another month. Or ask the vet if she can only do what tests are absolutely necessary instead of a full panel.
     
  16. JOJI and Kit

    JOJI and Kit Well-Known Member

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    we did fructosamine once after the first couple/few of weeks. i don't think we were testing at home much yet at that point. but when the vet suggested another one a couple of week's ago we said no thanks bc we see her numbers every day at this point.
     
  17. Deb & Wink

    Deb & Wink Well-Known Member

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    First off, Brady earned a dose reduction, from 1.5U to 1.25U because of that 87 today 4/1/20 at +7. Per the prozinc dosing protocol for SLGS. Reduction should be at the next cycle, the PM cycle if you see this in time. Eyeball it the best you can.

    Share Brady's SS (spreadsheet) with your vet.
    Tell your vet, you'd rather "stay at home" to avoid any potential exposure to the covid-19 virus.
    Basically, do a "telemedicine" checkup with your vet and Brady and what is going on.

    The fructosamine will not tell your vet anymore about the blood glucose levels than your daily testing is doing. Vet's aren't used to having people home testing. It's why they want to do those fructosamine tests, for those clients who do not home test, or who do not home test enough.

    As long as Brady is not showing any acute symptoms of pancreatitis, I don't think another fPLI test is warranted.
    Pancreatitis can be acute or chronic. It's usually only when your cat is showing symptoms, not eating being a major symptom or "meatloafing" because of the pain of pancreatitis, that any testing is needed, in my opinion.

    I don't know why your vet thinks another complete bloodwork is needed right now. Email and ask. Call and ask.

    The results are unlikely to change the treatment. Unless Brady had some underlying condition that you have not mentioned. Or is having some new symptoms that are troubling.
     
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  18. Irish Pat

    Irish Pat Member

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    Good morning...I didn't read this post in time, I stayed with the 1.5 U last night and this morning...had a lot going on yesterday. Anyway, I will monitor his levels today. As you can see at his +10 from his AMPS number it went up to 312, that was after he ate, he ate his 1/4 can at the +7 mark, so im assuming that food raised him right back up and then finally to a 454 at his PMPS. Again, this is the part that is super super confusing to me. Im trying to understand the goal of his insulin. What are we trying to accomplish. Are we trying to accomplish a steady BG level throughout the entire day or are his PS numbers always going to be high and then the insulin will get them leveled out throughout the 12 hour period.

    I have been trying to stay with a dose for a period of time to see what is going on and his numbers are still all over the place, so again, im trying to see what are goal is...

    As far as any other conditions, there are none, at least there was no other diagnosis given to us on anything. Just the pancreatitis and the diabetes. I have given you guys everything I know about him. I mean he did have a skin lesion that was diagnosed as spindle cell cancer but that was all taken care of about 5-6 years ago now. The vet got it all when she removed it.

    The vet didnt mention fructosamine test, just a complete bloodwork panel and the panc test. I am going to call and see what her reasoning is, i didnt know if this was something that was done to all cats at this stage of the diagnosis. His apt isnt until the 15th so i will wait a little to get in touch with her and let you know what was said.

    I will watch his numbers today and wait until you guys evaluate his SS and give me advice on what his "goal" numbers are to be and then move is insulin to the 1.25U if warranted.

    Thank you everyone

    @JOJI and Kit Wow looking at Kit's SS, your baby is just like mine all over the place with the BG levels.
     
    Last edited: Apr 2, 2020
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  19. Deb & Wink

    Deb & Wink Well-Known Member

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    With most insulins, the pre-shot numbers will stay high for some time. Those are the last of the BG numbers to come down. Your goal is to get the mid-cycle numbers lower, but not so low that your cat may go too low into hypoglycemic (low blood sugar) numbers and show symptoms of hypo. It's why I recommended you decrease the dose last night.

    It's why our Prozinc protocols have the limits that they do. Experience with hundreds of cats and some very talented people created and recently updated those protocols.

    When a cat's BG levels drop too far, too fast, their body reacts and dumps protective hormones and glucose into the bloodstream to bring your cat back up to what it considers safer numbers. See back a post #4 for an explanation of bouncing.

    It's what Brady was doing last night and again today. There's a very good chance, that Brady's BG levels were even lower at +5, +6 yesterday 4/1/20 before you got that BG test of 87.

    As time goes on, Brady's body will get used to some of those BG levels, and won't bounce so hard. Over time, you can learn to shoot the insulin with lower and lower pre-shot readings as you gather more data.

    Also, feeding a cat much past the middle of the 12 hour cycle, when the insulin is basically "used up", will simply cause your cat's BG levels to rise higher and faster towards the end of the cycle. So generally, no food after +6 is a good idea.

    Yes, I still think you should reduce Brady's dose to 1.25U. It will take him some time, a few cycles, to clear this bounce, but when he does, the BG levels will drop lower. I think Brady is just slightly overdosed at this point.

    Are you testing for ketones daily?

    Would you please start to make notes on the SS in the Remarks column, on what + times you are feeding? Similar what J&J are doing for Kit. It will help to add more info for those people taking a look at your SS and trying to see the patterns in the numbers in context with other factors.

    Thanks.
     
  20. Irish Pat

    Irish Pat Member

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    I can do that, I can add notes, thank you for the reminder to do that. I know there are things I could be doing better and im trying really hard to focus on Brady, we miss our grandson (10 months old) so much and with all that is going on in the world we are trying to focus as best we can....these little reminders you throw out are very much needed. I am still praying for you and hoping all is well with your health.
     
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  21. Deb & Wink

    Deb & Wink Well-Known Member

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    I have a friend with a 18 month old granddaughter. She used to take care of her granddaughter 2 days a week. Texting, phone calls, skype, zoom, emails, facebook, instagram aren't enough, but she needs to keep safe.

    Please do the same for yourself, and your family. I'm pulling for everyone right now.

    Cold symptoms not too bad right now. Thank you.
     
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  22. Juls and Billy

    Juls and Billy Member

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    I just popped in to agree with Deb about the dose reduction. Those high numbers you are seeing is probably bounce from that 87 yesterday. The thing to remember with the SLGS method, is you adjust dose based on the lows. The other numbers fluctuate to wildly due to other things going on, like bounce, what food the cat ate, and how much insulin the pancreas decided to make at the time. The low of any cycle is the steadiest criteria to make adjustments on. You can trust it more.
     
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  23. JOJI and Kit

    JOJI and Kit Well-Known Member

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    we cheated off of juls and billy. i give them a 10/10 for style points. we're still working our way up ;)

    believe me, it took us quite awhile to get to a remarks section that was useful and readable for others. and that was pre covid concerns.
    now it's pretty much second nature for us and we can copy and paste a lot from the previous days. plus it's uplifting to write remarks about the good days and helps when you look back and see that there are good days!!! :cat:

    ^jw
     
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  24. JOJI and Kit

    JOJI and Kit Well-Known Member

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    i want this on a t-shirt ....
     
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  25. Irish Pat

    Irish Pat Member

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    @JOJI and Kit I posted this on another part of the forum Shoot or don't shoot?

    One of these days, he is PMPS 132, Prozinc 1.5U, changing to 1.25U from advice from @@Deb & Wink, he just ate 3/4 can of Friskies, he was bugging terribly for food.
     
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  26. JOJI and Kit

    JOJI and Kit Well-Known Member

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    @Juls and Billy ?
     
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  27. Irish Pat

    Irish Pat Member

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    Well he ate about a half hour ago...not shooting tonight, to be safe
     
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  28. JOJI and Kit

    JOJI and Kit Well-Known Member

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    for next time maybe you could try the stalling technique?
     
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  29. Deb & Wink

    Deb & Wink Well-Known Member

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    @Irish Pat Replied in your Feline Health post, before I saw this one.
    Skip was fine.

    What is that saying we have on this message board?
    Oh Yeah, "Better too high for a day, than too low for a moment."
     
  30. Deb & Wink

    Deb & Wink Well-Known Member

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    Copied my response sfrom Feline Health forum.

    Part 1 of response: Back to the same decision point, full dose, reduced dose or skip.
    Same scenario. Plenty of test strips? Can you monitor tonight?

    You already fed, so you can't stall and retest in 20 minutes.
    Give me a moment to look at Brady's SS BRB.

    Part 2 response: That's kind of low to shoot the full dose of Prozinc, if you can't stay up and monitor.
    Token dose, so about 0.25U, so Brady does not bounce sky high in the morning.

    Skip if you can't monitor tonight.

    Next time, try to get a +11.5 test if you can and then the pre-shot test. That + 11.5 and the pre-shot together, can give you an idea if the BG is rising, or falling or about the same. Gives you a "heads up" as to where the BG's are headed.

    And stall next time at pre-shot, 20 minutes and take another test without food.
     
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  31. Irish Pat

    Irish Pat Member

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    @Deb & Wink Thanks Deb, Brady was terrible tonight, no matter what we tried he wanted fed, badly, I was going to stall but I felt so bad on how he was acting with wanting food....he was just going a little nuts...That's why I was TOTALLY amazed that his level wasn't up, thought it was going to be sky high from him stressing....I was wrong.....

    That's why I went to the saying, I didn't want to low because it would be difficult to monitor him during the night, wife and I are exhausted, so the best thing to do was wait until morning to give him his insulin......

    I am starting to worry a little, he is losing a little weight, and the home scale isn't the best thing to weigh him with. Hopefully the weight loss is due to low carb all moist food and no dry.....
     
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  32. Irish Pat

    Irish Pat Member

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    And with the Friskies he is getting about 360 some calories a day, now he doesn't always finish his complete meal, but almost all of it.....he does eat all his 1/4 can prior to the +6 time frames....
     
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  33. Irish Pat

    Irish Pat Member

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    So I just checked his levels and he is up to 298 and that's at +2 since he ate, im assuming its to late to give him insulin?
     
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  34. Deb & Wink

    Deb & Wink Well-Known Member

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    Yes, too late.
    You don't want to shoot more than 1 hour after the normal dose time.
    Get some sleep and call it a night, so you are a bit more refreshed in the morning.

    p.s. If he isn't eating all his food just after the pre-shot tests, try feeding him the rest a bit later, say around +2 or +4.
     
  35. Deb & Wink

    Deb & Wink Well-Known Member

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    Yes, sometimes our kitties get kind of antsy and vocal when they feel their body dropping to lower BG levels. That can be a good thing, to let you know they are "starving" and need some food "right now."

    Feed Brady a bit more, but maybe in a few smaller meals, if he'll eat them.
    You could also add some pure protein, like some plain cooked chicken to his food, about 10-15% of the food total. That extra protein may help him to gain weight back.

    Rest well.
     
  36. Juls and Billy

    Juls and Billy Member

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    You did right to skip the shot. Don't fret if he goes high, like Deb said, better a day of high numbers than to risk a low. 132 is too low to shoot, and if he was starvin' Marvin, I would have gone ahead and fed him too. When possible, you can try stalling without feeding for 20 minutes and then test again, or you can do a token dose, like .25 of a unit. But skips happen. When my Billy was headed for remission, we had a terrible time trying to find a dose small enough we could shoot twice a day. Ended up skipping most every evening.

    Okay, lets see if I've got this right. Brady can't always finish his big meals, though he has no trouble with the snack size. He's losing weight and often asking for food. I'd say his big meals are too big. Yes, he needs to eat when he has insulin, but it doesn't have to be a lot. Some cats simply can't eat too much all at once. Unless he's very overweight and you want him to lose weight, I'd feed him anytime he wants, smaller sized meals, and withhold food two hours before test and injection time. If it's too hard with your schedule to feed more often, they make timed feeders for wet food. Diabetics don't utilize their food well, so a lot of those calories are going straight into the litter box. Some diabetic cats need as much as twice as much food as a non-diabetic cat.
     
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