Did I make the right move?

[Haylee&Tigger]

Tiggers AMPS was 108! According to SLGS this means don’t give insulin. I wanted to keep on our set schedule so I skipped his shot and fed him. I just tested him at +2 and he’s at 469. I know it’s a spike because of food and I know that according to SLGS I am following the protocol correctly in regards to that pre-shot number however, would it have been better for me to have given him his shot anyways to balance this spike and all out? Did I make the right move?

Also, I think I could be ready to use the Modified Dosing method. I am usually always readily available to test Tigger and be there for any implications but there are rare instances when I’m not. Knowing that I am usually available. I wonder if I made the right move or if I should just wait and see what happens throughout the day.

I know stalling was an option but I want to keep his set schedule.

 

[Lisa and Witn (GA)]

You made the right call with skipping the dose. If you get an abnormal reading you can always test again to make sure that the first one is correct. It is better to skip a dose and be high, then give insulin when the reading is too low. That could cause hypoglycemia.

 

[Bandit's Mom]

Next time maybe stall and post on the Prozinc forum for advice? Someone senior could guide you. @Deb & Wink

I am not familiar with Prozinc, but with Lantus & Levemir, the idea is to gradually get used to shooting lower numbers. On SLGS, you don't shoot below 90 and you stall and ask for advice below 150.
However, if you cannot test after shooting a low number for any reason, it is better to skip.

 

[Deb & Wink]

Next time, try to stall for 20 minutes without feeding any food to Tigger, retest and look for that rising BG level before you decide to skip.
Do that stall, retest, repeat cycle for at least 1 hour if at all possible.
With Prozinc, you can stall for up to 1 hour, and still keep to your schedule for the next cycle.

Token dose would have been another option. To keep Tigger from bouncing so high.

 

[Haylee&Tigger]

Thank you all for the help! I have been a bit busy and wasn’t able to reply. I think it’s time for me to switch to the Modified Dosing Method. I have collected a good amount of data and am usually around to check him. I also think he is ready for another dose increase. I have a question about increasing the dose on the modified method though. I see where it asks “When does the current dose reach its peak nadir?”... well this is different day and night. It looks like during the day it’s between +4 and +6 but at night it’s different... last night specifically I can see it was at +4 however the previous nights it looks like around +6.
I can see how low it takes him just it’s different each cycle it seems.

Although I do still see if nadirs are between certain levels and what my options are and his nadirs do show that a dose increase would be warranted. So I’m guessing knowing when he peaks is pretty much just intel as to when I should watch for emergencies?

 

[Deb & Wink]

I can see how low it takes him just it’s different each cycle it seems.

Good observation Haylee.
Nadirs don't always stay the exact same time from cycle to cycle.
Makes knowing when to test to find those nadirs a bit more challenging.

So I’m guessing knowing when he peaks is pretty much just intel as to when I should watch for emergencies?

Both the MPM and the SLGS dosing protocols look at those mid-cycle nadirs to guide you in making adjustments. Those guidelines don't talk about specific times for the nadir to occur, only a BG range to look for in deciding what to do.

Sometimes, the pre-shot test can be your nadir for the cycle.

Knowing when the nadir occurs, helps you to watch for any behavior that may indicate a cat heading to hypo territory. Like more vocalizations or dilated pupils as 2 examples. Kind of provides you with a "head's up, pay attention during these times".

Some cats on Prozinc can rise a lot in the last 30 to 60 minutes of the cycle. That may be what you were seeing with that 163 at PMPS the other day, 7/17/20.

 

[Haylee&Tigger]

Some cats on Prozinc can rise a lot in the last 30 to 60 minutes of the cycle. That may be what you were seeing with that 163 at PMPS the other day, 7/17/20.

So around that time could have been his nadir and I might have missed a low an hour before possibly. I didn’t think of that! I’m going to set an alarm for a test at +8 and +10 every couple of days to fill in those blanks as I haven’t in a while. Thanks for the response!

 

[Haylee&Tigger]

Upon increasing his dose, it has been 3 cycles (on his third now), his BGs are higher than they were before the increase. I know this is not uncommon to see, per info in one of the dosing methods, but I have yet again made use of the search bar to try and find answers. I see NDW however I noticed that they are all in the Lantus thread. Certainly this could apply to Prozinc as well? I’m afraid of the length of time I have been leaving Tigger on his doses for now as I don’t want it to be too short or too long. If he stays in higher digits after his 3-6 cycles would I do another increase?

 

[jt and trouble (GA)]

I cannot give dosing advice but I CAN tag someone who answered earlier..
@Lisa and Witn
@Deb & Wink

 

[Deb & Wink]

I’m afraid of the length of time I have been leaving Tigger on his doses for now as I don’t want it to be too short or too long. If he stays in higher digits after his 3-6 cycles would I do another increase?

Yes, if Tigger's mid-cycle numbers stay high (or the nadir at anytime in the cycle), than it's time to increase the dose by 0.25U and even perhaps 0.5U. Depends on what the nadirs are. Nadirs > 200 mg/dL call for an increase of 0.5U. You'll need to monitor carefully, as Tigger has dropped low overnight. Probably lower than the 120-130 range you've caught with testing.

I see NDW however I noticed that they are all in the Lantus thread. Certainly this could apply to Prozinc as well?

Yes, NDW or New Dose Wonkiness happens with insulins other than Lantus.

You've got plenty of room with the nadirs (the lows or mid-cycle BG levels) to do increases. So if you need to, you can increase the dose again fairly quickly, since you are using the Prozinc MPM (Modified Prozinc Method) now. You want to see high greens (>50 but < 100 mg/dL) for the lows, the nadirs.