Dose help needed please

[Haylee&Tigger]

My spreadsheet kind of speaks for itself, plenty of notes, PLENTY of data

Tigger earned himself a dose increase to 1.25u based on MPM. He was doing better at first then had a couple not so good cycles. I guess somewhere in the PM cycle of 7/22 he dropped when I went to bed because the AMPS the next day was at 185. Being that it was an unusually low number that I wasn't use to, I waited and tested 10 minutes later to determine if he was going up or down. He was headed down at first but then it went back up a little. I wound up stalling without food for one hour when I determined he was rising and proceeded to give him his full dose and his food. During the AM cycle he was in the greens!

As you can see in the SS, he got to 43 as his lowest. He is still freshly diagnosed and I know that per the MPM I am suppose to reduce the dose if I am to see numbers below 50. I watched him carefully, tested and read the hypo quick reference. He was considered in the "Low Numbers Without Symptoms" section which states to give food or treats until he reaches safe numbers, I gave him a Fancy Feast chicken treat and continued to test. He hung there at 43-45 for an hour so I decided to give him a teaspoon of his LC food. He began to rise and all was well.

I debated for hours on how I wanted to do his next shot. I am typically at home all day and all night so I am available to monitor and test and keep close eye on him. While he IS technically newly diagnosed, I feel that I have a good amount of data and with my recent brush with those numbers in the 40s, I feel pretty confident about how to react and when to step in. (All coming from the same girl who said she didn't know if she could even give the shot! ) MPM says reduce by .25 anytime a newly diagnosed cat is under 50. There is also a section that says I could shave a little off the next dose and even though that applied to six months to a year of diagnosis, I feel like that was the best decision. The 1u itself was working alright with him but his numbers were still high, which earned him the increase. At first, the 1.25 was starting to look a lot like just giving him 1u until I remembered that one cycle affects the next so I am thinking, the greens are what 1.25 will do for him. I still shaved a little off of his PM dose last night and those greens are probably still from the previous cycle but this morning, they are high.

I guess my main question is, are the 40s bad for him? I know that even though he wasn't showing symptoms, its still considered hypo. I don't know... The 1F seems to not be as effective as the 1.25 dose, would feeding him a little more at meal times help balance this? I just really want to keep that progress I made with him

 

[Diane Tyler's Mom GA]

My spreadsheet kind of speaks for itself, plenty of notes, PLENTY of data

Tigger earned himself a dose increase to 1.25u based on MPM. He was doing better at first then had a couple not so good cycles. I guess somewhere in the PM cycle of 7/22 he dropped when I went to bed because the AMPS the next day was at 185. Being that it was an unusually low number that I wasn't use to, I waited and tested 10 minutes later to determine if he was going up or down. He was headed down at first but then it went back up a little. I wound up stalling without food for one hour when I determined he was rising and proceeded to give him his full dose and his food. During the AM cycle he was in the greens!

As you can see in the SS, he got to 43 as his lowest. He is still freshly diagnosed and I know that per the MPM I am suppose to reduce the dose if I am to see numbers below 50. I watched him carefully, tested and read the hypo quick reference. He was considered in the " Numbers Without Symptoms" section which states to give food or treats until he reaches safe numbers, I gave him a Fancy Feast chicken treat and continued to test. He hung there at 43-45 for an hour so I decided to give him a teaspoon of his LC food. He began to rise and all was well.

I debated for hours on how I wanted to do his next shot. I am typically at home all day and all night so I am available to monitor and test and keep close eye on him. While he IS technically newly diagnosed, I feel that I have a good amount of data and with my recent brush with those numbers in the 40s, I feel pretty confident about how to react and when to step in. (All coming from the same girl who said she didn't know if she could even give the shot! ) MPM says reduce by .25 anytime a newly diagnosed cat is under 50. There is also a section that says I could shave a little off the next dose and even though that applied to six months to a year of diagnosis, I feel like that was the best decision. The 1u itself was working alright with him but his numbers were still high, which earned him the increase. At first, the 1.25 was starting to look a lot like just giving him 1u until I remembered that one cycle affects the next so I am thinking, the greens are what 1.25 will do for him. I still shaved a little off of his PM dose last night and those greens are probably still from the previous cycle but this morning, they are high.

I guess my main question is, are the 40s bad for him? I know that even though he wasn't showing symptoms, its still considered hypo. I don't know... The 1F seems to not be as effective as the 1.25 dose, would feeding him a little more at meal times help balance this? I just really want to keep that progress I made with him

Hi Haylee I will tag a few experienced members for you
@Deb & Wink

@Wendy&Neko

@Bron and Sheba (GA)

@Sienne and Gabby (GA)

Thanks in advance ladies

 

[Wendy&Neko]

I guess my main question is, are the 40s bad for him? I know that even though he wasn't showing symptoms, its still considered hypo. I don't know...

I don't have experience with Prozinc, but do with low numbers. You don't want your cat hanging out in the 40's while on insulin. Some non diabetic cats can test in the 40's, but you don't want a non diabetic cat there because it leaves no margin for error. Was he showing any signs of hypo? Or was it just low numbers.

Any cat spending that long in the 40's really needs a reduction.

 

[Haylee&Tigger]

He wasn’t showing any signs at all, it was just low numbers. I did reduce his dose but I didn’t reduce it by .25 because 1U wasn’t a good dose for him.

 

[Deb & Wink]

The only signs Wink showed when he was in low BG ranges, was being a bit more talkative and dilated pupils nonreactive to light. Subtle signs to be sure.

Remember, glucometers can be within 15% of the actual number and still be considered accurate enough.
So those low 40's that Tigger got could have been down in the middle to low 30's.

We'd all like to get our cats OTJ (off-the-juice, insulin being the juice) but flirting with those low BG ranges in the low 40's is risky.
Prozinc can also hit a little harder than the L insulins (lantus, levemir) so the BG levels can drop quicker.

A 200+ point drop, from pre-shot to +5 is a 80% drop. So the bounce will be greater.
"The faster the drop, the higher the bounce."
You are looking for around a 50% drop. An 80% drop tells you the dose is too high.
Tigger is bouncing from the lows, and bouncing hard.

That 370 AMPS on 7/24, was Tigger bouncing, and bouncing hard from the previous cycle lows.
But he's clearing the bounces pretty fast now.

It also looks to me like you might be losing duration at the end of the cycle, and that Tigger rises quickly in the last hour or two before the pre-shot. See 7/23/20 AM cycle. He went from 75 to 171 in 2 hours, a big jump. But that could be a food influence too. Not enough notes on the SS in the Remarks column to tell when you feed him each cycle.

Unless you are using calipers to measure the insulin dose, it's unlikely there is that much difference between the 1.25U dose you gave and the 1F dose you gave. Tiny amounts like those 2 doses are practically impossible to measure accurately and consistently. I read a scientific journal article years ago, that said any insulin dose <2U was not possible to measure accurately from dose to dose.

There is a slightly, and I emphasize slightly, better chance of getting a consistent dose if you use the U100 syringes with the U40 Prozinc insulin and use the conversion chart (2.5 times the U40 dose = the amount to measure in the U100 syringe), and also use calipers. Syringes can be marked inaccurately. From box to box and even within the same box of syringes.

The tree green BG ranges are nice healing numbers, giving the pancreas time to heal. But the neon green numbers are tricky to navigate and you don't want to leave Tigger there for 3+ hours. He could have easily dived to the 30's or the 20's and you might not have been able to bring his BG levels back up with food.

When using the MPM Prozinc dosing protocol, you want to keep the BG levels ABOVE 50 during the cycle. If the BG levels drop below 50, than a full 0.25U reduction is in order.

Plus, with your stalling 1 cycle and then testing and dosing at the normal times the next cycle, the doses are sometimes closer together than every 12 hours.
For some cats, shooting early can act like a dose increase. Shooting late can act like a dose decrease. It's possible that is happening with Tigger.

Too much going on to pin down what is happening. But I've listed some of the possibilities. Hope this helps.

 

[Haylee&Tigger]

It also looks to me like you might be losing duration at the end of the cycle, and that Tigger rises quickly in the last hour or two before the pre-shot. See 7/23/20 AM cycle. He went from 75 to 171 in 2 hours, a big jump. But that could be a food influence too. Not enough notes on the SS in the Remarks column to tell when you feed him each cycle.

I didn't know that I was suppose to be documenting when I feed him, but I feed him twice a day the same time each day unless I have to stall. 9AM and 9PM. I always test him, shoot, feed. One right after the other. So the AMPS is basically his reading RIGHT before I give him his food. He doesn't eat at all during the cycles, nor could I honestly afford him to

Since the stalling the other day, I haven't needed to stall anymore and he did dip into the 40s today but only stayed there for one hour MAYBE. I understand bounces but at the same time, I don't. I just tested him and he's at 204 so I'm guessing thats bouncing from the lows. So I should decrease to .75? I just feel like his numbers will go right back up in the reds, pinks and yellows again...\

I had to stall for two cycles in a row and then the cycle after he was in high enough numbers to shoot at his regular time instead of wait until 12 hours later. Should I not have done that? Should I have given his shot exactly 12 hours later and not sooner even though he was high enough to shoot as his regular time?

 

[Deb & Wink]

You don't have to document when you feed him, but it can help to see that on the SS when you look back and scratch your head and wonder "Now why did the BG levels do THAT!"

So I should decrease to .75? I just feel like his numbers will go right back up in the reds, pinks and yellows again...\

I'd suggest dropping the dose to 1U. Not a fat 1U but only 1U. Agree that a drop to 0.75U would be too much right now. But the 1.25 to 1F wasn't enough of a reduction. So 1U would be my recommendation.

I had to stall for two cycles in a row and then the cycle after he was in high enough numbers to shoot at his regular time instead of wait until 12 hours later. Should I not have done that? Should I have given his shot exactly 12 hours later and not sooner even though he was high enough to shoot as his regular time?

That's a tricky judgement call. You are there to monitor, know your schedule, know when you will be home to test. The dosing sooner/later comment was to make you aware that the possibility of the numbers being a bit "wonky" could happen.

I mentioned it, because it makes interpreting what is going on by only looking at the SS a bit tricky for us. A bit early is fine, as long as the BG levels are high enough.

I think you could have your decision point BG pre-shot (sometimes called the shoot/no shoot or stalling number) set at 150. What do you think?

 

[Deb & Wink]

I didn't know that I was suppose to be documenting when I feed him, but I feed him twice a day the same time each day unless I have to stall. 9AM and 9PM. I always test him, shoot, feed. One right after the other. So the AMPS is basically his reading RIGHT before I give him his food. He doesn't eat at all during the cycles, nor could I honestly afford him to

One thing that can help, would be to split up his meals into multiple portions. Feed him after the pre-shot and insulin and make that the bulk of his food. But reserve some food for +2 and feed him then. That could slow down the steep drops, as that +2 is often the insulin onset for Prozinc. If you feed him at +2, the food will keep his BG levels a bit higher in the middle of the cycle and hopefully stop the steep 80% drops and the subsequent bounces. Maybe only 1 teaspoon or so would do the trick at +2.

Do you think you could try that?

(2 replies, so check the one before this one too, if you would please.)

 

[Haylee&Tigger]

Yes, I completely understand that you are all just going off of a spreadsheet and what I type in my post. I didn't think of it that way for some reason.

I think you could have your decision point BG pre-shot (sometimes called the shoot/no shoot or stalling number) set at 150. What do you think?

I agree to that, yes.

As for reserving some of his food for the +2, I will definitely give that a try. I will also try to make some more notes in my spreadsheet about what I do and what happens with him. Thank you for your help!

 

[Haylee&Tigger]

A 200+ point drop, from pre-shot to +5 is a 80% drop. So the bounce will be greater.
"The faster the drop, the higher the bounce."
You are looking for around a 50% drop. An 80% drop tells you the dose is too high.

So, basically half of his PS test number should be his nadir for that day? If I understand that correctly? For example the 292 he got today (7/27), his nadir should be near 146? Trying to go over what you said again and do some more research here on the forum. But if that is the case, Tigger's nadir for the AM cycle was below that. I notice that with each PS and nadir, it seems to be trending downward with each cycle, so that leads me to believe that I should leave him on his dose for longer than 3-6 cycles to let him "get there" I guess. His super high PMPS numbers make it look like he is bouncing from even the low 100s he gets during the cycle. Is that right? I just want to make sure I am saying and understanding things so I know what I'm looking at in the future.

The "General Information" section in the Prozinc board (bouncing section), says "If the BG does not return to normal in 6-8 cycles, an increase might be needed based on the method of regulation you are following."--so I am guessing that sometimes a little longer than the 3-6 cycles is sometimes needed especially with a bouncing kitty. I just don't want to run the risk of keeping him on a dose for too long. I was planning on keeping him on this dose for 8 cycles and continue to monitor. Afterwards, if his nadirs are 100-200 then I will increase him back to 1.25 per the MPM protocol and I'm thinking with feeding him at that +2 hour, it will help balance the drop. I'm just wondering why the extremely high PMPS numbers but not the AMPS numbers, strange.

 

[Deb & Wink]

So, basically half of his PS test number should be his nadir for that day? If I understand that correctly? For example the 292 he got today (7/27), his nadir should be near 146?

Yes it should, but cats don't always follow "instructions" well, and the BG levels will vary from the ideal norm. They'll vary from cycle to cycle. You are looking for the overall "trend" in the numbers.

With 50% or less of a drop, that "should" help to slow down the bounces. Make them less severe. It takes time for a cat's body to adjust to those low numbers.

-so I am guessing that sometimes a little longer than the 3-6 cycles is sometimes needed especially with a bouncing kitty.

Yes, sometimes you need to hold the dose longer.

I notice that with each PS and nadir, it seems to be trending downward with each cycle, so that leads me to believe that I should leave him on his dose for longer than 3-6 cycles to let him "get there" I guess.

Yes, that sounds exactly like what you should be doing.

It takes practice, looking at a lot of spreadsheets, to recognize those bounces.
As a general rule, the Red range and Black range BG levels for a cat that has been getting lower pre-shots is telling you they are bouncing.

Cats don't pay attention to the lesson plan, so the reds and blacks can signal a different situation occurring, but in Tigger's case, I don't think so.

Looks like the teaspoon of food at +2 is slowing down the drops somewhat. At least, Tigger isn't dropping into the low greens. He is still bouncing quite hard.
Blacks = bouncing
Reds = bouncing

I'd suggest keeping Tigger at this 1U dose, unless his BG levels drop below the reduction point, (50 since you are using MPM).
Let's wait until the bounce clears, before doing any dose adjustments.

We're trying to even out his BG levels a bit more at this point. Keeping him out of the 40's (and lower) but trying to keep the bounces from being so severe too. It's a delicate balancing act.

I'm just wondering why the extremely high PMPS numbers but not the AMPS numbers, strange.

So what is different between AM and PM? What can you tell us? Since we are not there to observe Tigger, you'll have to let us know what is going on.

 

[Haylee&Tigger]

Thank you for clarifying all those points to me!

So what is different between AM and PM? What can you tell us? Since we are not there to observe Tigger, you'll have to let us know what is going on.

Nothing changes with Tigger. He is naturally a sleepy cat so he sleeps quite often, he has his active spurs but then its like he gets bored of you and goes to lay down we have been doing extra things to be absolutely 100% sure he isn't getting into anything either. We use to be able to leave a few dishes in the sink and be able to leave food on the counter while we ate dinner but toward the beginning of all this we noticed he was starting to get onto our counter tops and eat it! But that was over a month ago when I was starting this whole journey and once I saw him do it once, I immediately knew we had to make a change and do dishes as we go and make sure all food, even if it could sit on the counter, is put away inside a cabinet and treats are stored behind cabinets as well. So I know for a fact he isn't getting into anything. I try to stay up as late as possible just to see what he does during the night and he really does just sleep or lay around, same in the daytime. As far as anything different to his meals, he only eats PS times and the +2 you suggested and thats it. I only ever gave him more food or treats when he dipped into the 40s. I will keep him at 1u for a while and cross my fingers for a nice balance out!

 

[Deb & Wink]

So it looks to me like Tigger cleared that bounce from yesterday morning, 7/28/20 when he was up in the black BG ranges at pre-shot.

That 54 at +5 last night, 7/28/20 is pretty close to the MPM reduction point of 50. If you wanted to, you could go ahead and reduce his dose back to 0.75U. It's a toss up if you do that or not. Something for you to consider.

I'm kind of getting the feeling that the 1U dose may be a tad too much insulin for Tigger.

You want to see Tigger spending some time in those green BG ranges, because it give his body a rest and lets his pancreas heal. So a reduction is up to you, unless he drops <50 mg/dL, then it's an automatic 0.25U dose reduction.

Some interactive play time may be helpful for Tigger. Does he like a laser pointer, or one of those string toys that you could move around for him? Or crumple up a bit of paper a toss those to him. Being more active can help with the diabetes. Of course, it may be really hot where you are, and cats want to sleep more in the heat. At least my civie Dancer loves to sleep in the warm sun, even when it's in the mid 80's inside the house.

 

[Haylee&Tigger]

We actually keep it pretty cool in the house. Its hot outside but I doubt he ever feels any type of heat lol. We do play with him from time to time with one of those toys on a string yes and a laser pointer gets him excited for a little bit. Since its before his PMPS I will go ahead and reduce his dose tonight to 0.75U, I got that feeling as well when I saw the low 54. I'm guessing before, I just wasn't giving Tigger enough time to adjust to his doses correctly.

I do have a question when it comes to the "shoot/no shoot" number. So if he is under 150 I don't shoot? If he is 150 and above then I do?

 

[Deb & Wink]

I do have a question when it comes to the "shoot/no shoot" number. So if he is under 150 I don't shoot? If he is 150 and above then I do?

That is more of a decision point threshold, that BG level of 150. A lot of these decisions depend on how much test data you have, if you have the ability to stay around and test, test strip supply, etc. As you gain more experience on how Tigger reacts, that decision threshold can be lowered from the suggested 150.

With the MPM method, it's possible to shoot Prozinc with a BG pre-shot that is 50 or above. Takes experience and enough test data to be able to shoot that low. With Tigger dropping from the lower yellow ranges (200-225) to the greens (<99) I don't think you are ready for that low of a pre-shot and still be able to shoot the full dose.

The first thing you should do if the pre-shot is lower than your decision point threshold, is stall.
No food, test again in 20 minutes. Keep that up for a max of one hour. You want a rising BG level.

Second option is to give a token dose. Which is 10-25% of the normal insulin dose. Again, it depends on how well you know your cat and how much test data you have. Some people have given as much as 50% of the normal dose. This is so situation dependent, there is no hard and fast rule.

Third option is to skip the dose entirely.

 

[Haylee&Tigger]

With Tigger dropping from the lower yellow ranges (200-225) to the greens (<99) I don't think you are ready for that low of a pre-shot and still be able to shoot the full dose.

Oh no, I definitely agree about that one.

I had to stall yesterday morning in fact (7/29/20). I did happen to stall 30 minutes extra after the hour mark but only because he was super close to 200 and I knew he would get there with just a little bit more time. I also feel like he is bouncing still because his PMPS was super high again

I changed Tigger's dose to 0.75 and will update in a few days. I am going to try to incorporate a few new things in our daily lives like more play time

 

[Deb & Wink]

I am going to try to incorporate a few new things in our daily lives like more play time

For both the cat and the human I hope! All of us need to play, even if we are old and have arthritic knees.

 

[Haylee&Tigger]

Update and question!

Last night, 8/1, we had to stall for one hour, he was still low enough that I wouldn't have given his full dose as it probably would've sent him below 50, or so I think. I gave him a token dose and this was my first time giving a token dose. 10-25% of his normal dose. Well, that would've been .075U-.187 (just for technical precision). Both of those are pretty much impossible for me to measure out unless I'm taking the percentages too literally. I wound up giving .25U. His SS looks as though I didn't even give him a shot but I am thinking that it probably did do something for him and perhaps the token dose just wasn't enough. Should I try giving a token dose of .5 next time this happens? He went from red to greens today so I'm sure that's a bounce as well.

 

[Deb & Wink]

I wound up giving .25U.

But the SS says you gave him 0.75U for 8/1/20 PM cycle?

I gave him a token dose and this was my first time giving a token dose. 10-25% of his normal dose. Well, that would've been .075U-.187 (just for technical precision). Both of those are pretty much impossible for me to measure out unless I'm taking the percentages too literally.

With those token doses, you get as close as you can. Don't take them literally, but get the dose somewhere in the ball park of the token dose.

Should I try giving a token dose of .5 next time this happens?

Sure. Since you don't think the small token dose of 0.25U dose did much of anything for Tigger, try a larger token dose next time. Doesn't have to be 25% or less. Sometimes, 50% or 75% of the dose is the right amount of insulin to give. It's a bit of trial and error I'm afraid to say.

 

[Haylee&Tigger]

But the SS says you gave him 0.75U for 8/1/20 PM cycle?

Sorry! I just kinda pre-filled it out and forgot to change it! Thank you for the extra advice. I was hoping it was a trial and error thing, learning all this is just so unpredictable sometimes

 

[Deb & Wink]

The protocols were written with general guidelines in mind. As you gather more data on how Tigger is reacting to the insulin, you can make adjustments in those guidelines, tailored to meet Tigger's needs better.

 

[Haylee&Tigger]

Tigger has been doing very well lately! Could I possibly get a spreadsheet look over? I skipped his dose last night and he actually did pretty well! I gave him his dose this morning but I just tested him 30 minutes ago at 51 and now at 52, will test again in 30 more minutes just to be sure. Should I give him a decrease or wait until he actually hits the 40s? Could it be possible that a decrease is needed anyways because of the fact I had to skip the dose last night?

 

[Deb & Wink]

So, what is your decision point threshold number, for giving insulin?

You've shot a 93 before, only a couple of days ago. You got a 48 BG at +4 on 8/6/20. You should have done a 0.25U automatic dose reduction the next cycle. Since you missed doing that, you should absolutely reduce the dose to 0.25U for the PM cycle for 8/8/20.

When you got that 48 on 8/6/20 PM cycle, you should have reduced the dose to 0.25U on 8/7/20 AM cycle.

p.s. BG's of 51 and 52 are so close to the reduction point that I would not quibble about a dose reduction Haylee. Take it. Please.

 

[Haylee&Tigger]

Update: he was hovering at 51 for +6 to +7 now at +9 he is 58.

 

[Deb & Wink]

Update: he was hovering at 51 for +6 to +7 now at +9 he is 58.

Is that +9 food influenced?

 

[Haylee&Tigger]

I just kind of went with: if its between 150 and 90 then give his token dose of .5, I know there is no rule for this but it worked for him, I'm just taking things day by day at this point with everything else thats been going on in my life. I wasn't necessarily quibbling about a reduction just wanted to make sure that a reduction was the right next step for him since its so close. I am for the reduction. I missed doing his reduction because I had some other issues I had to tend to and left my husband in charge of the shot that time. The next cycles were perfectly fine and not in or near the 40s so I just kept it at .5u.

Is that +9 food influenced?

This is not food influenced.

 

[Haylee&Tigger]

I try to give the insulin as much as I can (trying not to skip shots unless he was a definite no shoot for me; meaning that ecid and he responded well to it) so that he won't have to miss a shot so I gave him that special threshold of 90-150 for a token dose specifically, not for a full dose. I found this to be working and keeping him in the greens the majority of the time. I skipped the shot last night because he was for sure a no shoot and I wanted to see what would happen with him being in the greens for this small amount of time and he did really well in my opinion. He never even got close to the 200s. If he was above 150 I would give him his full dose. I still don't feed food/treats/honey unless he is in the 40s. So no, the +9 was not food influenced. I understand that the meters have a variance which is why I asked about the reduction being the correct next move for him.

I will reduce him to .25 at his PM shot tonight.

 

[Deb & Wink]

I wasn't necessarily quibbling about a reduction just wanted to make sure that a reduction was the right next step for him since its so close. I am for the reduction. I missed doing his reduction because I had some other issues I had to tend to and left my husband in charge of the shot that time. The next cycles were perfectly fine and not in or near the 40s so I just kept it at .5u.

Oh Good! You are willing to do the dose reduction, which is the right next move for Tigger.

 

[Haylee&Tigger]

So since the dose reduction was suggested, I have only given him two shots. One was a full dose and the other was a token, which I know is pretty much impossible to measure out but I got U40 syringes with the half unit markings so it made it a tad easier. I've been skipping because I don't think his PS's are shootable numbers. Am I correct? Have I been doing the right thing when I do decide to skip or does his threshold need to be lowered? I don't want to give him more than is needed. I don't know if .25 is safe to shoot below 90.

 

[Deb & Wink]

Personally, I would not shoot those super low pre-shots, not with Prozinc. Tigger is running pretty low as it is. I know that theoretically you can shoot any BG pre-shot above 50 mg/dL, but that whole idea makes me nervous. I'd be testing constantly, to make sure my cat was not dropping too low. I'd also have an extremely well stocked hypo tool kit and probably 100-150 EXTRA test strips in the hypo toolkit, above and beyond any regular test strip supplies you may have.

You do test enough that you could drop Tigger's threshold number for giving him the shot, the shoot/no shoot threshold.

There are actually 2 smaller doses that you can give.

1. "Some insulin", so the top of the plunger is barely on the very first line on the syringe.

2. 1 drop of insulin (or 2). Practice with a used syringe and some colored water.

I did a write-up on how to measure the drop dose. Let me go find it in my Word document and cut and paste it here for you.

p.s. Tigger is looking pretty good for a cat that hasn't had insulin in 3 cycles.

 

[Deb & Wink]

Here is that info on drop dosing, practice and for real instructions. Hope these help you.
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. To move/push the air bubbles to the top of the syringe. 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”. To move/push the air bubbles to the top of the syringe.

• Push out the air bubbles that have floated to the top.
• 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.

Be aware that some syringes can vary on where the lines are on the barrel.

 

[Haylee&Tigger]

Is this technically him having an OTJ trial? He only seems to go up when he eats which I presume is normal. I guess I just wonder if it’s even necessary to give him a shot at all. His cycles have taken him as low as a 60 and I just don’t see a purpose to dose him, even drop dosing, when his numbers are exactly where they need to be without insulin.

 

[Deb & Wink]

Would you please update your SS for the last 2 days, the last 4 cycles? No information showing for 8/12 or 8/13.

You could consider this an OTJ trial if you want. You still want to test. Wait a moment, and I'll get the OTJ trial guidelines.

Here you go.
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.

 

[Haylee&Tigger]

I will implement the above info... sorry I haven't had a chance to update the spreadsheet, I have his tests written down on a chart I made up. His numbers have remained the same as the past couple of days.

 

[Deb & Wink]

Keep those BG's low Tigger!
This is day 3 of the OTJ trial?

My cheering pic for day 3 for Tigger is here:

Spending time in the cool green grass.

 

[Haylee&Tigger]

Yes technically this would be day 3! I am extremely happy about these greens.

 

[Deb & Wink]

Than today is day 4!

 

[Haylee&Tigger]

Well this morning I gave him a little bit of insulin because he was at 90, maybe he isn't ready for an OTJ trial just yet. Of course once I say something about one, he needs insulin

 

[Haylee&Tigger]

He once again hasn't had insulin in a couple cycles and now he's in the 40s.

...What?! Should I not have given insulin on 8/14? Would that have even mattered by now?

Edited to add: When doing the OTJ trial, it says if the cat is in greens at PS times, no need to test further until the next test time. So... when the cat is off insulin, should I still be giving the honey and HC food or are the 40s just... something that just happens? I thought I remember reading somewhere that cats not receiving insulin do lower into the 40s but I don't want something bad to happen with Tigger. If it is better for him to eat meals throughout the entire cycle, I can purchase a timed feeder. Especially if that will keep him stable. Thats the only thing I can think of why he would drop like that without having a shot in a few cycles.

 

[Deb & Wink]

...What?! Should I not have given insulin on 8/14? Would that have even mattered by now?

Prozinc insulin does not last for days. 10-14 hours is the duration in cats.
So that would not have made a difference today in the low BG readings in the 40's, the fact that you gave Tigger insulin 2 days ago.

So... when the cat is off insulin, should I still be giving the honey and HC food or are the 40s just... something that just happens?

BG numbers in the 40's, for a cat NOT on insulin, and not on one of the depot type insulins like lantus or levemir where there is some residual insulin in the "depot", is perfectly safe.
No need to feed honey or HC food to bring up the numbers when your cat is not getting insulin.
Now you know for next time!
It's something that "just happens" as you said.

If it is better for him to eat meals throughout the entire cycle, I can purchase a timed feeder. Especially if that will keep him stable. Thats the only thing I can think of why he would drop like that without having a shot in a few cycles.

Sometimes the test strip is bad or doesn't get enough blood, or you get a watery mixture that is more lymph fluid than blood if you are squeezing the ear to get blood.
Won't hurt to double check and test again.

Timed feeder? 6 of one, half a dozen of another.

 

[Haylee&Tigger]

Wow, okay well yes now I do know for next time! Thank you for clarifying with me everything and helping me through this.

 

[Haylee&Tigger]

I didn't want to post about it because I was afraid it was going to jinx me but Tigger is on Day 14 as of 8/27!

 

[Panic]

EEEEE WAY TO GO TIGGER!!

 

[Shelley & Jess]

I've been peeking in on you and Tigger, watching your awesome progress & almost posted a couple of times to cheer you on - BUT figured you weren't posting for a reason and didn't want to jinx it either!!

You must be ready to burst!!

WOOHOO!!! I'm so happy for you guys!!

 

[Deb & Wink]

Whoo hoo!!!! Officially OTJ for Tigger!

3 long months, but you got him there. Welcome to the "falls" Tigger, named after a honeymoon at Niagara Falls.

Now here are some things to keep an eye on, to keep Tigger OTJ (off-the-juice).

Here are some tips to stay OTJ (off-the-juice, insulin being the juice)
1. Never feed dry - not even treats. (freeze dried is ok, Dr. Elsey's chicken flavor is ok.) If you change wet food types, be 100% sure the new food is also low carb and same low carb % as your current food. Some cats are very carb sensitive and an increase from 3-6% to 8-10% can spike the BG’s. Don’t feed if you aren’t sure!
2. Weigh every 2 weeks to 1 month to watch for weight changes. Too much of a weight gain can cause loss of remission. Too much of a weight loss alerts you to other issues, such as hyperthyroidism.
3. Measure blood once a week, indefinitely if possible. You want to catch a relapse quickly. Some people only do checks every 2 weeks to a month. BG checks can sometimes alert you to other issues.
4. No steroids or oral meds with sugar - remind your vet whenever giving you any medication. Always double check. (Steroids may be needed for other medical issues. But remind your vet your cat is a diabetic, diet controlled.)
5. Monitor food intake, peeing and drinking. If increasing, a sign of losing remission. Or another medical condition like Hyper-T or kidney disease.

6. Regular vet checks for infection such as dental , ear or UTI. And get them treated quickly!

7.Continue to ketone test even if your cat is OTJ. Ketones can develop if the cat’s pancreas is not producing enough insulin, or burning off too much fat if your cat is not eating properly and other reasons.

If your cat does fall out of remission you need to be more aggressive and resolve issues/ back on insulin as soon as possible as the window for a second remission is tight if any. Pancreatitis, hyperthyroid, dental issues are the most common reasons cats fall out of remission.

"Once a diabetic, always a diabetic." They are simply diet controlled.

p.s. There is a thread at the top of the forum, that lists recent remission. Would you please post a reply in that thread? So that other people know that getting a cat OTJ with Prozinc is possible. Thanks.