Bounce?

[Marlene82]

Hey there
Karl has been on prozinc for nearly a month now. Could any one tell me if im right that he might Be bouncing in the night when he runs outside? (Theres no food outside, only mouse) if you look on he’s spreadsheet, he turns pink in the morgning. So i have been giving him a lower dose instead. Is that the right thing to do?

Sorry for my terroble enghlish
Best regards Marlene the amateure

 

[Deb & Wink]

Mice are food. Good food for a cat!

Your spreadsheet says you are using the SLGS (Start Low, Go Slow) Prozinc dosing protocol.
According to that, Karl's dose should have been reduced to 0.75U when his BG level dropped to < 90 mg/dL (< 5 mmol/L).
That reduction should be his new dose going forward. Not only for a single cycle.

Yes, I do think that Karl is bouncing.
You should try to give Karl the same dose, both in the morning (AM) and the evening (PM).

I see the words "Kopi af" on your spreadsheet (SS). Is that Danish?
I'm asking because there is another member from Denmark, @SashaV.

 

[Marlene82]

Thanks Deb
It means “ copy off” it’s because Sasha helped me making the spreadsheet. But it’s my spreadsheet. She helpes me a lot, and she told me to write in here.
So i should reduce dose going forward no matter what i shoot? Is that right?

Thanks for helping.

 

[SashaV]

Have you learned a bit Danish, Deb?!

I've been helping Marlene and Karl since he got diagnosed. It was Marlenes vet I referred to as being somewhat surprisingly good!
However the vet wants to increase, I want to decrease since it looks like Karl is bouncing.

Karl is running outside during his nights cycles, that means exercise and that lowers his BG - or that's what I'm seeing.
And Karl is a wonderful gentleman who doesn't like being tested, and I believe it's rather insane to increase and not knowing what's going on.
His numbers wasn't that bad without insulin, so in my mind it doesn't make sense to increase based on pre-shot tests, specially since we don't know what's going on in his PM cycle.

So I've been pushing Marlene to get in touch with you, to hear your thoughts.
He is only one month in, so it's now we need to make an effort to get him regulated and hopefully OTJ. Fingers crossed!

Her old vet tried to tell her that Karl needed diabetic dry food, needed to be hospitalized for 3 days at an insane price to get him regulated, and they didn't want to prescribe anything other than caninsulin.
So Marlene went home, tossed the dry food, searched on Facebook, asked for help and found me. She felt that something was off about what the vet told her... so I confirmed and told her to run! She even started testing on her own!

 

[Deb & Wink]

So i should reduce dose going forward no matter what i shoot? Is that right?

Yes, I think you should reduce the dose right now.
I think the Prozinc insulin dose should be 0.75U for now.
I do see from Karl's SS (spreadsheet) that you have reduced the dose to 0.75U for the last 3 cycles ( a cycle is a 12 hour time period).
I'm glad to see that you did that.
That dose can be increased or decreased if needed.
We will have to see what this lower dose does for Karl over several more days.

You want the BG (blood glucose) pre-shot test to be at least 150 mg/dL (> 8.3 mmol/L) before you give Karl insulin. Do you know how to "stall", if the pre-shot test is not high enough to give insulin? Stalling means No food, retest in 20 minutes, look for a rising BG (blood glucose) level. You can "stall" for up to 1 hour if needed and still keep to your regular shot time schedule.

Sasha had mentioned someone else in Denmark that she was helping. So that is why I tagged her, to get her attention on this post.
Hey @SashaV ! Nice to see you here in Marlene's thread.

Have you learned a bit Danish, Deb?!

I've been helping Marlene and Karl since he got diagnosed. It was Marlenes vet I referred to as being somewhat surprisingly good!
However the vet wants to increase, I want to decrease since it looks like Karl is bouncing.

I do not know Danish, but I do know a bit of German still. My vocabulary is very rusty, as I haven't read, written or spoken German much in many years. The words in German and many of the Nordic languages are not that different, but they are often spelled differently. I can also use Google translate to help me understand another language. Google is not always the best at translating, but it gives me a better idea of what is being said.

Thanks for helping Marlene get her SS (spreadsheet) set up. That is a big help, to see what is going on with any cat that is diabetic and getting insulin.

There are several informational posts at the top of this forum, what are called the "Sticky" or pinned posts. They are all in English, since we are a diabetes cat forum that started in the United States. There is a lot of information there. Take you time reading any of those articles, and ask questions when you need to.

This document explains our Prozinc Dosing Protocols. Simply click on the blue text, to open this document.
Sticky PROZINC DOSING METHODS

p.s. If I know that someones main language is not English, I try to explain a bit better. I also like to include what the abbreviations mean, after the abbreviation and put that in brackets.

 

[SashaV]

And Karl has earned himself another reduction! Yay!!!

Deb, German has nothing to do with Danish
Norwegian and Swedish does. I think we have more in common with English rather than German. And it's such an ugly language, if you ask me. Danish probably is too when it isn't your first language

 

[Deb & Wink]

And Karl has earned himself another reduction! Yay!!!

He sure has earned another dose reduction. So his new dose should be 0.5U. I see that his insulin dose has been reduced to that already. Good job!

German, English, Danish, Swedish, Norwegian, and Finnish all have the same root language, proto-germanic. From many hundreds of years ago, they all spread from the same original language and have evolved over time, so they don't sound much like each other today.

 

[SashaV]

German, English, Danish, Swedish, Norwegian, and Finnish all have the same root language, proto-germanic. From many hundreds of years ago, they all spread from the same original language and have evolved over time, so they don't sound much like each other today.
View attachment 58960

They definitely doesn't sound much alike
In Norway as North as you can get, is the closest to Danish. Very funny to be so far from home, and they speak your own language

Karl has been getting some vitamins. Do you know if they can have a good influence his diabetes, Deb?

 

[Deb & Wink]

Karl has been getting some vitamins. Do you know if they can have a good influence his diabetes, Deb?

Most of the time, unless there is some kind of deficiency, any more vitamins or minerals given do not have an impact on the diabetes. Not that I know of anyway.
Ingredients on any supplements should be looked at, to see if there is something in the supplement that could raise the BG levels.

The exception we know about is for methylcobalamin (methyl form of vitamin B12) that can help cats with diabetic neuropathy. If a cat has diabetic neuropathy, getting the BG levels under control is the best thing you can do. But also adding methyl B12 can help with the nerve damage. That healing can take some time. Months.

 

[SashaV]

I'm writing for Marlene, she finds English challenging as I did in the beginning.

Karl is a challenge himself
He doesn't like being poked a lot, so Marlene is trying to pinpoint his nadir. She can't take his BG to close together, and after today's reading at +4 and his high PMPS we were wondering if he earned a reduction today, that Marlene didn't catch.

So should she reduce to 0.25 from tomorrow or keep the current dose for longer?

Would some lidocaine be wise for his ears?
I know something is recommended for sore ears, but I don't believe we have that kind

Hope you made it safe to 2021

 

[Deb & Wink]

So should she reduce to 0.25 from tomorrow or keep the current dose for longer?

I think I would have Marlene try to reduce the dose to 0.25U. So yes is the answer to this question.

I think that Karl's nadir is later than +4. Marlene may want to try testing at +5 and/or +6 some cycles.

Would some lidocaine be wise for his ears?
I know something is recommended for sore ears, but I don't believe we have that kind

There are some antibiotic ointments that also contain a topical pain relief in them. That is what we use on our cats ears, when their ears are looking very sore and red. Use only a very little bit, and wipe off any excess after application. You don't want a cat to ingest this pain relief, during grooming. Any sort of human medication used for pets can cause side effects. So checking with a veterinarian is a good idea. Especially if a cat has other health issues.

He doesn't like being poked a lot,

If Marlene uses some kind of pure protein treat when she tests Karl, that may help her to train Karl to accept the pokes better. She could even give a treat, do all the steps leading up to the poke with the lancet, and not do the actual poking. Basically, break down the process of testing into tiny steps, and do those steps as many times a day as possible. That can help to train your cat to accept something new.

Besides the testing, what we call the 5 P's plus appetite and water intake are a good indication of how a cat is doing. Those 5 P's are purring, preening (grooming), pooping, peeing, playing.

I don't think that google translate did a good job of translating this to Danish. peeing (urination), pooping (defecation), playing, preening (grooming),
purring in English would be tisse (vandladning), pooping (afføring), leg, preening (grooming),
rensende?

 

[Marlene82]

Thanks Deb
I’ll reduce dose to 0.25U in the morning. As you Can see i had a few good test to night, +3 9.7, +4 6.7, +5 6.2
I’ll try test him at +5 and tomorrow
I’ve tryed all the stuff you suggest to test him, but he’s a cat we found 10 years ago... he does not really trust nobody. He saw his sister getting killed by a dog and i dont Think he has been socialised as a small kitty. thanks for all the help
Happy newyear

 

[Marlene82]

Butt anyway... i’ve managed to do ower a 100 test on him now

 

[Deb & Wink]

I’ll reduce dose to 0.25U in the morning.

Hi Marlene.
I'm glad you saw the suggestion to reduce the dose for tomorrow. That will be Karl's new dose going forward.
If he does not do well on the reduced dose, let us know please.

I'm sorry to hear that Karl is not cooperative with the testing. Try to do the best you can with testing.

You are doing a great job, with getting more than 100 tests for Karl so far.

 

[SashaV]

Lol Deb, I love you tried to translate

Purring - spinde
Preening - gør dem selv rene
Pooping - har afføring, pøller, laver pølser
Peeing - tisset, urineret, pis
Playing - leg

Depending on past and present the endings change. One word can mean something, and in another sentence it can mean something totally different.

My former employer, who is from turkey, once said a colleague had a blown appendix and was deported from the hospital.
What he really meant was that he had a ruptured appendix and was discharged from the hospital. But the words mean the same, it all depends on the situation witch the words are used.
Even though we are a tiny country the language change a lot. I can drive 10 miles and they talk different and use other words.

I'm very excited to see what Karl thinks of his new dosage!

We don't have ornaments or creams with antibiotics in without a prescription.
Do you know the name of the one reccomened? Then I can Google and find something similar.
Or Marlene could get a prescription of something similar from her vet.

 

[Deb & Wink]

Neosporin with pain relief, the ointment not the cream kind, is the one recommended here most often. It's a triple antibiotic for topical use.
Bacitracin with pain relief is another possibility. Single antibiotic ointment, with some lidocaine added for the pain relief.
The generic equivalents work just as well, and are less costly.
These are available over the counter here in the US. No prescription needed.

The ointment is recommended, but not the cream type. That is because the cream has a lower fat (grease) content and can cause the blood drop to spread out too much and you won't be able to get a good BG test. The ointment has a higher fat (grease) content and the blood drop will still form a nice bead or droplet.

Some small percentage of cats can be allergic to the antibiotics in these preparations, and may lose the fur on their ears and elsewhere.

I see that Karl bounced up to the pink BG numbers at PMPS today, 1/2/21. I would recommend staying at this lower dose for a few more days, to see if his body adjusts to the lower amount of insulin.

 

[SashaV]

We only have lidocaine, antibiotics is a prescription drug.
Beside the lidocaine I can't find anything useful. So maybe she could try that and see how it goes?

By the way, I'd be like a kid on Christmas day if I were in an American pharmacy

 

[SashaV]

So Marlene shot on a 10.5 tonight, after worrying all day about Karl being too high.
I advised her to give a skinny 0.25, 0.4 instead of 0.6.
Based on that he dropped late in his cycle, and Marlene can't do more tests in a row, so to be safe I thought it was best to reduce tonight until we have clear game plan.
It might be the wrong approach, but you know me Deb, I'm a chicken
And with these tiny doses I'm scared to tip him over.

So! Shoot if above 150/8.3 as you said.
But when does Marlene reduce? On what number? And to what dose?

 

[Deb & Wink]

Beside the lidocaine I can't find anything useful. So maybe she could try that and see how it goes?

If her vet says ok, then go ahead and try the lidocaine. I know there are certain health issues, where you would not want to use the lidocaine. Such as heart disease, but there may be other health conditions that I don't know about that could cause issues.

So! Shoot if above 150/8.3 as you said.
But when does Marlene reduce? On what number? And to what dose?

Marlene is lucky to have you helping her.

Those blues are safe BG numbers. Those are high blues also, so far in this evening dosing cycle 1/3/21.
Numbers down in the neon green, the bright green color you see on the spreadsheet (SS) mean a definite dose reduction.
Numbers down in the tree green, the darker green color you see on the spreadsheet (SS) mean to be more aware of what is going on.
A number < 90 mg/dL( < 5 mmol/L) would be a dose reduction, since we are using the SLGS dosing protocol.
A number <50 mg/dL (< 2.7 mmol/L) would mean to feed to bring the low numbers up to a safer level. That < 50/<2.7 is getting into hypoglycemic territory, and we want to keep cats safe and bring those blood glucose levels back up to >90 mg/dL (>5 mmol/L).

Between 90 and 150 mg/dL ( 5 and 8.3 mmol/L) is a judgement call on what to do with the dose. If the person is not sure or there is not a lot of test data to base a decision on, it's better to skip the dose. Second alternative is to give a token or greatly reduced dose. That token dose should be between 10 and 25% of the regular dose. Since Karl is getting such a small dose anyway right now, it would be very difficult to measure such a tiny dose. So it's more likely that Marlene should skip the insulin shot for that particular cycle. Then there is option number 3, which is to stall without feeding, and look for a rising BG level.

Has Karl's appetite been good today? I'm asking because a cat that is not eating as well can get lower BG numbers.

p.s. I think of Karl as being a curmudgeon, with his dislike of the BG testing.

 

[Marlene82]

Karls appetite is Ok. This morning he did’nt eat as Much as normal. But i went out getting some fish for him and then it went much better. I’m not sure if i did it right this morgning by shooting a lower dose (0.4) but his BG were only 9.2.., so i did’nt now what to do if he keeps being blue... and gets under 8.3... then i should not shoot? Is that correct? But over 8.3 i should still give him a full dose? Not skinny?

i am very happy that Sasha helps me she’s an Angel

 

[Deb & Wink]

I think you did fine in deciding to shoot a lower dose this morning, 1/4/21.

If Karl's BG is less than 8.3 (<150 mg/dL), then you need to stall and not feed him for 20 minutes. Then you retest him. You want a BG number that is increasing before you decide to give him the insulin.

You have to use your best judgement in deciding to give Karl the full dose if he is under 8.3. A skinny dose is likely to be ok for him. But cats can surprise us with how their BG levels go for the day. It's not always very predictable.

If the BG is less than 5.5 mmol/L, you definitely want to use that stalling technique. If the BG does not rise above 8.3, then I'd suggest that you skip the shot for that 12 hour cycle.
If the BG is more than 5.5 but less than 8.3, you want to also use the stalling technique. There is a greater possibility that the BG level will increase, if it's in that higher range to start with when you do the pre-shot test. So it's more likely that you will be able to stall without food, retest, see an increasing BG level and be ok to give the full dose.
If the BG is more than 8.3, than I think a full dose would be ok. Or a skinny dose, if that makes you feel more comfortable.

But you are the one there to observe Karl. You are the one that knows what your responsibilities and schedule for a day are like. So you need to stop and think about those factors, your responsibilities for the day, in deciding what insulin dose you will give Karl for the day.

As you gain more experience and more data, you will get a better idea of what a particular insulin dose does for Karl's BG levels.

 

[SashaV]

Marlene and I was wondering how she can lower Karl's dose?
I've suggested a magnifying glass, calipers, and it doesn't work for Marlene. What else is there?
Not that we're there yet - unless you say so, Deb. But just to be prepared if and when. Perhaps even for some training in micro dosing

Right now she's doing a mid cycle test in his PM cycle, we have a theory that Karl is getting lower during the nights and that's why his amps have been pink.

He is definitely not low enough to do an OTJ trial but... how do we get lower?
His current dose of 0.25U is only a drop.
Like almost nothing.

 

[Deb & Wink]

Karl may be dropping lower at night, but not enough to take him down into the green range BG levels you see in the header of the SS. So not <100 mg/dL (5.5 mmol/L). I don't see that he needs a dose reduction. I think he is just bouncing, from lows that his body is not used to.

Is Marlene using U100 syringes or U40 syringes? Please add this information to the SS (spreadsheet).

Drop dosing.
Take a used syringe, and some colored water.
Draw up the tiniest bit of colored water that you can.
Make sure there are no air bubbles in the syringe. Tap, your fingers against the syringe barrel, needle pointed up to the ceiling, as you tap. This forces the air to the top of the syringe where you can squeeze out the air bubbles.
Practice twisting the plunger VERY SLOWLY, to squeeze the liquid out the tip of the syringe.
Practice until you get evenly sized drops, and the same number of drops each time.
You are looking for consistency with the amount of liquid you draw up into the syringe, as well as being consistent with the drop size as you squeeze out drops of liquid through the needle.

Practice. Lots.

Once you have achieved an even number of drops each time, see if you can leave only 1 or 2 drops in the syringe.
If only one drop is needed or desired, you can squeeze out that last drop to the needle tip of the syringe, and then pull back on the plunger to get that last drop back into the syringe. You are now ready to shoot one drop of insulin from our syringe into your cat.

 

[SashaV]

Deb, could you have a look on Karls spreadsheet? It seems to be going the wrong way.
Marlene has been around the neighbourhood asking if someone was feeding him, or their own cats outside, they all said no. But we're pretty convinced that he is eating some sort of contraband during the nights, specially in the weekends. We can't see any other explanations. Can you think of something else?
She's keeping him on his regular feeding schedule and not changing anything during the weekends. It makes no sense.
She tried feeding him from home, so he wasn't hungry when he went out during the nights, didn't work either.

 

[Deb & Wink]

I know this would be hard for Karl, but if Marlene could try to keep him inside, that would help to prove that he is getting into some food somewhere outside. He could be catching his own food too. Birds, mice, voles are all possibilities.

Cats are furry little opportunists. If they see some food, they will eat it, even if they have been fed.

I think Karl could use more insulin. Try an insulin dose of 0.75U.