Dosing advice for Oscar - Can't get out of the pinks :(

Oscar and Carrie

Oscar and Carrie

Member
Hi everyone,

I've been a bit quiet as we moved house last week so busy with that!

I would like a bit of advice with Oscar. I had him at 0.5u for just short of 3 weeks, in the hope that it was the bottle of ProZinc that was not as effective, but even after a change to another one there was no improvement in numbers.

I increased him to 0.66u just over a week ago, and this has had little impact. If anything his numbers have gone up!

The vet suggested I shouldn't have increased his dose as he hadn't been on the 0.5 long enough to see an impact and that his numbers looked fine before the dose increase ?? (though if I'm following the SLGS method, a week is enough isn't it?). My argument was that I'm testing frequently enough to see very quickly what the effect of a dose change is and that his nadir had never dropped under 10 so his BG levels were still too high.

I'm going to try and get a curve today, but it does look like he needs an increase. Should I go up to 1 after the 0.66, or should I do 0.75 first for a week, and then up to 1 if needed?
 
Carrie. I wouldn't advise on dose but my vet wanted Pabay on the same dose for 5 days when he was on prozinc. Even with prozinc the increase in the dose can cause a clinical hypo at about 3 days apparently. It takes time to have a full effect because one dose affects another. My vet has always told me to be careful at that point following a dose increase. So I don't understand your vets point.
 
Pabs&Ro said:
Carrie. I wouldn't advise on dose but my vet wanted Pabay on the same dose for 5 days when he was on prozinc. Even with prozinc the increase in the dose can cause a clinical hypo at about 3 days apparently. It takes time to have a full effect because one dose affects another. My vet has always told me to be careful at that point following a dose increase. So I don't understand your vets point.
Click to expand...

This is my thought!

I understand maintaining a dose for a week to clear any bounces that might occur from the initial increase (unless at any point the BG drops low enough to warrant an immediate decrease), but to keep going for weeks on a dose that is clearly not enough seems odd to me. I wonder if it is because they are not used to treating cats where the owner is testing daily, and normally they would keep you on a dose for a long time, bring you in for a curve and then adjust?
 
I'm not giving advice on dosage, but I definitely think he needs an increase.
Prozinc is not longer lasting, one dose CAN effect the next cycle, but Prozinc is more in and out.
And the longer you keep an ineffective dose, glucose resistance sets in and gets harder to break through. I'd wait on @Deb & Wink @JanetNJ or @Shelley & Jess to give a go ahead. Just my thoughts :oops:

And I think the vets are taking it very slow, since most doesn't test and wouldn't catch a low. They're just forgetting insulin is a hormone, and the BG is never the same two days in a row..
 
Deb & Wink said:
Sorry, but we disagree with your vet. 3 weeks is PLENTY of time to see if a dose is working or not. In fact, holding a dose for that long can lead to insulin resistance, as Sasha mentioned back in reply #4.

So be it.
Click to expand...

Thanks Deb,

I really feel awkward going against the wishes of my vet, but knowing that I am doing what's best for Oscar and have the knowledge of this board behind me makes me feel more confident in my decisions.
 
Oscar and Carrie said:
Thanks Deb,

I really feel awkward going against the wishes of my vet, but knowing that I am doing what's best for Oscar and have the knowledge of this board behind me makes me feel more confident in my decisions.
Click to expand...
Have you tried telling your vet, that you want to work with him or her?
I was told Mauer needed to eat diabetic dryfood before I had any chance of remission, because of the slow carbs.....?!
I tried... but it didn't make sense. My vet went out sick for most of the year, when she got back I wanted to make sure I had her support. I did, Mauer was doing GREAT, and I should let her know if and when I needed a prescription and she'd give me one. I proved I did better on my own.
Or maybe it's time for a new vet?
 
SashaV said:
Have you tried telling your vet, that you want to work with him or her?
I was told Mauer needed to eat diabetic dryfood before I had any chance of remission, because of the slow carbs.....?!
I tried... but it didn't make sense. My vet went out sick for most of the year, when she got back I wanted to make sure I had her support. I did, Mauer was doing GREAT, and I should let her know if and when I needed a prescription and she'd give me one. I proved I did better on my own.
Or maybe it's time for a new vet?
Click to expand...

I am keeping them updated with all the changes I'm doing, and I've explained that I'm following the AAHA guidelines. They have been generally supportive when I've discussed the change to low-carb diet and using a human meter instead of a pet meter, and they are letting me get on with looking after Oscar my own way, but they do like to tell me every time they call that they think I change his dosage too frequently and I'm not giving it time to settle in. That's the one thing we seem to disagree on.
 
Oscar and Carrie said:
I am keeping them updated with all the changes I'm doing, and I've explained that I'm following the AAHA guidelines. They have been generally supportive when I've discussed the change to low-carb diet and using a human meter instead of a pet meter, and they are letting me get on with looking after Oscar my own way, but they do like to tell me every time they call that they think I change his dosage too frequently and I'm not giving it time to settle in. That's the one thing we seem to disagree on.
Click to expand...
But instead they want glucose resistance to set in? Prozinc is in and out, no depot effects to take into consideration.
My vet refused to change dose on Caninsulin for a month!!!! Stupid :banghead::woot:

A blood glucose isn't steady, never the same, neither should insulin be. When it's not a depot.
 
Oscar and Carrie said:
but they do like to tell me every time they call that they think I change his dosage too frequently and I'm not giving it time to settle in. That's the one thing we seem to disagree on.
Click to expand...
If the dose and the frequency of changing it is the only thing you and your vet disagree on, you are ahead of the game. Many vets don't think their clients should home test at all, or use a low carb food.
Oscar and Carrie said:
Just got a reading of under 10 during the AM cycle for the first time in over a month! :joyful:

Let's hope this is a sign of better numbers!
Click to expand...
Yeah!

But it does look to me like Oscar will need another dose increase soon. We need to get him out of those darn pinks and yellows.
 
The vets haven't called at all since I e-mailed to tell them about the dosage change. I will take their silence as passive acceptance :D

We've had a few hours in the blue so far today, keeping those fingers crossed.
 
@JanetNJ @Deb & Wink

Would you be able to review and advise on Oscar's dosage?

After a day of high, flat numbers, he's dropped quite low tonight (+4 of 4.5/81). I'm going to get a few more readings tonight, but would you recommend an immediate dosage reduction to 0.75 in the morning, or maintain this dose of 1u if 4.5 is the lowest he goes?

PS. I have given a tablespoon of low carb wet food at +3 and +4 so the +4 reading may have been lower without food.
 
I think that Oscar is finally making some good progress on this 1U dose. So if you can monitor as usual, I'd keep the dose the same.

Technically, per the SLGS dosing protocol, Oscar earned a dose reduction. But he's been high for so long, for many weeks, I'd like to see him stay at the higher 1U dose for a bit longer.

p.s. Notes on the SS in the Remarks column about the +3 and +4 feedings will come in handy, as you look back at the SS in the future. It's good to have notes such as this on the SS, as a memory jog.
 
Deb & Wink said:
Technically, per the SLGS dosing protocol, Oscar earned a dose reduction. But he's been high for so long, for many weeks, I'd like to see him stay at the higher 1U dose for a bit longer.
Click to expand...

Thanks Deb, this is what I was thinking, which is why I was unsure as to whether or not to decrease. I work from home at the moment so I'm able to monitor regularly - will hold the 1u dose and keep an eye out.
 
JanetNJ said:
Oh I see an 81! Keep this dose a bit longer.
Click to expand...

Thanks Janet I will!

He had really good numbers during that PM cycle on the 25th, but he's been quite high since. He's been stuck in flat pinks all day, so I'm expecting another drop this evening. Does this look like bouncing to you from that earlier low number?
 
Bounces can take 3 cycles to clear. Flat lining high can mean too much insulin. See what deb and wink say as the earlier low number was a while ago.
 
Oscar and Carrie said:
Thanks Janet I will!

He had really good numbers during that PM cycle on the 25th, but he's been quite high since. He's been stuck in flat pinks all day, so I'm expecting another drop this evening. Does this look like bouncing to you from that earlier low number?
Click to expand...
Hmmm. That probably cleared by now. You may need a tiny boost soon but let's watch another day. :)
 
Morning!

After a day of flat pinks yesterday, Oscar had a better PM cycle and this morning had a lovely pre-shot number of 11.5/207! This is the lowest he's been in the morning for well over a month, so really hoping to see lots of blues and greens today. Keeping everything crossed :nailbiting:
 
JanetNJ said:
Oh nice! Did you have to steer to get that number up? Or did it come up on its own You could reduce. Our just give a skinny 1.
Click to expand...

He has a small meal of LC wet food at +4, so the +5 reading may have been influenced. I'm going to get another at +6 to see if it still keeps going up two hours after that small meal.
 
If you are able to steer the cycle with some food, then keeping the dose at 1U would give Oscar's pancreas a chance to heal. If the insulin injections are a good amount, then his pancreas can rest and heal a bit.
 
I'd recommend a dose increase, to the 1.25U amount. You've given the 1U plenty of time to see it's impact, and that lower dose simply isn't bringing down Oscar's BG levels enough.

UP, UP, UP with the dose.
 
Hi all,

So tomorrow will be Oscar's 7th day on 1.25u

Whilst his pre-shot numbers have now started to drop which is good, I'm still not really seeing any blues or greens mid-cycle.

Would you recommend increasing now to 1.5, or giving the 1.25 a little bit more time?
 
Deb & Wink said:
If Oscar were my cat, I'd increase to 1.5U. You've given the 1.25U plenty of time to show what it can do, and it's not doing enough.
Click to expand...

Cheers Deb.

I'm going to do a curve today to double check he's not going lower later in the cycle (and as evidence for the vet as to why I am increasing again) and then I'll start on the 1.5u dose from tomorrow morning if his nadir is still not approaching 5.5.
 
Oscar stayed in the yellows throughout the day, so made the decision to increase to 1.5 from his PMPS shot.

Really hoping we can keep bringing the pre-shot number down lower closer to the 11/200 point. Keep everything crossed!
 
Hi, just a quick update from me.

Day 3 on 1.5u and not much change as of yet. He's had pretty much flat numbers for the last few days so hoping to see some movement soon.

I've also purchased a ketone meter and tested this for the first time. The number came back at 1.4mmol. I've had a look at some of the files on here and it looks like if it's above 2.4 that's when I should seek vet treatment? For now, should I focus on increasing his water intake and try and get that a bit lower?
 
I belive you're right, but I'm not experienced in ketones.
Could you perhaps do some later readings? He might be bouncing from a lower BG you didn't catch.
Would also be awesome if you could record what he eats and when :oops:
Did you change anything around the time you lost control of his BG?
Could he have an infection somewhere?
 
SashaV said:
I belive you're right, but I'm not experienced in ketones.
Could you perhaps do some later readings? He might be bouncing from a lower BG you didn't catch.
Would also be awesome if you could record what he eats and when :oops:
Did you change anything around the time you lost control of his BG?
Could he have an infection somewhere?
Click to expand...

Do you mean recently, or back in March when his numbers just jumped up?
 
SashaV said:
Back when his numbers jumped up..
Click to expand...

No, nothing at all changed except he'd switched to a new vial of insulin. Diet and feeding schedule etc were all exactly the same so I have no idea what caused it to jump up.

I thought it may have been a dodgy vial, so I got a different one but sadly no change.
 
Oscar and Carrie said:
No, nothing at all changed except he'd switched to a new vial of insulin. Diet and feeding schedule etc were all exactly the same so I have no idea what caused it to jump up.

I thought it may have been a dodgy vial, so I got a different one but sadly no change.
Click to expand...
I thought so... why I'm thinking an infection of some sort. How is his teeth?
 
They seem fine to me, though he is back at the vets a week on Monday so I will get them to look over his teeth. Here's a picture if you can spot anything.
 

Attachments

  • Teeth.JPG
    Teeth.JPG
    65 KB · Views: 191
You must log in or register to reply here.
Back
Top