Your views on Duke's progress please and current dose.

[Teetee (UK)]

Hi everybody,
I haven't posted for a while but if anybody gets the chance could you have a quick look at Duke's spreadsheet and let me know how you think he is doing with his numbers and whether you think i could be doing anything else to help him.
I really do struggle with his low preshot numbers and i tend to give his a smaller dose if he's below 9 mmol (162 mg/dl), but by doing that he does not drop enough so should i risk it and give his full dose when he drops below 9 mmol (162 mg/dl)
Duke was not too well a few weeks ago and wasn't eating much and had to have antibiotics plus and appetite stimulant, he showed as having white blood cells in his urine but that's cleared up now, (checked last week)
Anyhow he's fine in himself now and eating well again but at the time i felt totally out of control with him and his dose.
Oh he had his dental work done just over three weeks ago, thankfully no extraction just lots of plaque and tartar removed.
Thanks,
Tee.

 

[Sienne and Gabby (GA)]

One thought... Is there any way that you wake up during the night and could get a test later in the PM cycle? I wonder if Duke's numbers are dropping past +6.

Overall, Duke's numbers are good. For many cats, the pre-shot numbers are the last to come down. Since Duke is seeing a lot of green, one thought may be to try giving him a snack at around +8 or +9. (This is when a timed feeder comes in handy.) The food may help to pull the pre-shot numbers down a bit.

I would not be overly concerned about shooting if Duke's numbers are below 162. I would try this on a day when you or someone is around to test so you have an idea of how your cat responds. I am most familiar with Lantus. The Modified Prozinc Dosing in this Prozinc Dosing sticky indicates that shooting low numbers is acceptable providing you have the data to support shooting low numbers. (With both Lantus and Prozinc, you can shoot anything above 50.) I would not suggest you immediately change your point at which you shoot -- rather, work your way down to shooting lower numbers. For example, You could consider dropping your number to 130, and keep working your way down.

 

[JanetNJ]

Hi everybody,
I haven't posted for a while but if anybody gets the chance could you have a quick look at Duke's spreadsheet and let me know how you think he is doing with his numbers and whether you think i could be doing anything else to help him.
I really do struggle with his low preshot numbers and i tend to give his a smaller dose if he's below 9 mmol (162 mg/dl), but by doing that he does not drop enough so should i risk it and give his full dose when he drops below 9 mmol (162 mg/dl)
Duke was not too well a few weeks ago and wasn't eating much and had to have antibiotics plus and appetite stimulant, he showed as having white blood cells in his urine but that's cleared up now, (checked last week)
Anyhow he's fine in himself now and eating well again but at the time i felt totally out of control with him and his dose.
Oh he had his dental work done just over three weeks ago, thankfully no extraction just lots of plaque and tartar removed.
Thanks,
Tee.

These numbers look excellent! As long as you are around to test and streer you're probably fine to give your reg dose.

 

[Teetee (UK)]

One thought... Is there any way that you wake up during the night and could get a test later in the PM cycle? I wonder if Duke's numbers are dropping past +6.

Overall, Duke's numbers are good. For many cats, the pre-shot numbers are the last to come down. Since Duke is seeing a lot of green, one thought may be to try giving him a snack at around +8 or +9. (This is when a timed feeder comes in handy.) The food may help to pull the pre-shot numbers down a bit.

I would not be overly concerned about shooting if Duke's numbers are below 162. I would try this on a day when you or someone is around to test so you have an idea of how your cat responds. I am most familiar with Lantus. The Modified Prozinc Dosing in this Prozinc Dosing sticky indicates that shooting low numbers is acceptable providing you have the data to support shooting low numbers. (With both Lantus and Prozinc, you can shoot anything above 50.) I would not suggest you immediately change your point at which you shoot -- rather, work your way down to shooting lower numbers. For example, You could consider dropping your number to 130, and keep working your way down.

Thanks @Sienne and Gabby (GA)
I will try and get a PM+7 in the next couple of days and nights, although i do plenty of AM+9's and he's always rising . The thing is with Duke is once he's in bed that's it, he's zonked till morning and does not wake up. (lazy cat snoring away all night lol) and is not hungry.
Regarding the low preshot numbers, i'm not working on it, it's just happening, sometimes he's in the blues and sometimes yellows and that's where i struggle with the dose, full dose or not. Don't get me wrong i love to see the low preshot numbers, infact i'm disappointed when i see a yellow preshot.
You say work your way down, how do i do that or does that just happen or do you mean keep giving a full dose until he drops below in duke's case 68 on the alphtrak.

 

[Teetee (UK)]

These numbers look excellent! As long as you are around to test and streer you're probably fine to give your reg dose.

Thanks @JanetNJ
Excellent, wow thanks. That's what i like to hear lol.
I knew that there would come a day when those low preshot numbers would appear, just after when i had started to get really comfortable, no panicking etc with low numbers, (remember lol) now we start again, plus i think i need to open a new vial as i don't think it's working quite as good. I'm just too rough when i roll it and it goes bad.

 

[Teetee (UK)]

Here he is chilling on his mums sun lounger this afternoon.

 

[Sienne and Gabby (GA)]

When someone is new to managing their cat's diabetes, we suggest setting a "don't shoot - post and ask for help number." Usually this is relatively high -- somewhere in the neighborhood of 200. As you get comfortable with testing and shooting, you begin to shoot progressively lower numbers. For example, on the Lantus board, that initial number is 150 if a caregiver is following the Tight Regulation Protocol. Once a caregiver is beginning to get comfortable with seeing blue and green numbers, they are encouraged to drop that pre-shot number to shooting at 120, or 100, or 75, and eventually shooting anything that's above 50.

While you're clearly comfortable shooting if Duke's reshot is over 162, I'd encourage you to lower that threshold so you don't skip or reduce the dose. Admittedly, Prozinc is more forgiving than Lantus when it comes to giving a reduced dose but it's a consideration. You may want to look over the alternative dosing methods for Prozinc so you have a feel for what I'm referring to.

 

[Teetee (UK)]

Rather than start a new thread i will continue here.
The problem i'm having now with Duke is he's now having lower preshot numbers which i'm happy with and comfortable at shooting at, but he's not dropping down into the greens now, should i increase his dose very very slightly, a drop or two to try to bring him down into the greens or do i leave his dose as it is.
I'm asking because as i understand it the greens are the numbers which heal the pancreas.

 

[FarmKitty]

Just wanted to comment because I am seeing some big similarities between your cat and mine. When I had Dixie on ProZinc, I noticed the same issue where 1 unit would drop her by a lot. It was great seeing the green mid-cycle values, but the preshot values would always go higher. Since we obviously don't want them dropping too low at the nadir, we get stuck in a sort of stalemate. I recently switched to Lantus last month (wish I had done it sooner) and have found it a lot better. I increased her dose and now her preshot values are pretty much the same as the midcycle values! Very flat curve. I know switching insulin is more involved money-wise, but just thought I would bring this up as an option!

 

[Teetee (UK)]

Just wanted to comment because I am seeing some big similarities between your cat and mine. When I had Dixie on ProZinc, I noticed the same issue where 1 unit would drop her by a lot. It was great seeing the green mid-cycle values, but the preshot values would always go higher. Since we obviously don't want them dropping too low at the nadir, we get stuck in a sort of stalemate. I recently switched to Lantus last month (wish I had done it sooner) and have found it a lot better. I increased her dose and now her preshot values are pretty much the same as the midcycle values! Very flat curve. I know switching insulin is more involved money-wise, but just thought I would bring this up as an option!

Hi @FarmKitty
Unfortunately switching to Lantus is not an option for us as the vets over here in the UK won't swap to human insulins unless all other options are exhausted, some sort of regulation. There is no way that would happen with Duke's numbers as they are. They would just say he's doing fine and regulated, not just my vet but all vets would say it.
It's called the cascade system.

 

[FarmKitty]

@Teetee (UK) Ah! I am sorry to hear that.

In that case, yes, you will want to learn to shoot him at lower and lower pre-shot values. Basically just make up a process that you are comfortable with. Let's suppose 8.1 is your threshold for shooting. If he is a little lower, like 7, you could give a half dose. If he is lower than that, try a token dose (something like 0.25u or just something really small). Work your way up from a half dose to a full dose and then lower the threshold. Basically just keep doing that. Also, only do this if you had a hypo kit ready (test strips, medium and high carb food that you know Duke will eat, corn syrup, emergency hypo instructions), and are around to test him. Suppose he has a low PS at night, then maybe be more conservative and give a token dose. If he does it in the morning and you are around to test him, you can give a higher dose.

Try to move away from skipping doses and work your way up to dosing at least some insulin each time. Even if he doesn't eat occasionally, you can still give some insulin (such as June 1st). Just make sure he has food left out for if he needs it.

Seems like you are opening new vials pretty often, so the insulin age probably isn't an issue here. My vial was 10 months old, and my vet noted that giving smaller doses (0.25 units) will make the old insulin even less effective! Wish I had opened a new vial sooner, because I noticed that Dixie's values started to rise.

Also, sometimes the BG levels will get higher on their own. Dixie had a random week where she just went to the pinks and then never did that again. Sometimes her mid-cycles are all blue, sometimes all green... it just waxes and wanes , so don't get too caught up in the 0.125 unit increments. I can't remember where I read it on here, but basically the syringe markings are not super reliable, and even if they were it is still impossible to dose out these small dosing increments consistently. You just gotta hope for the best! One day's 1.125 will not equal another day's 1.125u

Other things you can look into are switching his food to extra low carb. Could experiment with 0% or 1-2% ones. I noticed that these were able to bring Dixie's numbers down when I was trying them out, but I can't feed them because she had kidney disease and is a very picky eater . Not sure the food you are currently feeding, but it is worth a shot. I noticed Dixie's BG levels went up when I went from 5% carb to 9% carb.

 

[FarmKitty]

Rather than start a new thread i will continue here.
The problem i'm having now with Duke is he's now having lower preshot numbers which i'm happy with and comfortable at shooting at, but he's not dropping down into the greens now, should i increase his dose very very slightly, a drop or two to try to bring him down into the greens or do i leave his dose as it is.
I'm asking because as i understand it the greens are the numbers which heal the pancreas.

I wish I could help with this, but I am unfamiliar with the AlphaTrack glucometer readings and how it corresponds to MPM, so I don't want to give you any bad dosing advice! Duke seems to like suddenly dropping to those lime greens. Have you noticed any pattern to why he does this? Is he not eating during those cycles? Maybe you were playing with him extra (exercise can lower BG)? If you wanna be on the safe side, just keep him at that 1.0F and see how he does for a few more days.

 

[Sienne and Gabby (GA)]

It looks to me like you should increase Duke's dose. You may want to take a look at this sticky note on Prozinc Dosing Methods. In particular, the second section that discusses the modified method may be helpful.

 

[Teetee (UK)]

@Teetee (UK) Ah! I am sorry to hear that.

In that case, yes, you will want to learn to shoot him at lower and lower pre-shot values. Basically just make up a process that you are comfortable with. Let's suppose 8.1 is your threshold for shooting. If he is a little lower, like 7, you could give a half dose. If he is lower than that, try a token dose (something like 0.25u or just something really small). Work your way up from a half dose to a full dose and then lower the threshold. Basically just keep doing that. Also, only do this if you had a hypo kit ready (test strips, medium and high carb food that you know Duke will eat, corn syrup, emergency hypo instructions), and are around to test him. Suppose he has a low PS at night, then maybe be more conservative and give a token dose. If he does it in the morning and you are around to test him, you can give a higher dose.

Try to move away from skipping doses and work your way up to dosing at least some insulin each time. Even if he doesn't eat occasionally, you can still give some insulin (such as June 1st). Just make sure he has food left out for if he needs it.

Seems like you are opening new vials pretty often, so the insulin age probably isn't an issue here. My vial was 10 months old, and my vet noted that giving smaller doses (0.25 units) will make the old insulin even less effective! Wish I had opened a new vial sooner, because I noticed that Dixie's values started to rise.

Also, sometimes the BG levels will get higher on their own. Dixie had a random week where she just went to the pinks and then never did that again. Sometimes her mid-cycles are all blue, sometimes all green... it just waxes and wanes , so don't get too caught up in the 0.125 unit increments. I can't remember where I read it on here, but basically the syringe markings are not super reliable, and even if they were it is still impossible to dose out these small dosing increments consistently. You just gotta hope for the best! One day's 1.125 will not equal another day's 1.125u

Other things you can look into are switching his food to extra low carb. Could experiment with 0% or 1-2% ones. I noticed that these were able to bring Dixie's numbers down when I was trying them out, but I can't feed them because she had kidney disease and is a very picky eater . Not sure the food you are currently feeding, but it is worth a shot. I noticed Dixie's BG levels went up when I went from 5% carb to 9% carb.

Thanks @FarmKitty for your very detailed response.
I'm getting comfortable at shooting low numbers and i don't really have a threshold so it's just a case of like you say and see what he's like preshot and go from there.
Food wise he loves his Gourmet high carb when he goes low so no problems there.
So what you're saying about 1st June is i should have given him insulin, i thought if they didn't eat you should skip the dose or could i have given him say 0.25u just to make sure he has some insulin.
As for the vials i just think i'm a bit too rough with them by rolling it too much and after a while it starts to get floaters then i change it. I roll it ten times turn it over and roll another 5 times then insert the needle.
Regarding the syringes they are different as i have found out but i use this method so's that i can get the dose pretty accurate with my magnifying glass.
What i do is just sort them all out before i use them so i'm not messing about at shot time, i have three separate bags where the plunger is at the top, middle and bottom of the zero line, i then use all the syringes with the plunger at the top, then the middle and then the bottom. This way i can give more or less the same dose each time, and i adjust the dose very slightly when i use the ones where the plunger goes to the middle and bottom of the zero line, but still the same dose if you see what i mean.
The food we give him very rarely goes above 4% carbs unless he's not eating then we give him a medium carb food to try to get him to eat.
Tee.

 

[Teetee (UK)]

It looks to me like you should increase Duke's dose. You may want to take a look at this sticky note on Prozinc Dosing Methods. In particular, the second section that discusses the modified method may be helpful.

Thanks @Sienne and Gabby (GA)
I've had a good read again lol, but i find it so difficult to digest.
Anyway as you say i will increase his dose but not by 0.25u but just a drop or two and see how he goes. Would that be ok?
Tee.

 

[Teetee (UK)]

I wish I could help with this, but I am unfamiliar with the AlphaTrack glucometer readings and how it corresponds to MPM, so I don't want to give you any bad dosing advice! Duke seems to like suddenly dropping to those lime greens. Have you noticed any pattern to why he does this? Is he not eating during those cycles? Maybe you were playing with him extra (exercise can lower BG)? If you wanna be on the safe side, just keep him at that 1.0F and see how he does for a few more days.

I've no idea why he dropped low and there is no pattern that i can see, i would have noted it on his SS if he's struggling with his food, but i do drop his dose after and he seems to lose the greens.
Duke exercise lol don't make me laugh, he's the most laziest cat the world has ever seen. He just eats, sleeps and goes to the litter tray.
He's started to ask to go outside again a few weeks ago, strange really because when he was first diagnosed he refused to go outside at all, he was just so frightened to go outside and the slightest noise he would panic, just no confidence at all. That wasn't like Duke at all because he's the most chilled cat you can meet. Even his vet says she's never seen a cat so chilled.

 

[Sienne and Gabby (GA)]

That would be fine.

 

[Teetee (UK)]

Well so much for expecting a low PMPS. For some reason he's flown up to 13.5 mmol ( 243 mg/dl) from 7.1 mmol (128 mg/dl) in less than 3 hours, almost double. He did sneak up the road earlier this afternoon and whether he got food somewhere or something scared him raising his BG i don't know.
Oh well normally when he's high preshot he's drops into the greens.

 

[FarmKitty]

So what you're saying about 1st June is i should have given him insulin, i thought if they didn't eat you should skip the dose or could i have given him say 0.25u just to make sure he has some insulin.

ProZinc won't hit right away. It usually onsets around +2, but that can vary between cats. You could try getting some +1's and +2's in if you are curious. So when you shoot ProZinc, you aren't shooting the value he is at now, you are really shooting the value he will be at when the insulin onsets. Make sure food is available to him so that he can go eat when his values start dropping! Since Duke has been in the greens so much, maybe you are noticing some of his behaviours when he gets a bit too low? Cats will often seek out food if their BG drops. I can usually tell when Dixie is too low without even testing her because she will be meowing at her food bowl!

Check out Deb's response #41 here. I was asking a similar question about whether or not to shoot if Dixie wasn't eating everything at shot time, and learned that it can actually be bad to skip the insulin shot if she isn't eating. Ever since then, I consistently give the shot even if she only eats a little bit or nothing. And pretty much every time after 1-2 hrs, she will be back at her food bowl eating! As a side note, this has made the whole test/feed/shoot schedule way easier. However, if she wasn't eating and it was night time, I would stay up a bit to make sure that she does eventually eat something.

 

[Teetee (UK)]

Thanks for that info @FarmKitty i shall certainly take that on board.
Duke's just the same when he's low, infact when he went low the other day i thought to myself i wonder if he's dropped low because he wasn't sleeping and asking for food.
I've read the thread and there are so many similarities with Dixie and Duke and a lot of good information i can use, thanks.
I had to laugh at this sentence.
"Sometimes we give her a chicken treat on top of her meal to entice her, but now it seems like she expects it"
That's Duke now every meal lol.
Can i ask why you switched to Lantus when she was doing great on the Prozinc?

 

[FarmKitty]

Can i ask why you switched to Lantus when she was doing great on the Prozinc?

I wanted her to be Tightly Regulated, which means generally below 8.3 and usually in 3.3-6.7 range (you can find this info in the 'What is Regulation?' section of the ProZinc general info thread). She was in that range at one point after her dental, but then her values gradually started to trend up and, after 9 months on the same ProZinc bottle, she was getting up to the high blue range. The yellow values were making me sad as well, so knew I had to get some more insulin.

I was curious about Lantus because it is so popular on the forum, and it actually ended being cheaper than ProZinc for me. I also really like that it comes in smaller vials so that I can open fresh bottles as the months go on. The idea of a flatter curve was also appealing because 0.25u of ProZinc could really drop her down.

She was doing pretty great on ProZinc, and even my vet was wondering why I wanted to change. Honestly, I think I just wanted to try out something new. I am also very fortunate to be home all day and keep an eye on her, so the switch to a new insulin was a very minor inconvenience.

Also, I won't lie... she is just very easy to regulate. She never bounces and is just very easy going.

It is hard to say if a fresh bottle of ProZinc wouldn't give me the same results I am seeing now!

For what it's worth, my vet used Lantus for the last decade, but has seen better results with ProZinc. I think this forum tends to be a bit biased towards Lantus, and there will always be posts from new members going "oh no! did I pick the wrong insulin?", but really, you don't know till you try! Duke is making great progress on the ProZinc and is surfing in the greens very nicely. The longer he stays there, the more his body can heal, and then you will start to notice his preshot values coming down (which means some more work for you ).

I had to laugh at this sentence.
"Sometimes we give her a chicken treat on top of her meal to entice her, but now it seems like she expects it"
That's Duke now every meal lol.

Hah yeah now I have to add a bunch of medication to each of her meals, so she probably thinks she is getting some great treats sprinkled on every time

 

[Teetee (UK)]

I wanted her to be Tightly Regulated, which means generally below 8.3 and usually in 3.3-6.7 range (you can find this info in the 'What is Regulation?' section of the ProZinc general info thread). She was in that range at one point after her dental, but then her values gradually started to trend up and, after 9 months on the same ProZinc bottle, she was getting up to the high blue range. The yellow values were making me sad as well, so knew I had to get some more insulin.

I was curious about Lantus because it is so popular on the forum, and it actually ended being cheaper than ProZinc for me. I also really like that it comes in smaller vials so that I can open fresh bottles as the months go on. The idea of a flatter curve was also appealing because 0.25u of ProZinc could really drop her down.

She was doing pretty great on ProZinc, and even my vet was wondering why I wanted to change. Honestly, I think I just wanted to try out something new. I am also very fortunate to be home all day and keep an eye on her, so the switch to a new insulin was a very minor inconvenience.

Also, I won't lie... she is just very easy to regulate. She never bounces and is just very easy going.

It is hard to say if a fresh bottle of ProZinc wouldn't give me the same results I am seeing now!

For what it's worth, my vet used Lantus for the last decade, but has seen better results with ProZinc. I think this forum tends to be a bit biased towards Lantus, and there will always be posts from new members going "oh no! did I pick the wrong insulin?", but really, you don't know till you try! Duke is making great progress on the ProZinc and is surfing in the greens very nicely. The longer he stays there, the more his body can heal, and then you will start to notice his preshot values coming down (which means some more work for you ).


Hah yeah now I have to add a bunch of medication to each of her meals, so she probably thinks she is getting some great treats sprinkled on every time

Ah right i see, fingers crossed Dixie get into remission soon and looking at her numbers it looks very likely
So Duke has with his meal, 1/2 milk thistle tablet AM/PM and 1 krill oil capsule PM and we put 25ml extra water in his food AM/PM. Oh and the roast chicken in hand for when he looks to say where's my chicken.
Extra work lol. I don't care just as long as he feels better. I think like you we have been very lucky with Duke's and getting him into good numbers and below the renal threshold for the majority of the time.