Should Joe's dose be raised

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Susan Pomo

Susan Pomo

Member Since 2021
Joe has not had a good day in a while numbers wise. Wondering if he needs to go to 3.50. He seems like he feels alright and the diarrhea is clearing up slowly.
Today he pooped twice and peed once outside the litter box.
Is this caused by diabetes, CKD, or possible senility?
Joe is 14
 
Yeah, numbers are not promising huh. It looks like the last time he may have gotten in the blues was 8/5.
As frustrating as it is, do you want to give it some more time?
Are you doing the Prozinc SLGS method? If so, you hold the dose for at least a week. Also from the Prozinc Dosing sticky:
"If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete"
So since you started the Metronizadol on the 4th, I wonder if you're better off waiting until that course is completed?
Hopefully someone will respond tonight, I know you've likely gone to bed at this point.
Please don't increase without advisement tomorrow morning, k?
 
Here's the part about holding for a week:
"Hold the dose for at least a week:
  • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
https://www.felinediabetes.com/FDMB/threads/prozinc-dosing-methods.225629/
 
Susan, have you looked at the two dosing methods for Prozinc. They are at the top of the Prozinc page. If you decide on one, I would put it into your signature.
Until you decide which method, you need to hold the dose for 1 week before doing a curve. As you went back to 3 units 4 days ago, the count starts again from there.
 
Well, you know Susan, the more I look at your SS, I'm wondering if maybe this dose is ok for now. The last three days have been crappy, but before then he was getting quite a few blues.
More from the Prozinc SLGS dosing sticky:
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

Joe had a green nadir on the PM cycle of the 1st.

Then he got blue in the AM on the 2nd.

And then both cycles on the 3rd were lows in the blues.

AM cycle on the 4th also got a blue.

And since you started the Metronizadol on the 4th, I wonder if this is actually a good dose for now, and it’s just the meds screwing everything up?



That’s just my insight because I know how frustrating this all has been and you’re trying so hard. I’m sure a Prozinc user or someone more experienced can correct me if I’m wrong.
 
Bron and Sheba (GA) said:
Susan, have you looked at the two dosing methods for Prozinc. They are at the top of the Prozinc page. If you decide on one, I would put it into your signature.
Until you decide which method, you need to hold the dose for 1 week before doing a curve. As you went back to 3 units 4 days ago, the count starts again from there.
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I am unsure about that. I never knew about the choice of methods until a few days ago and I think it was you that pointed me to them. I just sort of followed along with first, my vet's advice and then here with what others told me to do. I guess I am doing the SLGS method. Thanks Bron.
 
smorgasbord said:
Well, you know Susan, the more I look at your SS, I'm wondering if maybe this dose is ok for now. The last three days have been crappy, but before then he was getting quite a few blues.
More from the Prozinc SLGS dosing sticky:
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

Joe had a green nadir on the PM cycle of the 1st.

Then he got blue in the AM on the 2nd.

And then both cycles on the 3rd were lows in the blues.

AM cycle on the 4th also got a blue.

And since you started the Metronizadol on the 4th, I wonder if this is actually a good dose for now, and it’s just the meds screwing everything up?



That’s just my insight because I know how frustrating this all has been and you’re trying so hard. I’m sure a Prozinc user or someone more experienced can correct me if I’m wrong.
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Smorg! Thanks for being there. I am just overwhelmed and confused. Poor Joe and not a good time for me to not be able to count on my own brain. Maybe it is all the soiling of carpets and crying that is making me tired and out of sorts. I am holding. I thank you.
 
Susan Pomo said:
I am unsure about that. I never knew about the choice of methods until a few days ago and I think it was you that pointed me to them. I just sort of followed along with first, my vet's advice and then here with what others told me to do. I guess I am doing the SLGS method. Thanks Bron.
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Susan, you are testing enough to do the TR if you wanted to. But it is completely up to you.
If you have decided on the SLGS, I would print off the dosing method.I found it much easier to follow if I had it in print in from of me, than trying to look it up all the Can also hilight things.
 
Susan Pomo said:
Smorg! Thanks for being there. I am just overwhelmed and confused. Poor Joe and not a good time for me to not be able to count on my own brain. Maybe it is all the soiling of carpets and crying that is making me tired and out of sorts. I am holding. I thank you.
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It's ok! That's why we're here :)
It's hard to see the progress when it's your own kitty, but I really do see good numbers after a good look at your SS, many nadirs were likely under 150:
8/1 PM cycle
8/2 AM cycle
8/3 AM cycle
8/3 PM cycle
8/4 AM cycle

So focus on cleaning the carpets and hugging Joe and ask us any questions you have to help with the confusion!

When does his Metronizadol course finish? And has it started to help?
 
Bron and Sheba (GA) said:
Susan, you are testing enough to do the TR if you wanted to. But it is completely up to you.
If you have decided on the SLGS, I would print off the dosing method.I found it much easier to follow if I had it in print in from of me, than trying to look it up all the Can also hilight things.
Click to expand...
Bron, I never could find anything that was called at "TR" method. Please tell me where I can find that
 
Bron and Sheba (GA) said:
Sorry Susan. I should have realised it was called modified Prozinc method. That is the one I meant.:)
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Hi Bron, no problem. Just more panicking, feeling lost, and feeling like I am not being able to follow what others seem to know ensued.
Can you please give me, in layman's terms, the difference between the two methods? I promise to try to understand what method I should be doing.
 
I am not a Prozinc user Susan, so I would not like to explain it as I might not explain it properly.
Maybe @Panic or @JanetNJ may be able to explain it to you.
I would recommend you print off the dosing methods and go through it with a hilighter to mark off important points.
 
I am going to raise Joes dose but I want to make sure I can get mid-cycle numbers and I am busy and not home all day tomorrow. I will be doing it Thursday. Thanks Janet
 
When does his Metronizadol course finish?
Is sure seems that it might be raising his blood sugar, though googling it, I'm not finding anything.

Also, eww, blacks :( Hopefully a dose increase will get him in better numbers.
Yes, make sure to get mid-cycle numbers.
Here's a bit about how important it is to get a test when he's near his nadir:

Increasing the dose: (numbers based on using a US human meter):

Questions to ask before increasing the dose:
  • When does the current dose reach it's peak (nadir)?
  • How low has the current dose taken kitty over the last 72 - 96 hours?
  • What? You don't know when your kitty reaches nadir on this dose?
  • You don't know how low the current dose is taking your kitty?
Nadir checks will provide the answer! It's your job to find out how low the current dose is dropping kitty before increasing the dose.

Once you know your kitty's nadir over the last several days/nights, you'll know if an increase is needed. If you don't know how low the current dose is taking your cat you run the risk of your cat becoming over dose as well as experiencing a hypoglycemic event... not what any of us wants to happen. So, please recognize the importance of getting those nadir checks (day & night) BEFORE you increase the dose.
 
smorgasbord said:
When does his Metronizadol course finish?
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He did his last dose yesterday.
smorgasbord said:
When does the current dose reach it's peak (nadir)?
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Hard to say because he is all over the place but it looks like mid-cycle, between 220 and 265, at between +3 and +9.
smorgasbord said:
How low has the current dose taken kitty over the last 72 - 96 hours?
Click to expand...
265 at mid cycle exactly
I cannot go back 7 days like they suggest because I did take him down to 3. (suggestion on the FB forum) and that was 7 days ago.
 
Susan Pomo said:
He did his last dose yesterday.

Hard to say because he is all over the place but it looks like mid-cycle, between 220 and 265, at between +3 and +9.

265 at mid cycle exactly
I cannot go back 7 days like they suggest because I did take him down to 3. (suggestion on the FB forum) and that was 7 days ago.
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I think you'll be feeling much more control over the whole situation once you get more mid-cycle tests in and get a better idea of his nadir.
 
smorgasbord said:
I think you'll be feeling much more control over the whole situation once you get more mid-cycle tests in and get a better idea of his nadir.
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Sadly, he is not allowing testing as he did a few weeks ago. I am lucky to get him to come on up to the testing table even when I offer his fav treat of tuna.
 
Better numbers today! Crazy flat after your 209 at +6.
Try to get at least one number after his PM shot tonight. If you can only get one because it's difficult, make it a +2 after his PM shot.
He dropped over 200 points today, and if he was only at 200 at PMPS... Well, you do the math ;)
 
Sorry you wonderful ladies that ride this with me. I had gone to bed by the time the above was written. I gave 3.25 this morning because I forgot I was going to raise it. The reason I forgot because I am dealing with massive diarrhea everywhere. I just had my bedroom carpet steam cleaned because he had peed and pooped in there even though I have 3 litter boxes in there that none of the other two cats use. So I had the carpet cleaned and now shut him out of my room at night. He caterwauls for an hour or two even though I feed him before bed. Meets me at my door when I open it in the morning and then I have to survey all the places he pooped overnight. This morning it was the counter, where he gets his shot daily. I assume he was looking for food? Sorry about the graphic pic. I AM AT MY WITS END, it is everywhere, all the time. We have finished thee metro and now switched to Albon
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Susan Pomo said:
Sorry you wonderful ladies that ride this with me. I had gone to bed by the time the above was written. I gave 3.25 this morning because I forgot I was going to raise it. The reason I forgot because I am dealing with massive diarrhea everywhere. I just had my bedroom carpet steam cleaned because he had peed and pooped in there even though I have 3 litter boxes in there that none of the other two cats use. So I had the carpet cleaned and now shut him out of my room at night. He caterwauls for an hour or two even though I feed him before bed. Meets me at my door when I open it in the morning and then I have to survey all the places he pooped overnight. This morning it was the counter, where he gets his shot daily. I assume he was looking for food? Sorry about the graphic pic. I AM AT MY WITS END, it is everywhere, all the time. We have finished thee metro and now switched to Albon
View attachment 62149
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Oh boy. That photo is kind of hilarious. I know you're not laughing though. I'm so sorry you're having poopy disasters.
How much food does he get overnight?
 
Joe seems to me to be so much better. He is filling out again. He struts to his meal again. It is the poop that is really really getting down. The fact that he peed all over my bedroom carpet and can no longer come to bed in my room makes me so sad. I have to think Joe is getting senile. The Joe I have always known never ever did his business outside of the litter box.
 
Susan Pomo said:
what does this mean???
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On 8/11 we can see that he started at 600+ and you got a reading of 205 at +7. That means he dropped at least 400 points once his insulin kicked in.

Based on that knowledge, you especially want to get another test before bed if he’s starting out his cycle in the mid 200s. If he started in mid 200s, he could get very low overnight.

Hope I didn’t scare you, I was trying to be lighthearted about it, and it came off wrong ;)

Keep trying to get those +2 readings at night, I’d hate to see him get too low, especially once you increase his dose.
 
Susan Pomo said:
Joe seems to me to be so much better. He is filling out again. He struts to his meal again. It is the poop that is really really getting down. The fact that he peed all over my bedroom carpet and can no longer come to bed in my room makes me so sad. I have to think Joe is getting senile. The Joe I have always known never ever did his business outside of the litter box.
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Aww buddy. Maybe it will pass. He could be getting senile, but to happen right now? hmm. At least he's eating well and gaining weight.
Has anyone suggested canned pumpkin as a diet supplement to firm up his poo? I think you could also get an unflavored pumpkin baby food as well.
 
Yay 118 blue!
Also, saw your remark as well, 127 is within meter variance so the 118 is accurate. You can write "118/127" and manually color the box blue, or just stick with 118 in the box. Either way, awesome number! Can't wait to see what the increase does for him.
 
smorgasbord said:
Yay 118 blue!
Also, saw your remark as well, 127 is within meter variance so the 118 is accurate. You can write "118/127" and manually color the box blue, or just stick with 118 in the box. Either way, awesome number! Can't wait to see what the increase does for him.
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are you sure he should have the increase based on his dropping 200 yesterday?
 
smorgasbord said:
Great appetite then! Make sure he has unlimited food overnight in case he needs it to keep his blood sugar up while you're asleep.
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I do not think there is so a thing as unlimited food supply for Joe because he will scarf until he pukes. He has not left any in his dish in years
 
Also, I am exhausted by evening and it is all I can do to get a +2 and then a +3. Do you think that is good enough after increasing his dose?
 
Susan Pomo said:
Also, I am exhausted by evening and it is all I can do to get a +2 and then a +3. Do you think that is good enough after increasing his dose?
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I feel you. I just reset my shot time to 5 hours earlier after we had a skip because I was also so exhausted. Getting a +2 will be good enough IF the +2 is higher than his preshot number. But if it's about the same or lower, he could get quite low at night. If you can't leave him food to munch on his own if he gets low, then it's even more important to get readings.
You can get a +2 and see what that is, then if it warrants another reading, go to bed and set an alarm for +4. I know, sounds horrid!
I have just ended up staying awake after his +2 until I make sure he's going to be safe.
If you aren't sure if the +2 is a "safe to sleep" number, you can post here and tag me. I'm on here all the time at night so I'll be able to see it fast.
Let me get some of the official advice on this, as it will be better written than my explanation!
 
I can't seem to find a guide for interpreting +1, +2, etc for Prozinc. Hmm. Maybe @JanetNJ or @Panic will know, is there an equivalent for Prozinc?
This is what we have for Lantus:
"+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number. Onset begins around +2 for most cats. You'll probably see an active cycle if the +2 is the same/similar OR lower than the preshot number. Continue testing!"
 
Susan Pomo said:
I do not think there is so a thing as unlimited food supply for Joe because he will scarf until he pukes. He has not left any in his dish in years
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That is beyond frustrating. Maybe an auto feeder? But if he scarfs until puking, even setting the feeder to cut him off after a certain time might not be enough...
Here's the advice for nighttime feeding from the Prozinc sticky:
"When you can’t be at home to monitor BG levels, making food available in the event that the blood glucose drops low adds a measure of safety, as most cats will search out food during those times. There are several timed feeders on the market that make doing this easy: One that allows 5 different feeding slots is the PetSafe 5; there are other models that have fewer food compartments. (Amazon has a selection of timed feeders to consider). Some of the models have a depression under the food tray that will allow for a freeze pack to ensure that food does not spoil. Another idea is to freeze your cat’s serving sizes in ice trays, then pop them out into the feeder in the time-slots you select. By the time the safe opens, the food is thawed!"
 
smorgasbord said:
That is beyond frustrating. Maybe an auto feeder? But if he scarfs until puking, even setting the feeder to cut him off after a certain time might not be enough...
Here's the advice for nighttime feeding from the Prozinc sticky:
"When you can’t be at home to monitor BG levels, making food available in the event that the blood glucose drops low adds a measure of safety, as most cats will search out food during those times. There are several timed feeders on the market that make doing this easy: One that allows 5 different feeding slots is the PetSafe 5; there are other models that have fewer food compartments. (Amazon has a selection of timed feeders to consider). Some of the models have a depression under the food tray that will allow for a freeze pack to ensure that food does not spoil. Another idea is to freeze your cat’s serving sizes in ice trays, then pop them out into the feeder in the time-slots you select. By the time the safe opens, the food is thawed!"
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Excellent idea! I found one in the garage I bought years ago when I went on vacation.
 
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