New here. Dosing advice needed

Status
Not open for further replies.
Julie -

We encourage new members to post on the Health forum as a place to get started. There are a few specifics (setting up your signature, adding Oscar's spreadsheet to your signature, diet, etc) that we like to check on before you switch to an insulin-specific forum. If you just copy over what you posted above to the Health forum, that would be great. Alternatively, any of the moderators can move the thread.
 
Welcome!

Has he been on ProZinc since diagnosis?

What did they do in the ER for the poop problems I see mentioned?

Any reason for the different AM and PM dosing? I'd like to even that out, the trouble is I'm not quite sure how low he might be going at night and sometimes during the day. Next time you get a lower preshot at night (260 or lower) definitely try to get some +4s to see how low he's going.

It feels counterintuitive, but I would probably try 1.5U both shots for at least 2 weeks. He is definitely going lower during the day when you get those low yellow preshots, question is how low.

The other option is 1.75U both cycles, but I am hesitant to advise that because he may already be seeing some greens in the 1.5U some nights and spiking up by morning.
 
Has he been on ProZinc since diagnosis?

Yes but it took a while for me to start testing at home regularly instead of listening to vets.

What did they do in the ER for the poop problems I see mentioned?

Just fortiflora. He had the runs, threw up and kept squatting in the box. Probably ground beef I gave him. No more of that.

Any reason for the different AM and PM dosing? I'd like to even that out, the trouble is I'm not quite sure how low he might be going at night and sometimes during the day. Next time you get a lower preshot at night (260 or lower) definitely try to get some +4s to see how low he's going.

I thought his nighttime dose might be keeping him high during the day and when I reduced it the numbers during the day came down and started seeing more movement. I will have to set an alarm to grab a number that late but I know I should.


It feels counterintuitive, but I would probably try 1.5U both shots for at least 2 weeks. He is definitely going lower during the day when you get those low yellow preshots, question is how low.

I think you're right. I've had a feeling 1.5 is his dose but he'd been bouncing around it was hard to get him there.

The other option is 1.75U both cycles, but I am hesitant to advise that because he may already be seeing some greens in the 1.5U some nights and spiking up by morning.

I might try this if the first plan doesn't work but I'm leaning towards 1.5 am and pm.. again.

Thank you!
 
Yep! Similar story for everyone here with the vets and home testing, no worries.

Hopefully it evens out a little more. We usually give ProZinc 3 months of consistent dosing and dose adjustments before saying consider a switch to a depot insulin like Lantus or it's generics. Based on what I'm seeing so far you probably will need a switch eventually, but it's worth trying for another 1.5-2 months to see how he does.

As for the diarrhea - s boulardii is the best for it if you have trouble again. More info, dosing,e tc here - https://www.ibdkitties.net/supplements/probiotics/

I buy Jarrow Brand s boulardii with MOS, but any s boulardii will work so long as it doesn't have added sugars or toxins
 
FrostD said:
Yep! Similar story for everyone here with the vets and home testing, no worries.

Hopefully it evens out a little more. We usually give ProZinc 3 months of consistent dosing and dose adjustments before saying consider a switch to a depot insulin like Lantus or it's generics. Based on what I'm seeing so far you probably will need a switch eventually, but it's worth trying for another 1.5-2 months to see how he does.

As for the diarrhea - s boulardii is the best for it if you have trouble again. More info, dosing,e tc here - https://www.ibdkitties.net/supplements/probiotics/

I buy Jarrow Brand s boulardii with MOS, but any s boulardii will work so long as it doesn't have added sugars or toxins
Click to expand...
I absolutely agree prozinc might not be the right choice for him but I'm giving it a honest go. It took a long while to get the hang of all this.
I have an appointment with a new in a couple weeks who seems more informed on diabetes. I will talk with them about considering a change in a month or two if we can't get him settled on a dose.
Thanks!
 
FrostD said:
Yep! Similar story for everyone here with the vets and home testing, no worries.

Hopefully it evens out a little more. We usually give ProZinc 3 months of consistent dosing and dose adjustments before saying consider a switch to a depot insulin like Lantus or it's generics. Based on what I'm seeing so far you probably will need a switch eventually, but it's worth trying for another 1.5-2 months to see how he does.

As for the diarrhea - s boulardii is the best for it if you have trouble again. More info, dosing,e tc here - https://www.ibdkitties.net/supplements/probiotics/

I buy Jarrow Brand s boulardii with MOS, but any s boulardii will work so long as it doesn't have added sugars or toxins
Click to expand...
I gave him his regular dose this morning of 1.75
Do you think I could wait like an extra hour before giving him his 1.5 pm or a lower dose tonight so he doesn't bounce up in the morning?
 
Typically it's best to give it 12 hrs apart, unless you get a preshot under about 200. If that happens, you can stall without feeding and retest in 20-30 mins to see if he comes up to a number you're comfortable shooting. Then you can decide on full or partial dose, or a skip.

I would start with 1.5U 12 hrs apart for now (as long as above 200).

You can keep stalling without feeding for up to an hour or so, beyond that he might start dropping from the lack of food. Are you withholding food 2 hrs before shot time?
 
FrostD said:
Typically it's best to give it 12 hrs apart, unless you get a preshot under about 200. If that happens, you can stall without feeding and retest in 20-30 mins to see if he comes up to a number you're comfortable shooting. Then you can decide on full or partial dose, or a skip.

I would start with 1.5U 12 hrs apart for now (as long as above 200).

You can keep stalling without feeding for up to an hour or so, beyond that he might start dropping from the lack of food. Are you withholding food 2 hrs before shot time?
Click to expand...
Yeah I'm withholding food prior to shot as much as I can. Sometimes I am asleep or out and don't always get to it in time.
I think I want to push back his dose tonight, from 5 to 8 because it'll work better for me and my schedule. It might help Oscar too if I just get up when he's whiney around 4 or 5 and feed him instead of giving him a shot when I'm half awake.
I feel like now would be the time to do that.
 
FrostD said:
Typically it's best to give it 12 hrs apart, unless you get a preshot under about 200. If that happens, you can stall without feeding and retest in 20-30 mins to see if he comes up to a number you're comfortable shooting. Then you can decide on full or partial dose, or a skip.

I would start with 1.5U 12 hrs apart for now (as long as above 200).

You can keep stalling without feeding for up to an hour or so, beyond that he might start dropping from the lack of food. Are you withholding food 2 hrs before shot time?
Click to expand...
Just to be clear. I would be adjusting his dose time permanently from 5ampm to 8ampm
 
FrostD said:
Yes that should be fine
Click to expand...
His glucose was 30 points lower at 8 than at 5... So he was still trending down
FrostD said:
Yes that should be fine
Click to expand...
It was SUPER hot yesterday and Oscar woke me up at 4 am puking. Turned the AC back on for him but he was still about 144 at amps so I skipped cause I had to leave for work for a few hours. Came back and he finally ate, 350ish at +4. Damn this heatwave. At least there's movement in his numbers lately and hopefully getting him on 1.5 both shots will start to help keep him in better range. Looks like he might bounce for a few days though.
 
That 30 points is within variance, so we consider it flat. The meters are allowed 20% variance (I believe I read somewhere pet meters 15%).

It looks like the 1.5 was good last night as far as I can tell. Now if you get a preshot in the 200s range, I would consider giving something like 0.75U until we see what he does. 344 to 144 (and likely a bit lower, my guess is 110 ish) is quite a drop. So the same dose given in the 200s might have him lower than we want, hard to say. Better safe until we can have a better idea of what he's doing.

If you are around to monitor, next time I would stall for about 20 minutes without feeding to see if he comes up (I'm pretty sure he was on his way up at shot time). In the 150-199 range I would try 0.25U just to give him a little something and help avoid those bounces - but again, only if you can keep an eye on him.

Still a pretty good cycle last night!
 
FrostD said:
That 30 points is within variance, so we consider it flat. The meters are allowed 20% variance (I believe I read somewhere pet meters 15%).

It looks like the 1.5 was good last night as far as I can tell. Now if you get a preshot in the 200s range, I would consider giving something like 0.75U until we see what he does. 344 to 144 (and likely a bit lower, my guess is 110 ish) is quite a drop. So the same dose given in the 200s might have him lower than we want, hard to say. Better safe until we can have a better idea of what he's doing.

If you are around to monitor, next time I would stall for about 20 minutes without feeding to see if he comes up (I'm pretty sure he was on his way up at shot time). In the 150-199 range I would try 0.25U just to give him a little something and help avoid those bounces - but again, only if you can keep an eye on him.

Still a pretty good cycle last night!
Click to expand...

Thank you. That's good advice. I would've given him .25 this am but, yeah, I had to leave for a few hours. Better safe than sorry.
I think last night was looking really good too!
Hopefully we can get on track here soon.
 
FrostD said:
That 30 points is within variance, so we consider it flat. The meters are allowed 20% variance (I believe I read somewhere pet meters 15%).

It looks like the 1.5 was good last night as far as I can tell. Now if you get a preshot in the 200s range, I would consider giving something like 0.75U until we see what he does. 344 to 144 (and likely a bit lower, my guess is 110 ish) is quite a drop. So the same dose given in the 200s might have him lower than we want, hard to say. Better safe until we can have a better idea of what he's doing.

If you are around to monitor, next time I would stall for about 20 minutes without feeding to see if he comes up (I'm pretty sure he was on his way up at shot time). In the 150-199 range I would try 0.25U just to give him a little something and help avoid those bounces - but again, only if you can keep an eye on him.

Still a pretty good cycle last night!
Click to expand...

Did you mean a reduced dose on low 200s? I gave him 1.5 for am. He was 280. This feels safe to me. Do you think I should've given him less? I will check him around +5 to see what that dose looks like. He was a PEST all night. I think he's feeling much better now that it's not blistering hot. I'm sure he will eat extra today.
 
Yes I mean a reduced dose in the 200s, just to be a little safe until we see what he's doing. It looks like he's still bouncing today, so not much movement and it worked out.
 
FrostD said:
Yes I mean a reduced dose in the 200s, just to be a little safe until we see what he's doing. It looks like he's still bouncing today, so not much movement and it worked out.
Click to expand...
Ah I see. I'm still learning what a bounce constitutes of and looks like. He tends to run lower at night. What would you suggest this pm of he's still 250ish and bouncing?
 
FrostD said:
I would try 0.75-1U. The trouble is we don't always know when they'll break it, but the more data you get I should be able to spot some trends hopefully
Click to expand...
Heya! Oscar's still stuck in this bounce. I know you said try this dose for two weeks and see what it looked like. I am pretty confident he's staying flat and high due to his behavior. He doesn't sleep at night if he's up above 300 and doesn't let me sleep either . What data should I grab to help get a good picture of his trends? He's extra thirsty and peeing & eating a ton. Do you think a fat 1.5 might bring a little more movement back? Just wait it out? Any advice is helpful. Thanks!
 
FrostD said:
I would try 0.75-1U. The trouble is we don't always know when they'll break it, but the more data you get I should be able to spot some trends hopefully
Click to expand...
Ugh, I also just realized the bone broth I gave him has carrots in it. Probably not helping bring down his sugar. I only gave him a serving but I'm gonna feed the rest to the crows. Those lucky birds get all his leftovers.
 
@FrostD
My spreadsheet is stuck on view only. Any ideas? Tried clearing the cache, update, restart, no dice.

Oscar was 474 +5 and 308 pmps. Wild day. Probs the carrots. Looks like he's starting to come back to Earth.
 
FrostD said:
Let's see what he does tonight, I don't think the bounce is over
Click to expand...
Still can't unstick the spreadsheet.
Oscar seemed much more comfortable overnight. I gave him 1.5 this morning. He was 291. I don't think he budged much overnight and I can keep an eye on him today. I know you said reduce in the 200s.. but that's practically 300.
 
Julie Sue & Oscar too said:
Still can't unstick the spreadsheet.
Oscar seemed much more comfortable overnight. I gave him 1.5 this morning. He was 291. I don't think he budged much overnight and I can keep an eye on him today. I know you said reduce in the 200s.. but that's practically 300.
Click to expand...

are you using the Google sheets ap? Some people have had this same issue I think, but mainly with the mobile app. Kill it and restart it has helped I think
 
Ah bounce broke! Get a +2 and +4 if you can.

It is a known issue with sheets app, it's infuriating. For some people it's faster to uninstall/reinstall. I personally just change the security settings to something random, change it back, close, reopen. Works every time and for me is faster, but requires a little more tech-savvyness. I had considered writing a macro for it lol I usually just change the "who has access" to anyone can comment, give it a few seconds to let it take effect, change it back to anyone can view, give it a few seconds. Close, reopen.
 
FrostD said:
Ah bounce broke! Get a +2 and +4 if you can.

It is a known issue with sheets app, it's infuriating. For some people it's faster to uninstall/reinstall. I personally just change the security settings to something random, change it back, close, reopen. Works every time and for me is faster, but requires a little more tech-savvyness. I had considered writing a macro for it lol I usually just change the "who has access" to anyone can comment, give it a few seconds to let it take effect, change it back to anyone can view, give it a few seconds. Close, reopen.
Click to expand...

Pain in the butt technology. Thanks for the tip.
I will get a +2 and +4 and see how it looks. Hoping for a nice day!
 
FrostD said:
Ah bounce broke! Get a +2 and +4 if you can.

It is a known issue with sheets app, it's infuriating. For some people it's faster to uninstall/reinstall. I personally just change the security settings to something random, change it back, close, reopen. Works every time and for me is faster, but requires a little more tech-savvyness. I had considered writing a macro for it lol I usually just change the "who has access" to anyone can comment, give it a few seconds to let it take effect, change it back to anyone can view, give it a few seconds. Close, reopen.
Click to expand...

Not a lot of movement.. none really considering he's been eating all day so far.
 
Hmm ok. Are.you able to monitor tonight? Probably need a +2 and +4. My concern is he'll break the bounce overnight, so if you increase tonight could be a fun night. If.you can monitor and have hypo kit you can try an increase, but I can't stay up to help. It may be better to increase in the morning when you can monitor better.
 
FrostD said:
Hmm ok. Are.you able to monitor tonight? Probably need a +2 and +4. My concern is he'll break the bounce overnight, so if you increase tonight could be a fun night. If.you can monitor and have hypo kit you can try an increase, but I can't stay up to help. It may be better to increase in the morning when you can monitor better.
Click to expand...

I feel like we're going around in circles. We've been here before.
I can do a +2 and +4 tonight. I wouldn't want to increase at night.
 
FrostD said:
Hmm ok. Are.you able to monitor tonight? Probably need a +2 and +4. My concern is he'll break the bounce overnight, so if you increase tonight could be a fun night. If.you can monitor and have hypo kit you can try an increase, but I can't stay up to help. It may be better to increase in the morning when you can monitor better.
Click to expand...
I feel like 1.5 isn't enough and 1.75 is too much.
What do you think if I try a fat 1.5 in the morning?
I have family in town and can't be around to keep a super close eye on him.
 
@FrostD I didn't increase last night. Got a +2 and then fell asleep. There must've been some movement overnight but I can't imagine he went low. He was much higher than I expected this morning. I gave him a fat 1.5 and I'll catch a few mids to see where it's taking him. I'm hoping it'll at least come down some.
Not feeling good about his numbers this week. Might give up on the prozinc soon if I can't get a handle on it.
 
Go ahead to 1.75U. I don't think he went too low, and you still have a bit of room to increase.

Unfortunately FD is a game of patience, no matter which insulin you choose. We say give ProZinc 3 months of methodical dose adjustments before making a decision. Depot insulins, more like 6 months (their strength is keeping things flats, not bringing down high numbers, so it's more of a long game with those insulins)
 
FrostD said:
Go ahead to 1.75U. I don't think he went too low, and you still have a bit of room to increase.

Unfortunately FD is a game of patience, no matter which insulin you choose. We say give ProZinc 3 months of methodical dose adjustments before making a decision. Depot insulins, more like 6 months (their strength is keeping things flats, not bringing down high numbers, so it's more of a long game with those insulins)
Click to expand...

I'll see how he looks tonight and tomorrow morning. I don't like to increase at night.
I'm hesitant to jump on it just yet. I think he'll just bounce again but I trust your judgement.
I'm worried I won't have a lot of time to monitor him this week. I can stop home in the middle of the day but won't be there all day and need sleep at night.
 
I always liked AM increases too.

Downside to holding a dose for too long is glucose toxicity starts to build up, so it's a tricky balance. Whatever works for you.
 
FrostD said:
I always liked AM increases too.

Downside to holding a dose for too long is glucose toxicity starts to build up, so it's a tricky balance. Whatever works for you.
Click to expand...

I'm seeing some movement today with the fat dose. What do you think about trying this 1.5f for a couple days before bumping up to 1.75?
I just have a gut feeling 1.75 is too much.
 
Not enough movement unfortunately. We always say "you hold the syringe", so it's your call. I think a full increase is ok, but do what you're comfortable with.

"Too long" differs by cat. Some it sets in after say a week and numbers start to trend up, some a little longer, some shorter. Since I'm not seeing a bounce break (which should have happened by now, it could have been 6/30 PM) it leads me to believe you're fighting a little toxicity. Not a criticism, but without those nighttime tests on 6/30 it's a little hard for me to say whether he's bouncing again or a little toxicity.
 
FrostD said:
Not enough movement unfortunately. We always say "you hold the syringe", so it's your call. I think a full increase is ok, but do what you're comfortable with.

"Too long" differs by cat. Some it sets in after say a week and numbers start to trend up, some a little longer, some shorter. Since I'm not seeing a bounce break (which should have happened by now, it could have been 6/30 PM) it leads me to believe you're fighting a little toxicity. Not a criticism, but without those nighttime tests on 6/30 it's a little hard for me to say whether he's bouncing again or a little toxicity.
Click to expand...

Ok I'll consider increasing in the am.
I still don't really understand the bounce. I can see how it looks like toxicity if it remained high.. but I don't see how he's bouncing again if he never came back down.
 
FrostD said:
Not enough movement unfortunately. We always say "you hold the syringe", so it's your call. I think a full increase is ok, but do what you're comfortable with.

"Too long" differs by cat. Some it sets in after say a week and numbers start to trend up, some a little longer, some shorter. Since I'm not seeing a bounce break (which should have happened by now, it could have been 6/30 PM) it leads me to believe you're fighting a little toxicity. Not a criticism, but without those nighttime tests on 6/30 it's a little hard for me to say whether he's bouncing again or a little toxicity.
Click to expand...

I think I have to trust my gut and on this and stick with the fat dose at least a couple days. He's come down to yellow which is some movement.. more than on a normal 1.5 and I was seeing carryover on the 1.75 dose I didn't like.
I'm not dismissing what you're saying. But I want to give this an opportunity to work before I skip over it.
 
Status
Not open for further replies.
Back
Top