New Member - Intro and Questions re frequent hypos with prozinc

Status
Not open for further replies.
IduraH

IduraH

Member Since 2024
Dear Everyone,

My name is Idura, and my cat with newly diagnosed diabetes is Tiger.

Tiger is 16 years old, and was diagnosed with diabetes mid January 2024.

Progress so far:

1. When she was first diagnosed, she had high BM >27 mmol/L. The vet started her on 1 unit caninsulin BD.
2. We were on this for one week, but then she began vomiting and had worsening incontinence, her BM was >33 at this stage, vet advice to remain on same dose.
3. One week later, She continues to experience lethargy, and fatigue so I took her to the vet again, her BM was >30, she had ketones in her urine, and was admitted for IV fluids for two days. She was discharged on 1.5 units caninsulin BD. She also had the freestyle libre
4. We continued this for another week but her sugars continued to be quite high with quite drastic dips and quick rise. (please see image caninsulin 1.5 units picture below for what a typical graph for her looks like: https://drive.google.com/file/d/1g_puKELJWdsUU1eE0mqjxrsgRy3sEqCL/view?usp=sharing)
5. A week later/start of this week, we changed to prozinc - the vet adviced for 3 units BD. I gave her 3 units on Monday PM (pre shot BM was 34), and her sugars were low on Tuesday so I omitted the morning dose, but it looks like she had a 3 hour hypo whilst I was at work. (please see graph of this - Prozinc day 1+2 (https://drive.google.com/file/d/1h52Q9EU19VFsa3e3JeY3TLvi24clxkiY/view?usp=sharing)
6. I then made the decision to change her to prozinc 2 units BD from 21st February, however, she has had multiple episodes of hypo over the last 24 hours (about 6). (please see graph prozinc 2 units - https://drive.google.com/file/d/1MMmyw6JJOGUFee0CyoE-KSQh5toxWyjp/view?usp=sharing) ; it's not very clear on the graph but she had a hypo at 5am, 6am, 11am, 12pm, and 4pm today (I was away for the last one, so was only able to give her honey etc when I got home and noticed)

She's quite asymptomatic during these hypo, but I'm really worried about her having a long one whilst home alone.

Changes I have made:
1. Metabolic food only - she gets 1 pouch AM, and 1 pouch PM. For lunch, as I work, we have to stick to the dry food. Unfortunately, she gets 10g of the metabolic dry food from Hills.
2. I notice she's quite anxious when I'm away for work/sleeping at night and I was worried re ?stress induced hyperglycaemia, so has installed feliway too

The vet adviced the following today after all her hypos:
- 2 IU insulin ONLY if above 20 just before the injection.
- 1.5 IU if between 14 and 20
- NO insulin if below 14

I am worried about continuing ion 2 units of insulin in view of how bad the drops are. Particularly as she still hypoed on it even though her sugars were more than >27.8 mmol/L and sometimes >30mmol/L pre shot.

I have checked the numbers of alphatrak 3 and on freestyle, and they appear to be the same.
 
Last edited:
Hi there. I’ve been looking at your graphs and I don’t see that your kitty hasn’t had a real hypoglycemic event (that I could see.). It appears that the blood glucose (BG) did not drop below 3, so not below 50 in our numbers. So she was actually safe. I would like to help, but I will need you to get a spreadsheet set up. I think you are right to be cautious about the dose since you are not at home. What is your schedule generally like on a workday? How many hours of the cycle are you away? I’m glad you are leaving out some food while you’re away. Normally, we would like it to be low carb wet food, bit we can talk about all that stuff later. I’m not familiar with how many carbs are in the foods that you have mentioned. I would probably drop the dose down to 1.5 units for the time being while you get a spreadsheet set up and we can see what’s going on with the dose. We should talk about feeding schedules. Definitely, Toger will be better off eating some small meals during the cycle (particularly the early portion of the cycle before nadir.)
 
@IduraH
Hi and welcome ,can you please tap on this blue link ,we need some information about Tiger. This link will also explain how to set up our spreadsheet and how to use it. If you should need help just ask , we have a member who will be happy to do it for you
Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help

Do you see the information I have in my signature for my cat Tyler
 
Suzanne & Darcy said:
Hi there. I’ve been looking at your graphs and I don’t see that your kitty hasn’t had a real hypoglycemic event (that I could see.). It appears that the blood glucose (BG) did not drop below 3, so not below 50 in our numbers. So she was actually safe. I would like to help, but I will need you to get a spreadsheet set up. I think you are right to be cautious about the dose since you are not at home. What is your schedule generally like on a workday? How many hours of the cycle are you away? I’m glad you are leaving out some food while you’re away. Normally, we would like it to be low carb wet food, bit we can talk about all that stuff later. I’m not familiar with how many carbs are in the foods that you have mentioned. I would probably drop the dose down to 1.5 units for the time being while you get a spreadsheet set up and we can see what’s going on with the dose. We should talk about feeding schedules. Definitely, Toger will be better off eating some small meals during the cycle (particularly the early portion of the cycle before nadir.)
Click to expand...

Dear @Suzanne & Darcy and @Diane Tyler's Mom - thank you both for your help. I have now set this up and my signature.

I'm a psychiatry residents and generally away for work from 8am to at least 6-7pm; but when I'm on call, I could be away from 8am to 11pm-ish at least. I'm happy to get a cat sitter to help for when I'm on call so she's not too delayed with her evening insulin dose. It's complicated because I have no family close by and all my friends are medics with equally long working hours.

Re the carbohydrate content:

the dry food, as per the website has 299/cup and is 31.6% carbohydrate
for the wet food, this one - I unfortunately cannot find the carb contents anywhere on the internet :( It's not on the pouches either, when I next get an order in, I'll look at the box it comes in.

Her current feeding schedule is
8am - 1 pouch + insulin
2pm - 10g of dry food from the automatic feeder
8/9pm - 1 pouch + insulin

Also, final note re the values on the spreadsheet, the freestyle libre can only detect up to 27.8 (the UK version), so when it's "28" it means that its unrecordably high, and the sensor cant' detect it. There's a value for 33 there because I used the alpha trak for that one.


Thank you everyone for your help
 
IduraH said:
for the wet food, this one - I unfortunately cannot find the carb contents anywhere on the internet :( It's not on the pouches either, when I next get an order in, I'll look at the box it comes in.
Click to expand...
Hi Idura
Are you using the U-40 syringes with the half unit markings, since we adjust the doses by 0.25 units at a time
If this is what your feeding
pd-feline-metabolic-chicken-pouch-productShot_zoom.jpg.rendition.991.991.jpg


It's too high in carbs I googled it and it says it's around 30% carbs on a dry matter basis.
Are you from the UK?

When was the DKA ? I can't make it out what month and Year?


Can you please add the meter you are using to your signature and at the top of your spreadsheet so members know

Also need you to add
Diagnosed: the date

Current Insulin: Meter:
On your spreadsheet also

I'm going to tag Suzanne for you now that you have some information and some BG tests done
@Suzanne & Darcy

Suzanne will let you know if you should start posting on the Prozinc forum yet

You should read this link all about Prozinc, read all the yellow stickys and especially the 2 dosing methods you want to follow
They will tell you when an increase or decrease is needed
https://felinediabetes.com/FDMB/forums/prozinc-pzi.24/
 
Last edited:
Hello Idura! It sounds like you work so hard. And I can tell that you love Tiger and are trying to do your best for her. We are here to try to help you. First, I am glad that you reduced the dose to 1.5. However, I see she had a lower preshot test this evening than we have data to support (whether to shoot, shoot a reduced dose, etc.). Did you skip the shot. If so, put NS in the cell for the number of units.

Would you tell me what time zone you are in? And what are your shot times? I am in the US Eastern time zone (Georgia).
 
I’m very glad that you have the Libre. Try to capture and put as much data from there and into your spreadsheet as possible, as you are able. I feel like at this point she’s going to be safe if we can get a handle on the data — and with the reduced dose — although I would like to see if she may still need a slightly reduced dose. Any changes in diet toward lower carb food will have to be done gradually and when you or someone else can monitor because they will reduce BG.
 
Dear @Diane Tyler's Mom , thank you for letting me know re the high carb content of the wet food. Do you have recommendations re alternatives brand?

The possible DKA was 10/02/24 - the vet admitted her for IV fluids. I'm not sure it's a true DKA as even though she was vomiting and becoming incontinent etc, the vet did not do any blood ketones etc or a venous blood glucose to check her blood pH. She was treated with IV fluids and her insulin was raised from 1 unit caninsulin to 1.5 units caninsulin on discharge two days later.

I've updated the spreadsheet with the info you requested on the US side. I have filled it on the 'World' side, but It didn't transfer over; thanks for noticing and reminding me.

I am based in the UK, and yes I do have needles with the 0.5 markings.


Dear @Suzanne & Darcy

I am based in the UK, and my timezone is Greenwich Mean Time. I've updated the spreadsheet further, I ended up giving her 1 unit, after waiting for about 2 hours (14 hours post AM dose), it went up to 11.5, and I gave her 1 unit. But about 8 hours after, her sugars went in the 'hi' range of the free style libre, which is >27.8. I've given her 1.5 unit again this morning.

I try to give her the shots at around 8/9am and 8/9pm (+/- 2 hours)
 
Last edited:
IduraH said:
Dear @Diane Tyler's Mom , thank you for letting me know re the high carb content of the wet food. Do you have recommendations re alternatives brand?

The possible DKA was 10/02/24 - the vet admitted her for IV fluids. I'm not sure it's a true DKA as even though she was vomiting and becoming incontinent etc, the vet did not do any blood ketones etc or a venous blood glucose to check her blood pH. She was treated with IV fluids and her insulin was raised from 1 unit caninsulin to 1.5 units caninsulin on discharge two days later.

I've updated the spreadsheet with the info you requested on the US side. I have filled it on the 'World' side, but It didn't transfer over; thanks for noticing and reminding me.

I am based in the UK, and yes I do have needles with the 0.5 markings.
Click to expand...
@IduraH
Hi Idura
I found information for you for members from the UK, it also lists human meters that most members use since that what our numbers are based on. So instead of using the Alpha Trak as a back up you can purchase a human meter since the Libre is considered a human meter
The list will also suggest low carb wet foods and med and high carb foods needed for your hypo kit in case Tiger drops to low and you need to being her BG up
https://www.felinediabetes.com/FDMB...ther-need-to-know-stuff.137376/?_params=Array

About transitioning to lower carb food on the list I agree with @Suzanne & Darcy
Any changes in diet toward lower carb food will have to be done gradually and when you or someone else can monitor because they will reduce BG.
I see you got a reading of 72 @+4 last night ,following SLGS method you would reduce by 0.25 units so the dose you gave this morning should have been 0.75 units. I'm going to tag @Suzanne & Darcy to confirm that and see what she has to say about what dose to give going forward.

I see you have SLGS filled in in your spreadsheet in the world tab, great but it's not listed on the US tab, can you please add it there also

Can you add SLGS and Libre to your signature also
 
Last edited:
IduraH said:
Changes I have made:
1. Metabolic food only - she gets 1 pouch AM, and 1 pouch PM. For lunch, as I work, we have to stick to the dry food. Unfortunately, she gets 10g of the metabolic dry food from Hills.
Click to expand...

Here's the UK food chart: https://docs.google.com/spreadsheets/d/1J5JpMe6TDXrHq_aTl9hUtHy6Gs9oRBqlz4nPGKxtySA/pubhtml# Food that has under 10% carbs is best for cats. You don't need the vet's permission or anything to feed something other than the Hills junk.

Can you leave canned / pouched food out all day? It's a cooked product so it won't spoil if left out. Some people use a programmable timed feeder to give mini meals to their cat throughout the day.


And general info for UK members: https://felinediabetes.com/FDMB/thr...-vit-b12-and-other-need-to-know-stuff.137376/
 
Thank you @Diane Tyler's Mom and @squeem3 for the resources.

I'll look at the list, and try an alternative out next weekend when I have a few days off to be at home.

According to the vet her dose should be
- 2 IU insulin ONLY if above 20 just before the injection.
- 1.5 IU if between 14 and 20
- NO insulin if below 14


But she goes too low quite a lot on these dosage, so I've decided to go to 1.5 units twice a day.

Unfortunately, her PM pre shot is usually quite low, which is why I've opted to do 1 unit. If it's a 0.25 unit reduction, then would 1.25 units be better? At 1 unit, she goes hyperglycaemia >27.8 again within 6-8 hours.
 
I hope you can get some readings from the Libre today during the mid-cycle. But don’t you have to be at home to scan the Libre with your phone? Do you have a plan to replace the sensor every two weeks? Many people place the Libre on their own to save money by not having the vets do it. There is a Facebook group for this, explaining how to do it yourself.
 
@Suzanne & Darcy , to clarify,

Do you recommend 0.75 unit for the PM dose, and then 1.5 unit for the AM dose as usual?

Or 0.75 units for both doses?

Is there anything I can do about her sugars going up too quickly with the PM dose? I'm so confused with tiger's sugars, because the night before, on 1 unit, she was persistently above >27.8, but last night, it went down, but then went up again super quickly. It yo-yo's so much.

ooh, yes, we are replacing the libre every two weeks. She's on her second libre now, after she took the other one off earlier after 7 days. I have two spare back-ups now just in case + alpha trak 3
 
Last edited:
The black blood glucose numbers that you are seeing are what we call a “bounce” which is her body’s response to being in BG ranges that she’s not accustomed to- like last night’s green. It’s a protective response where her body will release stored forms of sugar and counter-regulatory hormones like glucagon in order to raise BG. This can also occur when the BG simply drops quickly. It does not necessarily mean that the BG has dropped into hypoglycemic territory. Last night’s 72 was a perfectly safe green number. These bounces can last up to six cycles, but they don’t necessarily— every cat is different.
 
I'm pretty sure @Suzanne & Darcy
means to give 0.75 for both AM and PM
After 7 days on that dose you need to do a 12 hour curve and Suzanne can take a look at it
But if Tiger's BG drops below 90 at any time you need to reduce the dose by 0.25 units again
 
Yes. The new dose going forward for both a.m. and p.m. doses would be .75 units. I would not recommend different doses at this time. Having said that, with ProZinc, there could still be a time when it may be advisable to shoot a one-time reduced “token” dose if she has a preshot number that is lower than you have seen in the past (where we don’t yet have enough data to support shooting the full dose) and also if nobody will be available to monitor the cycle.
 
So if you’re on GMT, it’s like London time where I believe you are five hours ahead of me. That means right now it’s 1:37 in the afternoon for you. I’m just trying to get a handle on your shot times. At what time (your local time) do you give the insulin injections?
 
I do believe it would be safe for you to leave wet food out for her while you are away. With your schedule, I would definitely recommend getting a timed feeder (although I believe that you are already using one to dispense the dry food?) some of our members have an auto- feeder that has a place for a small ice pack or a bit of ice to keep the food cool for a while before it’s time to open the slot.
 
I will check back in with you later. I suppose you are working today.

If you are using primarily the Libre readings to fill in the spreadsheet, then we just need a way to differentiate between the occasional Alpha Trak reading. I would suggest putting an asterisk next to the AT readings in the spreadsheet. It’s also okay to just put HI in the cell. Black is black and it doesn’t matter that much how high the number is — but it’s also okay to put the 504 in there.

Oh, and while I am thinking about it, I have seen the Libre sensors read quite a bit lower than a handheld meter but it’s usually in the lower numbers. If you get a reading on the Libre of say 50 or 60 (or of course lower than that) then you should definitely check it with your AT.
 
ooh, I'm off today for the weekend. So I am around. I've had to take one day off as emergency leave this week, and another as planned leave to sort her sugars out this week. Thankfully, I have quite an understanding team who understands the importance of pets.

I usually inject her at 8am and 8pm - but sometimes I delay it +/- 2 hours, especially with the PM dose if it's lower. Also, on days I'm not working, I've overslept here and there and only managed to give it to her at 9 or 10am.

I'lll try 0.75 and send a message in a week's time, thank you for your help.

Also, just for my own learning, can you explain why we're going from 1.5 units AM and 1 unit PM to 0.75 units AM and PM?

Last question for today

- tiger has never been tested for pancreatitis OR acromegaly etc, I've asked the vet and he said it's not needed. She also hasn't had a fructosamine level. Should we try and get this done now?
- also, with her possible DKA, do you think it was a true DKA even though no blood gases was done? I'm aware that there's ketosis and then there's ketoacidosis, with the latter being more dangerous.
 
IduraH said:
Also, just for my own learning, can you explain why we're going from 1.5 units AM and 1 unit PM to 0.75 units AM and PM?
Click to expand...
Because on the 1 unit you gave when she dropped to 72 you go by that when you reduce
So you gave 1 unit and she dropped to 72 so you go by that and reduce to 0.75 units

I see you have SLGS filled in in your spreadsheet in the world tab, great but it's not listed on the US tab, can you please add it there also

Can you add SLGS and Libre to your signature also
@IduraH
 
Last edited:
IduraH said:
ooh, I'm off today for the weekend. So I am around. I've had to take one day off as emergency leave this week, and another as planned leave to sort her sugars out this week. Thankfully, I have quite an understanding team who understands the importance of pets.

I usually inject her at 8am and 8pm - but sometimes I delay it +/- 2 hours, especially with the PM dose if it's lower. Also, on days I'm not working, I've overslept here and there and only managed to give it to her at 9 or 10am.

I'lll try 0.75 and send a message in a week's time, thank you for your help.

Also, just for my own learning, can you explain why we're going from 1.5 units AM and 1 unit PM to 0.75 units AM and PM?

Last question for today

- tiger has never been tested for pancreatitis OR acromegaly etc, I've asked the vet and he said it's not needed. She also hasn't had a fructosamine level. Should we try and get this done now?
- also, with her possible DKA, do you think it was a true DKA even though no blood gases was done? I'm aware that there's ketosis and then there's ketoacidosis, with the latter being more dangerous.
Click to expand...

@Suzanne & Darcy
 
Her nadirs are pretty good for such a small dose. Later on when you have more data, you might consider switching her to the Modified ProZinc Method (MPM) where we will be able to adjust her doses more frequently and our desired nadirs will be between 50 and 120 (so more in the range of normal, healthy, non-diabetic cat numbers.) For right now though, I am sure that if you are able to find alternative foods that are less than 10 percent carbs, her BG will drop even more and she will need less insulin. Again though, when you do transition her food, you should do it ever so slowly and carefully and when you or another person can be around to monitor her cycles and intervene with food/carbs if necessary.
 
It's 5.3 now on the alphatrac, a bit worried she might have a hypo. According to the libre, her values were lower than 3.9 for an hour between 2-3pm Uk time (about 5-6 hours post dose). She did get 1.5 units this morning which is probably too high for her.
 
@IduraH

A favor that Suzanne suggested
If you are using primarily the Libre readings to fill in the spreadsheet, then we just need a way to differentiate between the occasional Alpha Trak reading. I would suggest putting an asterisk next to the AT readings in the spreadsheet.
The following is from me or put AT next to the Alpha Trak number in the cell or if you want to call it a square, some members won't see it in the remarks section
@IduraH

Edit do you think when telling us Tigers BG numbers can you give us the US numbers instead of the World BG 's . It makes it easier ,most of us are used to seeing US numbers
Just take the World BG number and multiply by 18 = The US BG

You don't have to but when we reply back to you can you tap the word like that's to the right just so we know you read it
 
Last edited:
Thank you Diane and Suzanne for your prompt advice, when I put an asterisk or a AT next to it, then there's no shading and it also doesn't convert it to the US values.

I've given her some wet food now, but did panic give her a small amount of honey too. will retest before I go and update.

I'm unfortunately away for a work trip for the next 5 days and I'm meant to leave in an hour, the cat sitter will stay over at mine (I decided against a cattery so she doesn't get stressed). She appears quite proficient in testing for sugars and administering insulin - I'll tell her to only do 0.75 from tonight.

Ooh, the libre is quite accurate in the middle values, but does seem to lose accuracy in the lower ones. Once it told me it was 2.9 but it was 4.3 on the AT.
 
Oh yes. That is a pain in the neck. You have to manually color code the cell with the “fill” color and the “text” color also sometimes. Sorry.
 
It’s okay. We all panic when these things first happen. I fed my cat a whole can of very high carb Fancy Feast Gravy Lovers food when I had my first green.

I didn’t realize you were leaving town. So your pet sitter is staying at home with Tiger?
 
Yup, it's very unfortunate timing with how low her sugars have been this week after starting prozinc. It's 6.4 now and appears to be going up, here's a link to the latest graph trend: graph

The cat sitter is staying over at mine, and we've had a test run with the insulin needles and attaching the sensor to her phone etc. But just in case, I've also left extra sensors, and she knows how to use the alpha trac.

I am still a bit worried, because she had this on Wednesday, it was 5am I gave her some honey and wet food, it went up to 6 ish almost 7, then I went to bed and it dropped drastically again.

Tiger seems quite sensitive to insulin; the vet suggests she might be starting to lose some of her insulin resistance or maybe producing some herself.

She has lost about 1kg in the last month, and is 5kg now from 6kg - which is about 16% of her body weight, so maybe that has helped with her insulin sensitivity.
 
I’m concerned. I wish there was a way for your sitter to contact us while you’re away. I think you should consider dropping the dose even further down to .5 units for a “holiday/vacation” dose. That’s what we usually call it. It would be a dose just for the five days that you are away (unless she does well on it and then we would keep the dose at.5)
 
IduraH said:
because she had this on Wednesday, it was 5am I gave her some honey and wet food, it went up to 6 ish almost 7, then I went to bed and it dropped drastically again.
Click to expand...
The rule is to continue testing for a full two hours after giving high carb food or corn syrup/honey — for exactly that reason— carbs wear off quickly and numbers can drop back down again.
 
You will have a big bounce this evening at PMPS time most likely. Just tell the tell the sitter to ignore the high numbers and only shoot .75 (or .5 if you read my post about doing a reduction to a vacation/holiday dose.) Any lethargy, vomiting, inappetance and she needs to go to the vet.
What day will you return?
 
Last edited:
IduraH said:
tiger has never been tested for pancreatitis OR acromegaly etc, I've asked the vet and he said it's not needed. She also hasn't had a fructosamine level. Should we try and get this done now?
Click to expand...
Also, in case you get a chance to read this. I would not bother with a fructosamine test at this point. This should have been done at diagnosis. Since it gives an average of BG over a period of 2-3 weeks. Now that you are gathering data and testing Tiger at home, you don’t need it. I also would not test her for Acromegaly at this time. She isn’t showing herself resistant to insulin— not with the nadirs she’s been seeing. If she was insulin resistant you would see very little movement in her numbers during a 12 hour cycle. Clearly, she’s not doing that, and I’m very happy about it. She is showing some good progress. Pancreatitis is quite painful and cats with pancreatitis are usually acting sick, lethargic, don’t want to eat, etc.
 
Last edited:
Hi Suzanne,
Ooh thank you for all the advice.

The cat sitter has agreed to join the group , woot woot! But she’ll also update me regularly and send me the values before any insulin administration and we’ve set up the hypo alarm on her phone.

I’ll be back on Wednesday.
I’m quite confident with her abilities to monitor etc, and update me - so I’m happy to stick with 0.75 for now.

she’ll send me the values regularly so I’ll keep updating the spreadsheet.
Thank you for your help, it means so much to tiger and the many people who adore and love her.
 
Suzanne & Darcy said:
Okay. Have a great trip!
Click to expand...

My partner has also left these guide for the cat sitter:


Minimum stuff for Amber to know/be able to do (please make sure to go through all of this):
1. Insulin is lethal at the wrong dose - the correct dose must be given. Insulin lowers blood glucose and giving a correct dose to someone with a low blood sugar or giving too much insulin can be lethal.
2. ⁠Hypoglycaemia is defined as a blood glucose less than 4 and this is a medical emergency
3. ⁠To treat a hypo, give honey by mouth and make sure that blood glucose rises above 4 (I.e. that the hypo has resolved). If chubby boney is unresponsive make sure that she is breathing. Smear lots of honey around her gums and call the out of hours vet. She will need to be taken to the out of hours vet immediately.
4. ⁠If a hypo occurs, Idura must be notified by text, the hypo should be treated as above and the next dose of insulin should be withheld pending instructions from Idura.
5. ⁠After teaching and talking it through, Amber must be observed drawing up insulin and administering a subcutaneous injection independently. If a dose of insulin is not due whilst Amber is there, she must be observed drawing up the correct dose of insulin with no assistance (which can then be discarded) and must be observed injecting Tiger subcutaneously (with an empty syringe so that injection technique can be observed). It is crucial that both of you are comfortable that Amber can do all of this correctly and independently.
6. After teaching and talking it through, Amber needs to be observed doing a manual BM with no assistance. This may become a crucial back-up if the glucose sensor stops working properly.
7. ⁠Amber needs to know how to change the freestyle libre for a new one (but does not need to be observed doing this)
8. ⁠Amber to please send Idura a screenshot of the graph twice a day (shortly before each dose is due) and to withhold the dose until we advise how much to give. If Amber does not receive our advice on dosing before 11am (morning dose)/11pm (evening dose) then a dose of 1 unit should be given unless Tiger has had a hypo since the previous dose was given (in which case the dose should be omitted)
9. ⁠Insulin should be given just before meal times if possible. It should be given 12-hourly just before breakfast and just before dinner
10. ⁠if Tiger has had an episode of vomiting/incontinence then a manual glucose should be checked and please message Idura as soon as possible.
11. ⁠Amber needs to be able to give Tiger her meloxicam/know her feeding regime etc.
12. ⁠If Amber has even the smallest query/concern she should not hesitate to contact us straight away.
13. ⁠The name, address, website and phone number for the out of hours 24/7 veterinary practice is xxxxxx.


Definitely feeling very anxious about leaving her since it’s the first time since her insulin diagnosis, but keeping all my fingers and toes crossed it’ll be okay. Hopefully the lower dose from tonight will get rid of these low episodes

he’s a human doctor so some of his advice might be a bit off, please let me know if there’s anything we need to do differently. For example, what level should we consider a hypo and needs treating? I’ve using 4 for now. Ooh he wrote this before we decided on the dose change, so I’ll change and update it too
 
Status
Not open for further replies.
Back
Top