New Member - Intro and Questions re frequent hypos with prozinc

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I noticed it said. give one unit so I am glad you are changing that to .75.

here is our sticky note on how to handle hypos. https://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/
For an Alpha Trac meter (pet meter) you need to not let her drop below 68 (3.7). So 3.7 is the “take action” number where you can start feeding regular low carb foods or medium carb food and test again in 20 minutes to ensure response to the food. If numbers are stable or rising then feed a little more. Only small amounts of food should be used at a time to ensure that the cat will not get full and refuse more food which may be necessary to steer the numbers. Small amounts like a spoonful are enough. If the numbers do not stabilize or rise, then add honey or corn syrup/glucose syrup to some food if the car is still eating. If numbers are dropping fast, put the sugar syrup on the gums directly for faster absorption. Testing must continue for two hours after the last high carb food or honey is given to ensure that BG will not drop back down. Generally, as the numbers rise, you can extend the test from 20 minutes at first to 30 minutes to then 45 minutes or an hour, depending on how high the numbers are going.

Oh, and with the Libre, which is a human glucose monitor, the take action number is a little lower (just as it would be with a handheld human BG meter) — so take action if number drops below 50 (about 2.8 on the Libre.). Again, unless the number is a lot below 2.8, you can start with the regular wet food (which I think is already medium carb for Tiger?) and depending upon the response you can increase carbs from there. Let’s hope none of this will be necessary. Paws crossed.
 
Remember, small meals given frequently during the early portion of the cycle (up to about +6) are best to help prevent steep drops and stabilize blood sugar. And no food should be given for two hours prior to the morning and evening preshot tests so that it is a fasting glucose number and not inflated by the influence of food (so that you know it’s safe to shoot.) I am so sorry for doing this massive dump of information on you. I usually like to take things slow and incrementally with people in the beginning so as not to overwhelm them. But since you are leaving town, I feel like it’s necessary.
 
Dear @Suzanne & Darcy ,

I've been able to update the graphs now. She unfortunately still had 1 unit last unit, but thankfully, her nadir was 9.

We started on 0.75 this morning, tiger's sugars went into the HI range after 6 hours, and she had a small amount of vomiting at 8 hours post shot. She looks fine otherwise.

I panicked and asked the pet sitter to give her 1.25 unit, not sure if its the right thing to do :(
 
Hi there. I hope your trip is going well. We don’t actually know if 164 was her nadir since that would be a little late for her nadir and we don’t have Libre readings from earlier— or do we? Do you have a graph that tells you? Also, why was she given honey? That was definitely not necessary when she was in the blue numbers. But it’s not a perfect situation with you not being at home and I totally understand. Our priority for the next few days until you return is to keep her safe! Although maybe I am not understanding the notes correctly — about the honey? I’m thinking that, with all the black, she may have dropped into the green, hopefully not too low.

It is not a good idea to move the dose around like that, but I really do understand your panic with those highs. Just make sure the pet sitter monitors her carefully. She is bouncing right now with all of those blacks, and when she breaks the bounce she may drop low with the increased dose — but we don’t know how low or when in the cycle she will break the bounce— we don’t have a lot of data on how long she tends to stay high in a bounce. It is all going to be okay, I think, because your pet sitter seems attentive. We can work on managing her numbers better when you return. Thanks for writing, I had checked her spreadsheet a few times hoping to see updates— so I am happy just to have this update
 
Suzanne & Darcy said:
Hi there. I hope your trip is going well. We don’t actually know if 164 was her nadir since that would be a little late for her nadir and we don’t have Libre readings from earlier— or do we? Do you have a graph that tells you? Also, why was she given honey? That was definitely not necessary when she was in the blue numbers. But it’s not a perfect situation with you not being at home and I totally understand. Our priority for the next few days until you return is to keep her safe! Although maybe I am not understanding the notes correctly — about the honey? I’m thinking that, with all the black, she may have dropped into the green, hopefully not too low.

It is not a good idea to move the dose around like that, but I really do understand your panic with those highs. Just make sure the pet sitter monitors her carefully. She is bouncing right now with all of those blacks, and when she breaks the bounce she may drop low with the increased dose — but we don’t know how low or when in the cycle she will break the bounce— we don’t have a lot of data on how long she tends to stay high in a bounce. It is all going to be okay, I think, because your pet sitter seems attentive. We can work on managing her numbers better when you return. Thanks for writing, I had checked her spreadsheet a few times hoping to see updates— so I am happy just to have this update
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Thank you for your reply, and for being so prompt as always. She was given the honey yesterday because of the greens, the lowest was 3.9, I gave it to her when it was 4.3 - that was before I realised that I’m only meant to give it to her when it’s much lower but was panicking.

I do have a picture of her graph here

my cat sitter is going to work tomorrow so we will return to 0.75.

When she messaged me that tiger vomited and has had very high sugars for a few hours, I got really worried and might have jumped to 1.25 too quickly

Do you think the vomitting is just because of the blood sugar changes and bounce? It was only once off and she is fine and asymptomatic otherwise
 
Good morning @Suzanne & Darcy

I’ve updated the spreadsheet further now, the nadir from the 1.25 last night was 21(378)

the cat sitter is now in during the day today, so I’ve asked her to just give 0.75 this morning.
Re what we do going ahead, should I press on with 0.75 even with the high sugars?
Tiger tends to get a bit nauseous when she has high blood sugars. Also, I wonder if me not being home is also causing some level of stress induced hyperglycaemia.
 
Good morning. So the sitter is going to be at home today? Then she should be able to scan that Libre quite a bit. Let’s see what happens with the cycle today. Please update the spreadsheet as you are able. Also, you can share the graph here. What time will her p.m. shot be? I will deduct 5 hours from that so that I can check in with you and we can make a decision about dosing for this evening. I do want to take into consideration that she may have had a DKA recently. I also would recommend that you purchase a blood ketone meter when you return. I used the Nova Max Plus Blood Ketone Meter, but I don’t know if that’s available in the UK, but I am confident that other blood ketone meters are sold there.
 
The cat sitter is away during the day today from 8am to about 5/6pm - so she gave tiger an earlier dose this morning. We opted for 0.75 unit in view of no one being around and to be safe. I'll buy a blood ketons meter now and get it delivered. I'll share the updated graph when the cat sitter returns this evening, the freestyle libre stores data for 8 hours until its scanned so we should still know what happens today.

I'll update you as soon as I know
 
Dear @Suzanne & Darcy ,

I have updated tiger's spreadsheet, and it looks like she's had a possible hypo whilst she was home alone today, please see graph here: graph for today

Prozinc is long acting, so it might just be the after affects of her getting 1.25 yesterday, as that is the longer acting one.

Do you suggest we push forward with 0.75unit? I'm quite hesitant to go down because she might get hyperglycaemia and start being sick/vomitting etc again.
 
Thank God you went with the .75 unit dose and not any more. She obviously cleared the bounce from the previous low numbers and dropped definitely lower than we want her to be when nobody is at home. That Libre graph scares me. It’s too low and nobody was with her to intervene with carbs, corn syrup/honey, etc. I am very relieved that Tiger is all right, but also frightened by that graph. According to the SLGS dosing protocol, she has actually earned another reduction down to .5 units because of the numbers I see in the 50s on her spreadsheet and most especially because those Libre graphs seem to show her dropping into even lower numbers. Doses of insulin are based on how low a particular dose takes the cat and are not based on the high numbers. That’s the only way to keep a cat safe from a hypo. Her PMPS this evening will likely be high as she begins another bounce — or if it takes a little longer she will likely rise quite high some time in the evening cycle. We cannot do anything about those highs that will not endanger her. Believe me, I hate it that she feels sick and vomits with the higher numbers, but we cannot use the ProZinc to try to shoot down the high numbers of a bounce without endangering her when she hits her nadir. The bounces are just too unpredictable at this point. It would be different if she just had consistently high numbers (with no lows) that we were trying to lower — then we would be talking about increasing her dose. But she’s having low to dangerous nadirs. Anything under 50 is potentially dangerous for a cat on insulin. So I can’t emphasize enough that we base the insulin dose on the nadir.

Oh, and ProZinc lasts a maximum of about 14 hours. If your pet sitter shot earlier than 12 hours then there could be some undue influence from the previous shot, but we can’t know that and it would be risky for is to simply try to guess about it.
 
I most definitely would not shoot more than .75 units tonight— and even that looks like it could be too much based on today’s nadirs. And I would only allow the .75 units IF the sitter can carefully monitor the cycle and will be able to check the Libre with the Alpha Trak as well.
 
Tiger had 1.25 units the night before at around 7.45pm, and had her morning shot this morning at around 7.40pm - so almost 12 hours. Her next dose is due in the next hour.

Her current levels are 25.7 - what do you recommend we give her for tonight?

Also, with the bounces and reduction in insulin, will she not get a DKA?

Do you have any ideas why she's having these massive bounces/lows with such a small dose?
 
IduraH said:
Tiger had 1.25 units the night before at around 7.45pm, and had her morning shot this morning at around 7.40pm - so almost 12 hours. Her next dose is due in the next hour.

Her current levels are 25.7 - what do you recommend we give her for tonight?

Also, with the bounces and reduction in insulin, will she not get a DKA?

Do you have any ideas why she's having these massive bounces/lows with such a small dose?
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Okay, so the shots were almost 12 hours apart and I do not think that the previous night’s 1.25 dose was the cause of her dropping so low. If it’s within 30 minutes of 12 hours apart then there should not be a problem with undue influence of the previous night’s shot — you can see that because of here high preshot value this morning.

As for DKA, it will take more than high numbers to cause it. For a DKA we usually see a combination of not enough insulin combined with infection or inflammation and the high numbers. We don’t know if she’s producing ketones. Is she eating well for the sitter? Tonight, I would like to make sure she gets a snack at +2 and again at +4 at least.
 
Since she had the possible DKA, I would allow the .75 dose for this evening only with the conditions of monitoring closely as specified above. However, if tomorrow during the day she is going to be left alone again then I most definitely would not recommend anything more than .5 units.
 
Adding water to her wet food is a good idea.

And about the bounces, those are simply caused by her being in lower numbers that he body is no longer accustomed to. We cannot stop them because it’s her body’s protective mechanism. They are very frustrating. And what is worse than seeing a black number on her spreadsheet or seeing the word Hi on a meter? And then she vomits! It’s very upsetting. I really hate that part of it all.
 
IduraH said:
oooh, yes, she is eating fine and still playing. She sends me picture of the food bowls etc.

I've asked her to go with 0.5 tonight then. Thank you Suzanne for your help.
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That is so great to hear that she’s playful and eating well. I feel very relieved about that. I feel she will be safe from a DKA with those positive clinical signs. I’m really glad you wrote me with the update and I was here to see it and to respond. I will be watching her progress.
 
Hi there, I'm really sorry for the late reply. It's been a hectic couple of days, I've updated the spreadsheet now. I'll start a new thread - should I do it in the prozinc group?

It seems she's quite insulin responsive during the day, but not at night. I'll persist with the current dose for now. But do let me know if you think I should change it soon.
 
IduraH said:
Hi there, I'm really sorry for the late reply. It's been a hectic couple of days, I've updated the spreadsheet now. I'll start a new thread - should I do it in the prozinc group?

It seems she's quite insulin responsive during the day, but not at night. I'll persist with the current dose for now. But do let me know if you think I should change it soon.
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@Suzanne & Darcy
Suzanne might tell you to start posting on the Prozinc Forum since she spend more time there and gets alerts when a Prozinc user posts there
 
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