Dosage increases without Vet

Nisha & George

Nisha & George

Member
Hi! I have a previous thread about glucose numbers and monitoring that has been extremely helpful.
https://felinediabetes.com/FDMB/threads/georges-ear-pricks-and-numbers.298400/?_params=Array
It has gotten kind of long and has moved away from the ear prick and numbers and into dosing. I'm currently between vets as my old was was not helpful and felt that gaslighting me about the dose. Last time George saw the vet he was at 2 unit ProZinc. I increased on my own with the help on one of the members on here. He is currently getting 2.5 units 2x daily, every 12 hours. His numbers are getting better but are still in the yellow range. (I'm in Canada so my spreadsheet is in mmol/L). He does occasionally drop down into the blue zone once in a while but not regularly. I'm having some anxiety about raising his insulin again without consulting a vet. I've made calls to one vet and am waiting on a response to my interview questions. Hopefully I'll hear from them by Friday. So, I guess my question is... is it safe for me to continue to raise his dose in .25 increments on my own? What number (or colour on the spreadsheet) am I aiming for?
Thanks so much in advance. This Forum has been a life saver. You are all fantastic!
 
George looks ready for an increase to 2.75 units. You have held the dose long enough for us to see how it is working. You will need to get some mid-cycle tests and at least one before bed test at night.
As for needing the vet to adjust doses, most vets have very little training in feline diabetes. There are hundreds of members here who are managing their cat’s diabetes and insulin dosing without consulting their vet. They follow the protocols and get assistance from experienced members here.
 
Update on my George! We went to a new vet on the 2nd! This is a CAT ONLY vet. They were sooo helpful! They answered all my questions and gave me information I didn't have before hand. They were open and honest and listened. It was fantastic! The price was not what I wanted but they seem to be worth the cost. They gave me some new dosing information for him. They looked at the tracking notebook I have (I started it before the spreadsheet but have continued to use it as a backup, in case the SS is lost somehow) and saw his numbers and adjusting what I should be giving him. The vet said were aiming for 8-13 mmol/L (144 -234). If he is 10 and under do not give him insulin. If he is 10-15 give him 2 units. 15 or higher give 3 units. We shall see how this works. Also he is almost completely switched over to the Hound & Gatos chicken and liver brand of cat food which only has 1.5 % carbs instead of the 6% the Go! Solutions had. I have a good feeling about going forward. I'll keep you updated as we go along and reach out if I have more questions!
 
That is a very odd way to dose ProZinc. Also the 144-234 range is not within the range that a normal, non-diabetic cat would have. It’s not in the range where a cat’s pancreas will heal. I don’t think this vet believes in a cat being able to achieve remission.
I am very glad that they are responsive and seem caring. That hopefully will help. I definitely want George to heal and thrive.
 
Some cats will go into remission on their own. Usually it’s if there was an identifiable cause like steroid use — something that can be changed (stopping steroids) or some cats who have been eating high carb kibble will go into remission with a diet change — that kind of thing.
 
Suzanne & Darcy said:
Did you have an idea what caused George to become diabetic?
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No. My best guess would be his kibble. But if that were the case I'm surprised my other cat who is 12 isn't diabetic as well. The original vet said they're was no way to know what caused it. He wasn't on any medications before his diagnosis. He was eating wiskas dry kibble.
 
Nisha said:
Update on my George! We went to a new vet on the 2nd! This is a CAT ONLY vet. They were sooo helpful! They answered all my questions and gave me information I didn't have before hand. They were open and honest and listened. It was fantastic! The price was not what I wanted but they seem to be worth the cost. They gave me some new dosing information for him. They looked at the tracking notebook I have (I started it before the spreadsheet but have continued to use it as a backup, in case the SS is lost somehow) and saw his numbers and adjusting what I should be giving him. The vet said were aiming for 8-13 mmol/L (144 -234). If he is 10 and under do not give him insulin. If he is 10-15 give him 2 units. 15 or higher give 3 units. We shall see how this works. Also he is almost completely switched over to the Hound & Gatos chicken and liver brand of cat food which only has 1.5 % carbs instead of the 6% the Go! Solutions had. I have a good feeling about going forward. I'll keep you updated as we go along and reach out if I have more questions!
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The Prozinc Dosing methods used on this forum help pick a safe dose for your cat based on how LOW kitty's current dose is taking him at the nadir, not only on how high his Pre-Shot BG is. There were many times that, had I selected a dose based on my cat's high Pre-Shot BG, I would have administered too much insulin and risked a dangerous hypo for Kobe.

Look at this example. It looked like the 1.5 units wasn't really doing anything because Kobe's BG seemed high all the time. Then BAM! 64 on a Pre-Shot. In hindsight, there could have been some blues hiding in there, and I had no idea. Who knows what could have happened if, on February 9 in the AM I decided that 340 was too high and increased his dose? I could have had a hypoglycemic cat when I got home from work. I reduced his dose that PM even though all my other readings were pink and yellow.

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Here's another example. In March, Kobe got a whole bunch of reductions, but look at the two pinks. Those pinks are what we call a bounce. Kobe's BG was starting to go lower than his body had become used to. Look at the 59 on 03/04; his body felt like that was too low even though he was still safe. In reaction, his body released a whole lot of homones designed to prevent hypo. From the 59, his BG climbed on that tide of hormones until he nearly reached 400. His BG hit 59 and then "bounced" up really high. Would you have guessed from that 398 on 03/05 that he was going to need another reduction in just 3 cycles? What if I had increased his PM dose on the 5th? or worse, his AM dose on the 6th? I don't want to think about it. You are welcome to look at the rest of Kobe's sheet, if you want. The beginning is a mess because it took me a while to follow all of the suggestions. The more I listened, the better my cat got. I look at everybody's sheet all the time. It helped me to start seeing patterns in what seemed like absolute chaos. Bouncing happens to lots of cats.

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I would thank the Vet for the advice, and then I would follow Suzanne's suggestion to increase to 2.75 based on your cat's nadirs.
 

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Kobe (Dean and Lesley) MO said:
The dosing methods used on this forum help pick a safe dose for your cat based on how LOW kitty's current dose is taking him at the nadir, not on how high his Pre-Shot BG is. There were many times that, had I selected a dose based on my cat's high Pre-Shot BG, I would have administered too much insulin and risked a dangerous hypo for Kobe.

Look at this example. It looked like the 1.5 units wasn't really doing anything because Kobe's BG seemed high all the time. Then BAM! 64 on a Pre-Shot. In hindsight, there could have been some blues hiding in there, and I had no idea. Who knows what could have happened if, on February 9 in the AM I decided that 340 was too high and increased his dose? I could have had a hypoglycemic cat when I got home from work. I reduced his dose that PM even though all my other readings were pink and yellow.

View attachment 73412

Here's another example. In March, Kobe got a whole bunch of reductions, but look at the two pinks. Those pinks are what we call a bounce. Kobe's BG was starting to go lower than his body had become used to. Look at the 59 on 03/04; his body felt like that was too low even though he was still safe. In reaction, his body released a whole lot of homones designed to prevent hypo. From the 59, his BG climbed on that tide of hormones until he nearly reached 400. His BG hit 59 and then "bounced" up really high. Would you have guessed from that 398 on 03/05 that he was going to need another reduction in just 3 cycles? What if I had increased his dose instead? I don't want to think about it. You are welcome to look at the rest of Kobe's sheet, if you want. I look at everybody's sheet. It helped me to start seeing patterns in what seemed like absolute chaos. Bouncing happens to lots of cats.

View attachment 73413

I would thank the Vet for the advice, and then I would follow Suzanne's suggestion to increase to 2.75 based on your cat's nadirs.
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‍ I'm not sure I understood all of what you said. I'm still trying to learn what the numbers mean. If you look at Georges SS... What would you say about his numbers? Is he "bouncing" or is he progressing well? I'm not really even sure what I'm supposed to be looking for in his numbers. I feel really lost right now...
 
Nisha said:
Is there anything I can/need to do with him bouncing?
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Yeah, but you're not going to like it... We wait patiently and follow the protocol. It's frustrating, but it's cool, too. As the pancreas heals, the breakthroughs were your cat sees lower numbers will become more frequent, and the bounce become less severe. But we let them run their course. Coming down from a bounce, cats can be MORE sensitive to insulin, so we can't safely raise the dose to try to flatten a bounce. Very dangerous, that would be.
 
Okay. So the insulin is working, his body just thinks he's dipping too low because it's not used to it being normal anymore. So the high numbers aren't actually bad numbers right now. I trust this forum more than I trust vets at this point... 2.75 is where he'll stay for now. What am I supposed to be looking for to adjust his dosage? Like number wise... His lowest reading ever was a 104. But his lowest average seems to be around 180-200. What are we aiming for?
 
Nisha said:
Okay. So the insulin is working, his body just thinks he's dipping too low because it's not used to it being normal anymore. So the high numbers aren't actually bad numbers right now. I trust this forum more than I trust vets at this point... 2.75 is where he'll stay for now. What am I supposed to be looking for to adjust his dosage? Like number wise... His lowest reading ever was a 104. But his lowest average seems to be around 180-200. What are we aiming for?
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That is exactly right. It's sort of like reprogramming your cat so that his body can heal and recognize what normal is again. Ultimately, you are aiming for normal cat numbers, from 50 - 100 most of the day. The dark green on your sheet. Getting to those dark green numbers most of the day with insulin is getting your cat regulated. Staying dark green without insulin is diet-controlled remission.

The people who offer dosing advice on this forum have years of experience. The rest of us field other questions based on our experience, helping where we can. Under Kobe's picture you can see that I joined on January 1 of this year, so I'm still pretty new. Suzanne joined in June of 2020. And her cat Darcy was on PZI for a while. These are the Prozinc Dosing Methods from the Sticky in the Prozinc Forum. She'll help you follow them.
 
Kobe (Dean and Lesley) MO said:
That is exactly right. It's sort of like reprogramming your cat so that his body can heal and recognize what normal is again. Ultimately, you are aiming for normal cat numbers, from 50 - 100 most of the day. The dark green on your sheet. Getting to those dark green numbers most of the day with insulin is getting your cat regulated. Staying dark green without insulin is diet-controlled remission.

The people who offer dosing advice on this forum have years of experience. The rest of us field other questions based on our experience, helping where we can. Under Kobe's picture you can see that I joined on January 1 of this year, so I'm still pretty new. Suzanne joined in June of 2020. And her cat Darcy was on PZI for a while. These are the Prozinc Dosing Methods from the Sticky in the Prozinc Forum. She'll help you follow them.
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Thanks for chiming in! Suzanne has already been such a great help. Together I know we'll get through this. Sometimes I feel alittle dumb when it comes to learn ing about all this.
 
Nisha said:
Okay. So the insulin is working, his body just thinks he's dipping too low because it's not used to it being normal anymore. So the high numbers aren't actually bad numbers right now.
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We have all been new. And you are asking really great questions that will help other people searching this forum trying to help their cats.
And look at how many more blues you've seen recently. He's coming down more often. We want that to continue. He'll stay down longer (we call that surfing LOL), and the bounces tend to get smaller and shorter. It gets better.
 
Kobe (Dean and Lesley) MO said:
We have all been new. And you are asking really great questions that will help other people searching this forum trying to help their cats.
And look at how many more blues you've seen recently. He's coming down more often. We want that to continue. He'll stay down longer (we call that surfing LOL), and the bounces tend to get smaller and shorter. It gets better.
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I hope that switching his food will help too. I'm almost done switching over to a 1.5% carb wet food from a 6%.
 
Nisha said:
I hope that switching his food will help too. I'm almost done switching over to a 1.5% carb wet food from a 6%.
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This may or may not make a difference. The lowest carb is not always the best for some cats. Some cats actually get better numbers with a few more carbs. Any food that is 10 percent or less is considered low carb and is appropriate for a diabetic cat. It’s fine that you have been gradually changing his diet, so I would go ahead with whatever low carb food (under 10 percent) that he likes to eat. It’s good to have different foods with differing carbohydrate levels available to you.
 
I appreciate @Kobe (Dean and Lesley) MO coming along and sharing their experiences with Kobe. Kobe is on a different insulin than George is though (Lantus) so the dosing protocols are different than ProZinc. One thing that is similar is that we do make dosing adjustments based on how low a dose takes the cat (the nadir.). With ProZinc we have to give a little more consideration to the preshot BG test numbers. Also similar is the bouncing. Any time your cat drops into BG numbers that are lower than his body is accustomed to — or if the drop in BG is really rapid (100 or more points in a single hour, for example) you can have a bounce, which will result in an extended period of high numbers. We usually have to wait for the bounce to clear before making dose adjustments (or we run the risk of overdosing the cat if we increase the dose because we are “fooled” by the bounce numbers making us think it just means he needs more insulin. What we call bouncing is a protective mechanism of the cat’s body in response to what it perceives as too low BG. The liver releases stored form of sugar (glucagon) and other hormones are released that raise blood glucose. A bounce can last up to 3 days (6 cycles) but it doesn’t always last that long. We look for patterns for each individual cat.
 
Okay, Nisha…. Having said all that, today, George is ready for an increase to 3 units. I say increase, but you already did increase so it’s really a continuation of the increase. Please keep his dose at 3 units. You held the dose of 2.75 units long enough for us to see how low the dose was taking him. You saw some nice blue nadirs.
 
Yesterday, 4 April, he was not in a bounce. See how he started out in red then went down to yellow and down even further into blue. That shows us a good response to the insulin. We want to hold this 3 unit dose for 7 days total before making a decision about the next dose. Okay?

Please try to get a nighttime test before you go to bed. If he’s dropping a lot, you may need to set an alarm to wake up and test him. Many cats will drop into lower numbers during their p.m. cycle, so it’s important for us to have an idea of the nadir during the night as well as the day.
 
Nisha said:
But his lowest average seems to be around 180-200. What are we aiming for?
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For the beginning, with ProZinc, we start with the Start Low Go Slow method of dosing while we gather data on the spreadsheet and get to see George’s patterns. The target nadir for SLGS is 90-150. After a few weeks, many cats will be able to move to the Modified ProZinc Method and our target nadirs will be lower (50-120).
 
Suzanne & Darcy said:
For the beginning, with ProZinc, we start with the Start Low Go Slow method of dosing while we gather data on the spreadsheet and get to see George’s patterns. The target nadir for SLGS is 90-150. After a few weeks, many cats will be able to move to the Modified ProZinc Method and our target nadirs will be lower (50-120).
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I will try to get some night time tests tonight. His number right now is 9.3 mmol (167) is it safe to give him his full 3 units?
 
This is a good example of how it would be helpful to have night tests. Last night he started out in red, but we don’t have any tests after that. Then he surprised us with this blue AMPS. He must have dropped lower than that blue last night at his nadir and has now come up to 167.
 
Also, two nights ago he had a PMPS of 185 but after that we don’t have any tests so we don’t know if the reduced dose of 2 units was enough for him.
 
Okay. Good. Thank you. Based on his data in early March and the fact that you have to leave around +3, I would reduce to 2 units. I was going to recommend 2.25 units but you need to leave the house at about +3 or so. We should be cautious. Please do get a +2 test and then a test when you leave home. Please don’t forget to put the numbers into the spreadsheet (so I won’t worry!) Make sure to give a +2 snack of his regular food and feed again before you leave. Okay?
 
Okay. I'll test again now, test at +2 and one right before I leave at +3. I'll leave some food for him before I leave and give him some at +2. I'll leave the higher carb stuff. (Still under 10%)
 
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