11/1 Charlie amps:391 4.2u

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Charliemeow

Charliemeow

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Amps:391, 4.2 u again
A little better today, but it's nothing I'm getting too excited over! Hope everyone survived their candy comas!
 
and yet still, a very shallow drop.
going to gaze for a moment at you ss.
 
219 is the lowest recorded number for charlie ever!
i am not suggesting youdo this...but if it were tom, and having been here for awhile, i would be so tempted to try something...more dramatic. just sayin...and i'm not suggesting you do it.
like i would up tom 1 full unit and just give a curve that day and the next. if i still saw nothing i would begin to suspect pzi is not the insulin for tom and then after crying i would xamine lantus, still crying as that insulin is just too much work. that is what i would do.
 
I see your point, and if I were a fd veteran I may try that, but I'm not ready for such a dramatic step. I'll wait it out with these small increases through the 45 day settling in period of prozinc. I'll revisit the idea again if things don't improve around that point. You assume that our ideal dose (if there is one for Charlie on pzi) is higher than our current dose, right? You don't think we missed it, do you? I feel like I held the doses plenty long, so I guess I don't think we missed it. Thanks Lori!
 
i have to admit i'm not sure...going at your current rate is probably best
 
i spoke to robin, i see her point about the days when you had the yellow mid cycles.
but....still.....gosh, i always think too much insulin will show as too low a # with a bounce that will end up giving you these highs...and since we have'nt seen a low# and i don't agree necessarily that the dose has come and gone.
believe me i hope i am wrong.
 
lori and tom said:
219 is the lowest recorded number for charlie ever!
i am not suggesting youdo this...but if it were tom, and having been here for awhile, i would be so tempted to try something...more dramatic. just sayin...and i'm not suggesting you do it.
like i would up tom 1 full unit and just give a curve that day and the next. if i still saw nothing i would begin to suspect pzi is not the insulin for tom and then after crying i would xamine lantus, still crying as that insulin is just too much work. that is what i would do.
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I wouldn't be so dramatic as a full unit. Maybe a half unit. But how old is this bottle of PZI at this point? Isn't the open shelf life like 30-90 days? I know when I used PZI years ago with Tilei...I was lucky to get 45 days from a bottle.
 
So we had some nice movement on numbers about 2 weeks ago, now weak action.

1. Insulin issue
2. Insulin resistance that needs to be broken by more assertive dosing
3. Rebound

Lori, you can answer question #1. Insulins can go bad from rough, improper handling, wrong storage temps., or even being dropped! Most have a good tolerance for such things, but opened insulin tends to compromise sooner. Based on the length of time and not knowing if Claudia is using a manufactured or compounded PZI this would be my first suspect.

Question #3 is answered by simply doing a rebound check and dropping the dose back to I'd estimate around 3.5u. The one spot check on the overnight indicates he does go lower at night, but not by much at this level. A rebound check wouldn't be out of the question.

The answer for #2 will take courage, vigilance, and fortitude. If it is resistance, then the suggestion I made a few days ago about raising the dose in 0.5u increments is the direction to go.

How long can a PROZINC vial be used after it is opened?

Although product literature or labels for other insulin products advocate replacing insulin vials every month, there are no special requirements to periodically replace PROZINC once the bottle has been punctured under normal use conditions. PROZINC is a suspension and once mixed has a whitish cloudy appearance. Of course, if discoloration or other abnormal appearances are observed, indicating contamination within the vial, it should be discarded. Loss of insulin activity in the bottle should always be considered whenever clinical symptoms or signs recur, regardless of the amount of insulin in the bottle http://www.prozinc.us/faq.aspx#prozinc_opened
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Pmps:381, 4.2 u
Thanks Lori and blue! I'm pretty sure prozinc is manufactured, not compounded (according to their website). I don't know how that affects shelf life, though. Sounds like you two are on the same page with more aggressive increases. I may be moving that way, too. How do I do a rebound check? Just drop back a bit and do several tests? I suppose it may make sense to do that now rather than lots of little increases, then back off to 3.5, right.
 
hi blue!
from everything i can gather by nagging i thing the insulin has been handled expertly.
as far as rebound..would'nt charlie of had to seen some lower #'s? and this rebound is the longest in history if it is rebound. i don't think rebound could be the culprit.
at least if we go with the bigger dosecrease we should have an indication of pzi effectiveness on charlie. during the day of course, and with a good hypo tool box, and a phone # or two. it is just the way i'd go.
fwiw.
lori
 
My first course of action would be to do a rebound check. This would mean backing off about 10%. In Charlie's case though, since his last action appears to be around 3.5, that is where I would go. If his numbers improve, we'll wait a few days and then make a determination.

My second course of action would be to get a fresh bottle of insulin as soon as I could afford it. If the insulin has gone bad for whatever reasons...then everything else we're talking about is a mute point. (Man I wish they made insulin activity tests.)

Last course of action would be to speak with the vet regarding possible insulin resistance and more assertive dose increases. Most vets like to be at least informed of what you are going to do. There is some risk to it. At that point sometimes the vet will decide to try a different insulin.

I would suggest potentially having Charlie tested for Acro, if this is a direction you end up going in. The test is fairly inexpensive in and of itself. It will be the cost of the vet blood draw and shipping...

I currently use Lantus pens for Atlas. And Lori is sort of correct as working with Lantus throws almost all "rules" out the window.
 
lori and tom said:
hi blue!
from everything i can gather by nagging i thing the insulin has been handled expertly.
as far as rebound..would'nt charlie of had to seen some lower #'s? and this rebound is the longest in history if it is rebound. i don't think rebound could be the culprit.
at least if we go with the bigger dosecrease we should have an indication of pzi effectiveness on charlie. during the day of course, and with a good hypo tool box, and a phone # or two. it is just the way i'd go.
fwiw.
lori
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Even with all our home-testing sometimes an animal can suddenly drop and recover between shot times. You or I would never realize it happened. Trust me...take a look at Atties spreadsheet ...and he is on Lantus. Yeah, not supposed to happen on Lantus...right. :lol:

Now we didn't see those low numbers, but Charlie's liver knows they happened and he keeps getting to much insulin and more...so the liver is overcompensating causing chronic high numbers. The dreaded high flat curve. Plus we don't have any overnight numbers.

Repeated overdose with long-acting insulins can even cause high, flat numbers all day long. http://petdiabetes.wikia.com/wiki/Somogyi_rebound
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My gut is telling me to do a rebound check for several days to see if the numbers improve.

If we get more aggressive with dosing in this case, Charlie could crash. I'd rather take a few days to "check" and "check" the insulin...then if nothing improves move forward with aggressive dosing. If we move forward and the insulin activity is compromised...then when Charlie gets a new bottle....??? Too many if's for my liking.

PS. Keep in mind that rebound can also be triggered by a fast drop too. Charlie's lack of overnight numbers and high morning pre-shots.
 
well i always follow the gut feelings!
only question is with these #'s being as high as they are for as long as it's been is that the prudent way to go? i'm amazed charlie is in as good shape as he's in with his high's.
and will a dosecrease down show worse numbers rather quickly? and if so...would it be safe to shot right back up to 4 something?
 
I'm really glad this discussion came up. I was thinking rebound check yesterday, the best action they got was actually at 2.5u.

My feeling is that they did not hold the best doses long enough and may have passed up the perfect dose.

Prozinc has an extended shelf life and is not as fragile as other insulins so I don't think that it's the insulin.
 
To determine the dose of insulin or if dysregulation problems exist, use these guidelines:

* The ideal midpoint of the range is 200 mg/deciliter. However, the midpoint is satisfactory if it is from 150 to 250 mg/deciliter. If the midpoint is less than 150 mg/dI, the dose of insulin is too high and should be reduced. The nadir also should be below 100 mg/dl when the dose of insulin is too high.

http://www.felinediabetes.com/bg-curves.htm

Claudia you were only about 40 points off here back at 2.5u. If he took a fast drop overnight, which we'll never know, could have been missed.

A day or two to check for rebound will be OK, especially if the numbers fall back.
Rob are you thinking to drop all the way back to 2.5u?

If the numbers don't fall back, we'll then be moving forward at 0.5u, instead of these micro-increases. We know we can move quickly up to 4.0.

Rob the more I look at this the more I think you are correct. He needed a bit more time down around 2.5-2.75u.
 
lori and tom said:
and will a dosecrease down show worse numbers rather quickly? and if so...would it be safe to shot right back up to 4 something?
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A dosecrease down will show withing 24-48 hours. You have to give the liver hormones time to clear.

If the numbers don't fall back a bit...

Then you will be looking at going up in 0.5u increments at least until 4.0.

The day they hit 219, they were real close to midpoint range. +/- 20%.

My fear is if we start increasing the dose...he will crash. That is what happens when you miss the ideal dose with longer acting insulin. Eventually the body can't fight it off or resist it because it is just way too, too much.


Glycogenolysis: The liver may dump glucose in reponse to other events, too. Dr. E. Hodgkins[12]believes that in some cases, an animal accustomed to extreme hyperglycemia may consider even a number such as 150mg/dL (8.5 mmol/L) "low", and proceed to dump glucose. See also obstacles to regulation.
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Rebound due to single overdose: Sometimes your pet's blood sugar will suddenly seem much higher than usual. This is often not a good time to increase their insulin dosage -- quite the opposite. It may instead be another case of "reduced need". It often indicates that a low blood sugar condition (or rapid sugar drop) was experienced a few hours before, and a Somogyi rebound[33] is in progress.

To be sure, drop the next dose by 15%-50% and take glucose readings every 4 to 8 hours until the glucose levels out. Then wait a day or two for the Somogyi hormones to decrease in the body, and then you can increase again by 0.5-unit steps every 5-7 days. If you experienced this rebound, chances are that your original dose was too high, or the pets' insulin requirements decreased, so you should try to find an ideal dose at a lower point.
http://petdiabetes.wikia.com/wiki/Obsta ... n#Rebounds
 
I would like to see what he could do with 2.5u, give it a chance, I think it's safer to try a rebound check first, give him a chance to settle into that dose, if his #'s don't inprove than go with plan B, have him checked for acro and aggressivly up the dose.

Honestly, I believe that Prozinc is different than any other PZI and requires a longer settling in period.
 
well, just to add to the party mix of ideas. charlie's first dose was blind. a day after dx where dx # was in the mid-high 300's and claudia was advised to shoot 2u. charlie was so utterly lethargic and limp that day she did not shoot that evening. that could have been a hypo before the 500 #'s ever hit town.
just in case you did'nt know.
i found this out today and thought it was very interesting...and relevant. a dx of 300 something is really a low dx #.
anyone more or less confused?
 
lori and tom said:
charlie was so utterly lethargic and limp that day she did not shoot that evening. that could have been a hypo before the 500 #'s ever hit town.
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Charlie was a bit rough around the edges the day I met him & Claudia. According to the ss though she dropped the dose to 1.0u (50%) which I think was right after my visit. If he should have been down below a 2.0u dose, one would think a crash would have happened by now. It makes a great case for home-testing right from the start.

Claudia, if you are up and reading or getting ready to shoot,

please //// cut the dose to 2.5u and hold for 5 days. Some of the links explain why five days, but if this is chronic rebound, then Charlie will need at least the first 3 days to clear the hormones.

I want to assure you & Lori, that you did everything right for Charlie. And Charlie most likely will still need a slightly higher dose than 2.5u, but cats can sometimes experience rebound from high numbers. And this is another of the advantages of home-testing, this is why we initially go slow and collect as much data as possible. If per chance we miss a dose or a cat needs longer time at a certain dose level...we're better equipped to deal with it.

So, what to expect for the next few days. High numbers. Every cat is different and every cat can vary in response to recovery time. Some cats will clear it in immediate response to the cut dose ...others may take the full 72 hours to clear. I actually will mark out the full 72 hours on my spreadsheet if I anticipate a hard rebound. That sort of keeps me from getting overly antsy about upping the dose, which is exactly the opposite thing you want to do.

Last month your readings were up in the 400-500, now you're down into the 300-400. You had the 200-300 ranges for a few days. Let's see if we can get him back there and let him settle back in.
 
Charlie is very happy that all of you are on his side! We saw the posts before his shot, so we dropped back to 2.5 u today (481 amps-yuck!). I'll give his ears a break and not check mid-day...I'm not expecting anything big today. Thank you Lori, blue and robin!!
 
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