3/31 Merlin - Need Guidance with Doses

[Merlin]

Hello. My name is Cindi and I live in Phoenix, AZ. I am hoping I can get some guidance and recommendations regarding doses. Could someone take a look at Merlin’s spread sheet? I posted a few days ago in the main forum regarding his PM dose on 3/29. It was suggested that I post here. I am new at this and am trying to make his dose somewhat consistent but as you can see his numbers are all over the place.

Merlin is 16 years old and was diagnosed six months ago. He is my daughter’s cat and unfortunately, she had to move to Hawaii so she couldn’t take him with her. I have been taking care of him since March 4. When he was diagnosed in October, Alex did a lot of research. I really wished that during our research we found this wonderful forum but unfortunately we didn’t, until I stumbled upon it a few weeks ago. I have been spending hours each day reading all the threads and articles on this website. I can only think that if we had that Merlin would have been doing much better today.

He is on Prozinc. I use an AlphaTrak 2 meter with U40 syringes. He is getting Fancy Feast Classic food 100% of the time which includes Methyl B12 in the am and pm (neuropathy condition). I just transitioned him to LC canned food two weeks ago. He is eating, drinking, sleeping and everything else well. I test him for ketones and they are negative. Bottom line, I am so unsure of what dose to give him every morning and night. I am so unsure of my decisions. My vet would like me to bring him in to do a fructosamine test. In October, she started him off at 2U and then moved it to 3U very shortly after. I am afraid to just give him 3U all the time and that is why I have jumped all over with his doses.

Today, when I took his blood at nadir or mid-point, I was so surprised to see 34 after giving him 2.50U for 488 BG this am. So I tested him 30 minutes later and he was at 110. I will test him again in about an hour. In looking back, I should have retested when I got the 34 to confirm that number. I gave him just a tablespoon of HC food and just a little mixture of honey and water. He did not have any hypo symptoms. He has never dipped that low especially after starting the day with 488.

So again the main reason, I need some expert help on my doses. Any guidance would be very much appreciated. Thanks, Cindi.

 

[nckitties3]

Hi Cindi. Want to welcome you and Merlin and let you know that those more experienced than I will be along to help you out. I know nothing about ProZink, a little about PZI and too much about Lantus and Levemir. :lol:

Hang in there, it's a little slow on this board, but there will be others around.

 

[Jen&Eddie]

Hi Cindi!

I'm struggling a bit because I'm not used to Alphatrack numbers (most of us use human meters), but it does look like Merlin's dose is probably quite a bit too high. Did you have a chance to look over the chart that BJM posted in your thread on health? Here's a link to it again: viewtopic.php?t=116320#p1222798. You really don't want to "aim" for under 80 with an Alphatrack,..anything below that is hypo territory. That number in the 30's is way too low. Merlin's high pre-shots are probably due to bouncing...meaning that his body releases glucose and counter-regulatory hormones as a protective measure when they hit numbers that are too low (or sometimes just lower than they are used to).

You might want to consider a switch to a human meter, like one of the Wal-Mart Relion meters, which is what most of us use. The meter itself costs under $10 (if I'm not mistaken), and the strips are much cheaper than the Alphatrack strips. Most of the charts on FDMB that use human meter numbers have already accounted for the difference between the Alphatrack numbers versus the numbers on a human meter, so there's no need to convert the numbers to "cat numbers" or anything like that.

It is very common for a kitty's insulin needs to go WAY down after a switch to low carb food, so that may very well be what you're seeing. Some kitties go OTJ (off the juice - insulin) all together and are diet controlled, after changing to a low carb diet.

It looks like on the cycle of 3/30, Merlin had dipped to 111 within three hours on a dose of 1u so it looks like 1u may be plenty. You may want to consider doing a "reset" and seeing if 1u is enough to get nadirs at are above 80 and below 160 on the Alphatrack. Merlin may need even less than 1u. For that many of us ProZinc users use u100 syringes and a conversion chart to allow us to dose in increments as small as 0.2u.

Here's a document with the steps for dealing with numbers that are approaching hypo territory, which on Alphatrack is under 80: http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=15887 If you catch a low number like that again, I strongly encourage you to post on the PZI board or on the Health board (which is more active) with a 911 symbol so folks can help walk you through dealing with those low numbers.

Welcome! Looking forward to seeing more of you and Merlin! It looks like the diet change is going to do wonders for him.

 

[Sue and Oliver (GA)]

Welcome! I agree with Jen that your dose was too high if you got the low greens at midcycle. Maybe start with one unit, get those midcycle numbers and see how he does. (It is always safer to raise the dose a little if needed than to deal with low numbers.). It may take a cycle for him to get back to normal numbers also, as he dropped low and may bounce to higher numbers as a reaction.

Could you add AlphaTrak meter to your signature in larger font and maybe a color? We can adjust our thinking (as human meters are more common) but need a reminder to do that.

The more data you get, the more you will begin to see patterns and understand exactly how the insulin is working for him. And yes, the change to wet low carb can make a huge difference downward in numbers.

 

[Merlin]

Thank you for your suggestions. I have a few questions.

1) How do I reset? Do I skip like tonight's shoot or do I just start off with 1U tonight?
2) When I go with 1U, even if the numbers are high, do I just keep doing 1U at least for a 3-4 cycles and see how it goes?
3) While trying out 1U at AM & PM shot, how often should I test? Every 2 hours? Every 3 hours?
4) While I am going through these cycles, would you mind checking out Merlin's spreadsheet and let me know how we are doing?
4) My suggested a fructosamine test. Would that be useful?
5) I think I still have 100U syringes. Are they the ones with the orange cap? I think that is what I mistakenly used the first part of March.
6) I will add that information to my signature. Just having a tough time trying to find out how to do it.
7) If I switch to the human meter, do I just use those numbers for the spreadsheet? No transposing or adding 30 points to reflect a cat meter?
8) If I switch to the 100U syringes, do I transpose on the SS to reflect 40U?
9) Early March, I mistakenly used I believe the 100U syringes and thought I was giving 3U and 4U but kept on getting high numbers. At that time I was giving I believe 1.2 & 1.6U and numbers were high at least at shoot time. It is the numbers in between is what I am aiming for good numbers correct? So having high numbers at shoot time (AM & PM) is somewhat expected at least at first...correct?

Sorry for all the questions, but I am eager to try your suggestions and want to make sure I got it.

 

[Jen&Eddie]

Great questions! Keep them coming! When I first got started, I devoured everything I could read on this board. And now, I go back and re-read things I read before. There's a huge wealth of information here.

1) How do I reset? Do I skip like tonight's shoot or do I just start off with 1U tonight?

No need to skip tonight to "reset." Assuming Merlin is over 230 or so, you can go ahead and shoot 1u tonight. I'd not shoot under 230 for the time being until you have data showing it's safe to do so.

2) When I go with 1U, even if the numbers are high, do I just keep doing 1U at least for a 3-4 cycles and see how it goes?

Yep! There isn't really a specific time that a dose is "required" to be held with ProZinc, but there are some kitties that do seem to need a couple cycles to "settle" in. Another thing that can occur is that if kitty is bouncing, it may take a couple cycles for those "bouncy" hormones to clear out so you can see how a dose actually works. That said, if Merlin drops below 80 on 1u, you should most likely reduce the next cycle.

3) While trying out 1U at AM & PM shot, how often should I test? Every 2 hours? Every 3 hours?

I don't know if there is such a thing as too much testing, if you are able to do so. Every kitty has a little bit different patterns, but its often helpful to get a reading around +2 or +3, and again at +5 and/or 6/ and/or 7, depending on what's happening with the numbers. The ones around +6 or so are usually around nadir, or the low point of the cycle, but that can vary. My Eddie sometimes has nadir at +5 or sometimes its at +10. You kind of let the numbers guide how frequently and when you're testing. I always feel that the more data you have, the more easily you can spot patterns.

4) While I am going through these cycles, would you mind checking out Merlin's spreadsheet and let me know how we are doing?

Absolutely! I encourage you to post just like you did on the PZI board with Merlin's numbers as you're testing. If someone spots something wonky or good, or whatever, we can comment on what we're seeing. Lots of us post a daily "condo" with period updates/questions/etc. in a single thread for the day.

4) My suggested a fructosamine test. Would that be useful?

If you're testing BG at home frequently, it's really not necessary to do a fructosamine test. That generally measures what the glucose has been over the past few weeks. It can't spot patterns or differentiate if kitty is going low and bouncing.

5) I think I still have 100U syringes. Are they the ones with the orange cap? I think that is what I mistakenly used the first part of March.

U100's have the orange cap. It looks like you have fixed the designation on Merlin's SS. The ones with the 1/2 unit markings make it easiest to measure in those small increments.

6) I will add that information to my signature. Just having a tough time trying to find out how to do it.

If you click on the "user control panel" link, then go to the "profile" tab, you can select the option to "change signature" there. It's helpful to denote that you're using an Alphatrack (for now) since the numbers mean different things than with a human meter.

7) If I switch to the human meter, do I just use those numbers for the spreadsheet? No transposing or adding 30 points to reflect a cat meter?

If you switch, you just enter the numbers as you read them on your meter. No adding or subtracting. If you do switch, you don't have to go back and change Merlin's SS...just make a big line across the SS that denotes that you're switching meters.

8) If I switch to the 100U syringes, do I transpose on the SS to reflect 40U?

If you switch to u100's, you'll enter the dose as though you are shooting with a u40, just like you did already on Merlin's SS. For example, I use u100s and to shoot 2.2u like I did tonight, that is measured as 5.5 on the u100 needles. I enter that as 2.2u on my SS.

9) Early March, I mistakenly used I believe the 100U syringes and thought I was giving 3U and 4U but kept on getting high numbers. At that time I was giving I believe 1.2 & 1.6U and numbers were high at least at shoot time. It is the numbers in between is what I am aiming for good numbers correct? So having high numbers at shoot time (AM & PM) is somewhat expected at least at first...correct?

Yes, with ProZinc, generally your pre-shot numbers are going to be the highest points in the cycle. An "ideal" ProZinc curve looks like a smile. Nadir, or the lowest point of the cycle "on average" occurs around +6, but this can vary pretty dramatically from cat to cat. That's why it's nice to get spot checks throughout the cycle. :smile: Here's a link to the general ProZinc protocol: http://www.felinediabetes.com/FDMB/viewtopic.php?f=24&t=109077. I will point out that ProZinc is a very flexible insulin, so there's lots of ways in which you can "tweak" what you're doing beyond what is described in the protocol. Here's some other reading materials on ProZinc to get you started: http://www.felinediabetes.com/FDMB/viewtopic.php?f=24&t=32799

A couple other things -- I encourage you to read the "condos" of other PZI kitties, and ask questions, ask for clarification on terminology, etc. Take a look at other ProZinc kitty spreadsheets. I personally also read a lot of the "condos" of Lantus/Levemir kitties. There's so much info to be gleaned from reading the daily condos of other kitties. Just bear in mind that ProZinc is used very differently than the Lantus/Levemir insulins, so you do not want to try to apply their dosing techniques. We get our own special section of the board for that part!

 

[Sue and Oliver (GA)]

Ditto. :mrgreen: What Jen said.

 

[Jen&Eddie]

Ditto. :mrgreen: What Jen said.

I was wondering which of us would post first. :lol:

 

[Merlin]

Looks like I have homework to do tonight. I am so excited about trying this. I just tested Merlin and he was at 192 so no shot tonight! I will go with 1U tomorrow morning no matter the number and will test him throughout the day. I just thought of something else. When I accidentally used the 100U syringes back early to mid-March, he was not completely 100% on LC food. He was still transitioning (I think 50/50) so of course he would have high numbers then. This time, I feel is going to be much different.

Just to make sure that I have 100U syringes. I have two that are orange cap. 1) Capacity - 1/2 ml cc; gauge 29; length 12.7 mm; and the number goes to 30. The other 2) 3/10 ml cc; gauge 31, 8mm length and the number goes to 50. I am assuming that they are both 100U, it's just second one (31 gauge) has a smaller needle?

What does condo mean?

I will post my numbers tomorrow. I think I am done with questions for now. Thanks for being there.

 

[Jen&Eddie]

I just tested Merlin and he was at 192 so no shot tonight!

Have you fed yet? If not, you do have the option of stalling, which is basically re-testing in 30 minutes to see if he is climbing to a safe and shootable number, and repeating, as necessary, till he's high enough to shoot. I do this all the time with Eddie. Of course, it also depends on whether that works with your schedule. It's not absolutely necessary to shoot on a 12/12 schedule with ProZinc, so you can usually get back on track relatively easily. Or, you can certainly skip tonight, and see where he's at in the morning. With a skipped shot, Merlin may be high in the AM, but if for some reason, he's below 230, don't shoot - post and ask for advice.

When I accidentally used the 100U syringes back early to mid-March, he was not completely 100% on LC food. He was still transitioning (I think 50/50) so of course he would have high numbers then.

This very well could be the case! There was a Lantus kitty that recently went OTJ in a very big hurry down from several units when his mamabean discovered that he was getting into dry food.

1) Capacity - 1/2 ml cc; gauge 29; length 12.7 mm; and the number goes to 30. The other 2) 3/10 ml cc; gauge 31, 8mm length and the number goes to 50. I am assuming that they are both 100U, it's just second one (31 gauge) has a smaller needle?

I think most of us use 3/10 capacity. Does it have 1/2 unit markings?

What does condo mean?

It's basically your cat's daily post. Most of us title it something like "3/31 Eddie AMPS 300, +4/200" or something along those lines. If you hop over to the PZI board, you can see how I've formatted Eddie's "condo," or I think Lucian's mama Deb has posted his "condo" recently, too. You just add a reply as you go throughout the day, to add questions, or to add numbers. I like to post a "summary" that I edit throughout the day of Eddie's numbers in my very first post, so his numbers are right on top and easy to see.

Looking forward to seeing Merlin's progress!

 

[Merlin]

Yep I fed. Drats, I forgot about stalling. Will try to remember next time. How long is it appropriate to stall? Yes I would expect his numbers to be in the 400's tomorrow morning but will give him 1U. Regarding the syringes, they both have tick marks between 0 and 5. I am assuming that each tick mark is 1U??? There are not any tick marks between each unit on either syringe. The 1/2 ml syringe appears to be smaller than the 3/10ml. Both are ReliOn syringes.

 

[Jen&Eddie]

How long is it appropriate to stall?

If your schedule allows, theoretically you can stall as long as you want. If kitty is just below safe numbers, you may want to retest every 20 -30 minutes. If they are still quite a ways off and seem to be rising slowly, you can stall an hour at a time. You just need to be aware that shooting several hours after your normal shot time will likely mess up your next shot time. You also need to not feed while you're stalling, so sometimes kitty insists that the stalling game is over and its time to be fed. ;-) You will want to make sure that there's been at least two hours with no food before the shot. To see an example, I stall on Eddie's pre-shots all the time. You can see this happening when there's multiple numbers in the pre-shot columns with the time indicated as well.

Regarding the syringes, they both have tick marks between 0 and 5. I am assuming that each tick mark is 1U??? There are not any tick marks between each unit on either syringe. The 1/2 ml syringe appears to be smaller than the 3/10ml. Both are ReliOn syringes.

The 1/2 ml syringes hold up to 50 units and the 3/10 ml syringes hold up to 30 units. I'm guessing that there's more space between the tick marks on the 3/10 ml syringe. You'll probably eventually want to pick up some 3/10 ml syringes with the half unit markings so you don't have to try to eyeball the 1/2 units. u100's also come in different length and gauge needles. That pretty much comes down to preference. My DH (dear husband) and I prefer a shorter needle but I know there are some that like a longer needle. I don't know that gauge really makes much of a difference. Theoretically the finer gauge needles might pinch less.