4/9 Shakes - ANy advice would be great

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dmartini4

dmartini4

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Good morningEveryone,
Hope you all had a great night and are enjoying your weekend

If you could please look at the spreadsheet because I could really use some help.

his numbers do not make any sense to me
I am starting to think that I should lower him back to 1.5.....
or should I raise him....but raising him makes his numbers go up...
do not know where to go from here

thanks as always for your input

Denise and Shakes
 
Denise, if you would get even a modified curve today - numbers every few hours - it would really help us decide where to go. It is true you got better numbers the first day on 1.5 But we aren't sure whether they held since we had no nadir numbers in the daytime after that at that dose.

Tell use more about why you took him to the vet yesterday. Did they find anything wrong? What did they test for? If it is something else - like an infection - that can also impact your numbers.
 
Prozinc has a 40 or 45 day settling in period. I looked through the sticky, but I could locate where it talks about this timeframe. Someone else might know. Some kitties need a little longer settling time on a dose - like a five or six days. Just something to keep in mind. I think Sue's suggestion of getting in a few more tests today would definitly help you figure out where to go from here.
How is Shakes overall? All p's in place?
 
The 45 day "settling period" comes from the FDA study on prozinc. The researchers waited 45 days before evaluating the effectiveness of prozinc. It doesn't *necessarily* mean that it takes 45 days for it to settle. Any type of insulin will take a few weeks for kitty's body to get used to 85% of the time though.


On to the numbers - I am still seeing a drop here from Shakes. That dip into the blues on 1.5u could have been a fluke, and you don't know if he did that on 1.75u because no day time mid cycle checks happened. I am still seeing roughly the same preshots, so I don't think 2u is too high. I'd suggest staying with 2u for another day and then evaluate upping the dose to 2.25u after that.
 
The 45 day "settling period" comes from the FDA study on prozinc. The researchers waited 45 days before evaluating the effectiveness of prozinc. It doesn't *necessarily* mean that it takes 45 days for it to settle. Any type of insulin will take a few weeks for kitty's body to get used to 85% of the time though.
Click to expand...
Thanks for clarifying, Kelly! :smile:
 
just a thought...i think that settling in period would hold more true for a kitty on insulin for the first time...a kitty already having been treated on insulin albeit a different insulin i would honestly not expect a period of settling in. IMHO verra verra humble i might add.
 
wow you must shoot early as half your curve is done and it's 10:15 my time!
an unusal curve....for pz. not for lev or lantus but for pz.
this insulin 90% of the time is a one way street...down and then up with very little staying with one number for long and very little bouncing up and down within the same cycle.
soooooo, i see why sue thinks more testing is needed, and i see why you are confused.
me? i would hold steady with this dose for a few more cycles if you can.
remind me tho' was this the former dka kitty?
 
Hi Ladies,

Ok I took his +8 and he was at 261...hhmmm..??
and his +10 is 316

I noticed at 9 hours he started getting tired which is usually means his numbers are rising

soo... he has been mid 200;s pretty much from +3 to +8
I did not think that was normal,
but then again Shakes is not normal

I took him to the vet yestereday because his legs are getting worse,
so I wanted to talk to her about putting him on prednisone
hoping that will help him some
his front legs have the neuropathy too and his back legs are getting more wobbly
there is nothing wroong, no infection or anything,
she said he looked good

so..I am guessing I should keep him where he is and keep testing,
or possibly lower(only because his start and finish numbers were lower )
but you are right it could have been a fluke

THanks for any advice!
 
They aren't awful numbers and it is early in this process. A regulated cat generally is in the 200s at preshot and in the 100s at nadir. So, if you think in those terms, he doesn't have far to go. I would stick with your dose for a few more cycles, getting numbers whenever possible.

His walking is most likely due to neuropathy Neuropathy Improving numbers will help him improve, but so will MethylB12, as suggested in the link. I would NOT get a steroid. I am not sure it would help at all, and it can make the diabetes a lot more difficult to treat.

And we have gone over lo carb treats, right? And small frequent meals. Just checking to be sure we have all the basics covered.
 
I have been giving him the correct Methly B since Oct last year
that is the only reason he is able to walk
I only feed him FF classic and for a treat I boil chicken for him

I was told that he has arthiritis in his back and a few degenerative discs
so I was hoping the steriods might help his back
as his back is getting lower to the ground as he walks now

I will hold the 2 and see how he does tomight
I am hoping that his pmps number is not as high as it has been

Thanks for the input
 
I forgot about the arthritis. You may eventually have to balance his quality of life (pain from the arthritis) with the diabetes and treat both. Have you posted about the arthritis on Health and asked what other people are using? I know we have some arthritic kitties.
 
Great job getting a curve done! The dose looks likely too low to me. I'd give it another day and if the #s don't improve I would raise by another 0.25. What I used to do when on a dose raise path was get PSs the 1st day and then on the 2nd day try to get at least a nadir spot test in. That way you have at least some minimal data to base a decision on whether to raise more or not. If you can get more data that's great, but if you can't, PSs and something in the +4 - +8 zone will give you the minimum at least. The nadir on day 1 often isn't a reliable indicator of how they'll do on that dose, that's why I usually tried for day 2.
 
Hi Joanna,
I wish I could get numbers during the day but I work 45 minutes from home so there
is no way I can swing home to check, and i dont know anyone inthe area
who could check for me,
so unfortuantely I can only do the day checks on the weekend

so you think i could raise not lower? he seems to be going up at night
I cheked him at +2 for tonight and he is at 352.
I am going to check again at +5 tonight and then I will check a couple of times tomoorrrw
to see where we are at

When we were on Lantus he would always do well in one of the 12 hours
and the other 12 hours in a day he would stay high
and I am wondering if he is doind that with this insulin too.
I am starting to think that when I check at night he is high
but during the day he is going lower like with the Lantus
 
Weekends are fine if that is what works for your schedule - I'd just be sure to always get in some sort of nadir check before you raise a dose.

The pattern you described isn't a typical one as far as I know for PZI. Anything is possible though, and if you can get some spot tests in at night (ooooh, fun!!! LOL) that will help you figure it out.

I don't see anything in the #s that would suggest the dose should be lowered....? I may be missing something, and have not read every thread/post. Are others suggesting that? I am thinking you may have some ways to go since the dose was quite a bit higher on Lantus before you saw any action.

If you are looking at the blue #s on the 3rd, that looks to me like WOW factor on a new dose. Generally when you see that on cycle 1 of a dose but not after that, it's basically lost. Their body has already overcome that dose and it's not enough insulin. I'd actually consider raising at 0.5 increments until you see better #s. My read is his body is getting ahead of the doses pretty fast, and the 0.2 increments maybe aren't giving you enough oomph to gain some ground.

Today is a little wonky - if you get something like a late drop down to blue #s for tonight's PS then I'd say that supports the dose being too high, but if it stays flat or goes up by the end of the cycle, I'd say it's time to raise.

See what others think.... I haven't read all the history so maybe there is something I'm missing.
 
p.s. just went back & read a little more - if the neuropathy is bad that definitely supports the dose being too low. Bix used to get worsening neurpathy before I would see it in the #s even, so I could often tell from that that he needed insulin. Symptoms trump #s. Your #s aren't awful-awful, but they are still high, and if you are seeing symptoms, and nothing in the #s to suggest dose is too high (like low #s, or an inverse curve) that's pretty much a = dose increase needed IMO.

Also, I would stay away from the Pred if you have any non-steroid options.
 
could pain be a factor in the high's? does he take any pain meds?
 
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