6/23 Cookie ProZinc AMPS 550, +2 344 / +3 219

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I have to make my nightly rounds, I'll try to keep an eye on you if I can. Very surprised she's not bouncing yet.

Here's my thoughts, do with them what you will:

Her PMPS is going to be significantly food-influenced because of the HC and MC.

If she's above 200 at PMPS (I did factor in the HC/MC food influence), I am thinking a drop dose. It's where you push the plunger in all the way, then insert in the vial, and let the plunger go. When you inject, hold it down for 10 seconds. That results in a single drop shot. I say this mainly because of DKA, we really really really try not to skip with a recent DKA.

If she's below, I really don't think any shot is safe at the moment, or rather you'll end up staying up all night and repeating the day you just had.

Your other option is to keep stalling without feeding until she's rising on her own, but that will put you way off schedule.

Unfortunately you're going to have to make the call...do you risk ketones, risk a night like today, or get off schedule. If it were me, I'd lean towards skipping and just check ketones (this is where the blood meters are a godsend).
 
FrostD said:
I have to make my nightly rounds, I'll try to keep an eye on you if I can. Very surprised she's not bouncing yet.

Here's my thoughts, do with them what you will:

Her PMPS is going to be significantly food-influenced because of the HC and MC.

If she's above 200 at PMPS (I did factor in the HC/MC food influence), I am thinking a drop dose. It's where you push the plunger in all the way, then insert in the vial, and let the plunger go. When you inject, hold it down for 10 seconds. That results in a single drop shot. I say this mainly because of DKA, we really really really try not to skip with a recent DKA.

If she's below, I really don't think any shot is safe at the moment, or rather you'll end up staying up all night and repeating the day you just had.

Your other option is to keep stalling without feeding until she's rising on her own, but that will put you way off schedule.

Unfortunately you're going to have to make the call...do you risk ketones, risk a night like today, or get off schedule. If it were me, I'd lean towards skipping and just check ketones (this is where the blood meters are a godsend).
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What about fluids, should I still do that? How does that affect BG?

Thank you again for the assistance. I really do appreciate it!!!
 
pstanfield said:
I don't know what to make of the numbers. I actually gave the HC right away, and she acted like she was starving, so gave her 2 TBS, didn't give the honey, and now she is reading at 89. She is all over the place with ups and downs, although the only real symptom I saw at all was the hunger.
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Ok so this bump to 89 is likely just from the single tbsp. The 2 tbsp should be hitting her system in a short while. At this point I'd take advantage of her appetite if she still has it, and let her eat as much of the LC as she wants.

These fluctuations are very odd this late in the cycle. Im actually wondering if the triaditis and other stuff had been brewing for awhile, and her pancreas is actually more functional than we thought. So once the antibiotics kicked in, it could do its thing.
 
Ok we are at 93 PMPS, so I am going to skip her dose tonight, and see where we are in the morning and see how she she doing through the night. As underweight as she is, I don't want to withhold food if she is hungry. At least when her numbers go up I can then give her fluids. I do have the ketone meter, so I can check for ketones.
 
pstanfield said:
Ok we are at 93 PMPS, so I am going to skip her dose tonight, and see where we are in the morning and see how she she doing through the night. As underweight as she is, I don't want to withhold food if she is hungry. At least when her numbers go up I can then give her fluids. I do have the ketone meter, so I can check for ketones.
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Sounds like a plan. I am so glad she's eating! FYI a lot of us that deal with pancreatitis keep the meds going past when we think they need them, usually at least 3-5 days after they're behaving like themselves and eating and drinking normal amounts completely on their own.

ProZincs max duration is usually around 14-16 hrs, so I think as long as she's in blues or higher by +3 get some much needed sleep.

I'm not usually on around your AMPS, but I usually am up during the night to feed the baby. I'll check on your SS then. Based on today, assuming pink or higher, I'm thinking 0.75U, 1U max. Blues I'd really have to think about, something like 0.1U.
 
FrostD said:
Sounds like a plan. I am so glad she's eating! FYI a lot of us that deal with pancreatitis keep the meds going past when we think they need them, usually at least 3-5 days after they're behaving like themselves and eating and drinking normal amounts completely on their own.

ProZincs max duration is usually around 14-16 hrs, so I think as long as she's in blues or higher by +3 get some much needed sleep.

I'm not usually on around your AMPS, but I usually am up during the night to feed the baby. I'll check on your SS then. Based on today, assuming pink or higher, I'm thinking 0.75U, 1U max. Blues I'd really have to think about, something like 0.1U.
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So from skipping tonight's dose, is it ok to start tomorrow's dose earlier, and stick with that new time? I've been trying to slowly work down from the 8:30 -8:30 the doctors had put her on, and would really benefit more from a 5:00 - 5:00 schedule. Today I was on a 7:45 - 7:45. So could I just start her tomorrow at 5:00?

Awe on the baby!!! Congrats!!!
 
pstanfield said:
So from skipping tonight's dose, is it ok to start tomorrow's dose earlier, and stick with that new time? I've been trying to slowly work down from the 8:30 -8:30 the doctors had put her on, and would really benefit more from a 5:00 - 5:00 schedule. Today I was on a 7:45 - 7:45. So could I just start her tomorrow at 5:00?

Awe on the baby!!! Congrats!!!
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Yep! Well, as long as she doesn't pull any funny business like a blue preshot, but based on what I see so far she's on her way (solidly) up. Probably going to visit the blacks again.

Thanks! I've got 2 under 2 plus a diabetic cat, what even is sleep :rolleyes:
 
pstanfield said:
So do I go back to offering her the usual LC food, what's the "after-hypo" protocol?

And THANK YOU for sticking with me through this. I've got the notes, but your mind goes into ultra panic mode. Well, mine does....:confused:
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Just been reading your thread (Melissa was also helping me today - thank you! - and that led me here) - what an ordeal by fire. You're doing a great job. On the plus side, you've started with everything hard so when Cookie is feeling better this all will be a breeze to you!

and YES on ultra panic mode!

Hang in there!
 
I’ll be getting up in 2.5 hours, and will be ready to shoot within 15 min. What is the suggested insulin? As a reminder, she had fluids last night, so maybe that’s why her numbers haven’t risen sharply as of +6.5. (So I’ll be doing her AMPS at the +9.5 on her 6/23/21 PM chart). I’ll of course do an AMPS, but assuming it’s in pink or black, since her +6.5 is pink.
 
My thought is 0.75U assuming she's pink. The last time she was pink we tried 1U and it took her down to 60s but that was after antibiotics were stopped, so I suspect the infection was working it's way back in there and elevating her a bit. So you could try 1U again as well if you wanted, but 0.75U should still get her down to blues/greens and hopefully a little less stressful day.

I'll be back to bed shortly and won't be around again for probably 4 hours at least. Not many ProZinc users will be, so always err on side of caution if needed (skinny dose, feeding slightly more carbs if dropping, those things). Guidance on feeding at various BG ranges from the other day always applies. Just if you see bigger drops once in the blues/greens and it's early in the cycle, go ahead and give a little MC to slow it down.

Edit: In a normal situation we dose almost solely based on nadir. That's the primary factor in what I'm recommending, but in this case I'm using her overall trend and preshots as extra data to try and guess what she may do.
 
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I agree with the 0.75. They are sometimes more sensitive to insulin after a hypo.

I can't believe how much she dropped later in the evening. I'm sorry I didn't check in but looks like you had everything in control. Nice assist there, frost.

I hope this is a sign that the infection is clearing.
 
To add - I'm hoping today is a little more calm and we can actually start a proper dosing protocol, where we hold the same dose for a few days unless a reduction is earned. It's always better to be as consistent as possible in dosing...I know I sound like a broken record, just trying to balance the infections, keep DKA at bay, yet hopefully not go too low.
 
FrostD said:
To add - I'm hoping today is a little more calm and we can actually start a proper dosing protocol, where we hold the same dose for a few days unless a reduction is earned. It's always better to be as consistent as possible in dosing...I know I sound like a broken record, just trying to balance the infections, keep DKA at bay, yet hopefully not go too low.
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I have no experience with Prozinc, but applying the logic of other insulins, I agree with Melissa. Cookie saw low green nadirs at 1U. I wonder if it might make sense to hold the dose (0.75U or 1U) a few days and give it time to see how she does on it. Ignore the bounces which are a natural consequence of low numbers.
 
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