Advice Needed Re: Duration Change

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Mom2Missy

Mom2Missy

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Hi all.

Missy has been on ProZinc since the middle of August. Her vet started her on 0.5units, and in the beginning this would last a good 12 hours, sometimes longer. Occasionally she would have some higher AMPS numbers, so the vet started upping the dose to 1 unit. Her numbers started jumping around a lot and I got frustrated. I consulted with Dr. Lisa Pierson on 09/02/10 who suggested 0.75units. After the first dose, Missy dropped to 39 at +5, so we decided to lower her dose to 0.5 unit. I misunderstood initially and only gave 0.3 units yesterday morning, so her numbers stayed in the pink all day. At +8, she was at 318 so Dr. Pierson said to go ahead and shoot 0.5. +7 she was at 140. +8.5 she was at 314. Dr. Pierson had mentioned that some cats need insulin every 8 hours as opposed to every 12. I shot another 0.5 last night at +8.5. Now this morning at +7 she is at 322.

I'm not understanding why 0.5 unit used to hold her over throughout the day and now it's not. But the 0.75 unit appeared to be too high. At this point, do I increase the dose a little, maybe to 0.6 unit (I have U100 syringes I can use) or do I play around with her feeding schedule/food type to try to stretch out the duration? She's currently eating FF that's around 9% carbs. I found another one she might eat that's 5% carbs. Maybe she's super carb sensitive...

I'm still new at all of this and Missy keeps throwing me curveballs every time I feel like I'm starting to understand. Any advice would be appreciated. I've also posted on the Health board, but y'all are the ProZinc experts! ;-)

Thanks,
Krista
 
Hi Krista,
I'm still a "newb" myself so I don't have much advice for you. I did read somewhere on this board that Prozinc has a 45 day adjustment period...
I'm sure others will chime in. Hang in there!
 
Hi Krista,

In the beginning with Harley any dose change no matter how small, up or down, sent him pinballing all over the place. It takes him at least 5 to 6 cycles or more for the dose to settle in. I once held his dose for 2 weeks before he came around to it.

I've also discovered that his dose changes have to be in .1 or .2 increments, Harley can get big results on a .1 increase.

When we started Prozinc I was told about a 45 day settling in period and didn't understand it but sure enough around 45 days things started improving.

Food does play and important part in this. I'm sure you know this but be sure to withhold food for 2 hours befor your PS tests so you are getting a true bg# and not a food spike.

IMHO the .5u at +8.5 might have been too much and that is why you're seeing the higher #'s this morning, just a guess, sorry I didn't look at your ss yet but I will.

Unfortunatly the perfect dose one day may not be perfect the next day for all kinds of reasons, food, excercise, infection, etc., but that is what we are all striving for. The sugar dance steps can change daily.

This will be the most intreging strategy game you will probably ever play.

Welcome to PZIsland. You can post here everyday with your AM & PM preshots so we can stay current on your progress but there isn't alot of traffic here so posting on health will get more responses in an emergency.
 
Thanks Rob. This is all very confusing with so many ups and downs. It would be so much easier if her numbers just did what they were supposed to do instead of jumping around all the time. They'll do one thing and I'll do some research and finally think that I know what's going on, and then the next cycle is completely different. Luckily, I work from home, so I'm able to keep an eye on her throughout the day.

The food issue is my next battle. She is very picky. She tends to only like the shredded meat variety. She is not a fan of the pureed/pate. I have found that there are not many options of shredded meats. This morning I mixed her normal food in with a pate and she actually ate some. Most of the time, she just looks at me like "You can't fool me by putting my normal food on top. I know that nasty stuff is hiding underneath!" I'm planning on trying the 5% carb food this weekend. I'm also trying to keep her on a more regulated eating schedule. I've been leaving the food out for her, but I do keep her away from it for some time before testing.

Patience is something I am not very good at. In the beginning of all of this, her numbers were very good! 0.5unit lasted her all day and some days the vet was having me skip the PM shot because her numbers were so good. I thought she would be OTJ fairly quickly. So now that her numbers are crazy, there are times when I can feel quite defeated. I need to keep reminding myself that this is not a race and I need to just stick with the program. In time, she'll be regulated and things will be easier.
 
Hi Krista,

I know exactly how you feel. I think somewhere here I even posted that "I want his bg's better and I want it now". This can be overwhelming at first. When you finally think you have it figured out they will throw you another curve ball. There is a saying here that this is a marathon not a sprint.

I've looked at your ss and you were getting good results on the .4 - .5u. I don't think that the insulin was pooping out before 12 hours, I think Missy was dumping sugar (liver training) from seeing the green numbers and not being used to it. But you can't react to those numbers or you will end up on a rebound rollercoaster, consistancy rules, the bounce will clear within a day or so and you will be back on track.

I've read your thread on Health and see that you are looking for a sliding scale approach. I think that will work for you but I also think you need more data on how the insulin is working on a daily basis for Missy so you can decide on your scale based on your data.

If Missy were my cat I would stick with .4 or .5u and get a curve or spot tests when you can over several days to let the pattern show itself.
 
I am interested in the sliding scale. Maybe not so much as a rule, but at least to have as a guideline to follow. I'm still very new, and I have no clue how to adjust her dose based on her numbers. Luckily, I work from home so I'm available to test her throughout the day as needed. That should be helpful in getting more numbers to establish a pattern. Again, I appreciate your help and support. I will definitely be hanging around this board a little more often.
 
Don't worry, the #s almost NEVER do what they are supposed to LOL!!!! After a while you will start to get used to the patterns and it will make a lot more sense.

My first line of suspicion would be the food. Bix gets 4% carbs. If he goes low and I want to bring him up, I will use a mid-carb food sometimes that is around maybe 12% carbs. Three bites of that will bring him up quite a bit, and if I let him eat as much as he wants, it will put him up in the 300s. Of course that is a lot more carbs than what you are feeding, but just to give you a sense of how much difference it can make, 9% is a lot different than 5%, almost 2x the carbs.

As Robin said, with some cats even 0.1 can make a big difference. With PZI sometimes from what I've seen if it's not enough insulin the #s are all high, but then a tiny bit more can hit the sweet spot and give you perfect #s. It's often not what you'd expect, that a little more will give you slightly better #s, and something that is sort of a measurable correlation between the insulin and the #s. To some extent you get that, but to some degree it seems sort of all-or-nothing to me sometimes. They can be all reds, and then one day go to all blues when you get a dose their body likes. It's tricky, and often puzzling.

Some have had great success with TID shooting. I find it a bit overwhelming so have preferred BID myself. I usually advise people to stick with BID unless you have clear evidence they need shots more often. Sorry I don't have time right now to look at your SS and make any comments, that is just in general terms. (noting that Dr. Lisa knows TONS more than I do, so I'm not saying TID is wrong, just that personally I had a hard time when I tried to do that)

Do you have a no-shoot level set? Just wanted to mention that in case you haven't heard of it. Most people using PZI have a level where we won't give insulin, for safety reasons. Often if you are just starting out you set that at 200 so you can gather some data and see how the insulin is working. Then once you know it's safe you lower your no-shoot to 180, and with more data, to 150. If you get a PS below your no-shoot, you retest in maybe 20 minutes, and then give insulin once it is over your no-shoot levels. There are variations on how people do it, but that's a good starting point if you are feeling like you haven't made sense of the #s yet and want to be sure you are giving the insulin safely.
 
Thanks Joanna.

I am working on the food situation as we speak. She was originally on Science Diet dry before her diagnosis (because Science + Diet = good, right? ;-) ) When she was first diagnosed, she did not have much of an appetite. I has syringe feeding her for the first 4 days or so. The Fancy Feast Elegant Medleys Shredded Variety was the only thing I could get her to eat on her own. Luckily, the flavors we buy are 10% and under, so better than the dry, but I would feel so much better if she would eat a lower carb food. Unfortunately, she hates the pate/pureed foods. Maybe she's scarred for life from the syringe feedings. I tried mixing a pate with her usual FF this morning. At first, she looked at me like I was crazy. Then I pretended to eat some. All of a sudden, she was all over it, like she was saying "Well, if Mom eats it, it must be good". I seem to have to remind her every time I put food out that I think it's yummy so she'll try it, but at least she's eating it! That's a huge step from where we were.

We'll try the TID shooting schedule. Of course, the first day I decide to try it, she's in the blue all afternoon long, so she may not even need the mid-afternoon dose. I think she enjoys throwing me for a loop by switching up her glucose levels. Probably because she likes laying in my lap while I scramble around on the internet trying to figure out where I went wrong and what to do to fix it. I had been using a no-shoot at 200, but Dr. Lisa said 180 should be okay. The past couple of days, she has been well above 180-200 at shot time so it hasn't been an issue. I guess we'll burn that bridge when we get there.
 
That is hilarious on you pretending the food is yummy!!!

180 is fine for a no shoot, and for eating, even higher carb is better than not eating, so if you have to make a choice for slightly higher carbs, don't worry about it. Sounds like she may be coming around though, yay!
 
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