AMPS 126 roller coaster numbers dosing advise

[Spike's Mom]

I am holding off to give a shot for now. Based on our numbers in the last 24 hours I really have no clue what I should shoot when he starts to come up. Suggestions please??
Changes in the last few days are starting to change over to Ziwipeak rabbit & lamb. Also I started a new bottle of insulin last night after being on the 600's yesterday.

 

[Elizabeth and Bertie]

Oooh, well that looks interesting....
It looks to me as though Spike is dropping out of a bounce, but that he is holding in the blue numbers longer than he's been doing before...

Is the Ziwipeak much lower in carb than what you were feeding previously?
.

 

[Spike's Mom]

Yes the Ziwipeak is lower in carbs. According to Dr Lisa's chart it is 1 carb. Feeding has been impossible since he got really sick on 3/22. He was on a homemade diet and started vomiting for a couple of days. He refused to touch it ever since he was sick. I have attempted multiple times.Every other food I have given him has caused the roller coaster you see. The other problem was I would try a new food and he would eat it for a day and then want nothing to do with it again. He has been a difficult finicky cat.

 

[Spike's Mom]

Per vet I gave the normal 3units 1 1/2 past normal shot time. I try to stay on the 12 hour shot schedule.
He said to test today and let him know as we may have to lower starting at pm dose.
I am considering starting to use the sliding scale with prozinc but I am not confident on how this works.

 

[Blamethecats and Hannah]

I am considering starting to use the sliding scale with prozinc but I am not confident on how this works.

Hi, @Spike's Mom! I also use ProZinc on my sugar kitty, Hannah... and we currently use the sliding scale. We base the amount of insulin on the preshot numbers and how low a particular dose has taken her. We have collected a lot of data and base our dosing on that. Hannah has been a very difficult kitty to manage, so I am far from being an expert on offering advice on sliding scale dosing. However, we have several folks here who know all about ProZinc and specific ways of using it. I'm hoping someone will chime in, here, to give you advice. @Sue and Oliver (GA), @BJM, anyone else... are you available to take a look and perhaps offer @Spike's Mom some advice?

In the meantime, best wishes to you and Spike.

 

[Sue and Oliver (GA)]

He is definitely bouncing all over. I think the dose is too high overall. For example, the pmps on 4/24 was 363 and he got 3 units. The next morning, after 12 hours, he was 126 . Not only is that a low pre shot number, but he may have dropped very low overnight. So if 3 units gave him that kind of response on a pink, you wouldn't want to give 3 units on a much lower number. (Today may just be a completely weird cycle with the lows which his body probably reacted to with a spike in glucose so I would just monitor and make sure he doesn't decide to dive mid cycle. It could also be a high flat cycle - no telling) The other complicating factor is a lower card food which may be tilting the numbers downward.

If he were mine, I would lower the dose. Maybe on a pink pre shot, 2.5 for a few cycles to allow things to shake out. If you get a pre shot under 200, do just as you did - wait until you are sure it is rising, not falling. But then shoot less, not the same. Maybe 1.5 or 2 for a yellow? Hold these doses for a few days and see if things flatten out and he quits bouncing up to the black numbers.

There is a protocol for ProZinc that we put together in my signature. It may be helpful.

 

[Spike's Mom]

He is definitely bouncing all over. I think the dose is too high overall. For example, the pmps on 4/24 was 363 and he got 3 units. The next morning, after 12 hours, he was 126 . Not only is that a low pre shot number, but he may have dropped very low overnight. So if 3 units gave him that kind of response on a pink, you wouldn't want to give 3 units on a much lower number. (Today may just be a completely weird cycle with the lows which his body probably reacted to with a spike in glucose so I would just monitor and make sure he doesn't decide to dive mid cycle. It could also be a high flat cycle - no telling) The other complicating factor is a lower card food which may be tilting the numbers downward.

If he were mine, I would lower the dose. Maybe on a pink pre shot, 2.5 for a few cycles to allow things to shake out. If you get a pre shot under 200, do just as you did - wait until you are sure it is rising, not falling. But then shoot less, not the same. Maybe 1.5 or 2 for a yellow? Hold these doses for a few days and see if things flatten out and he quits bouncing up to the black numbers.

There is a protocol for ProZinc that we put together in my signature. It may be helpful.

Yes I was concerned when I woke up this morning and got a 126. It really had me wondering how low he went while I was sleeping. I am thankful he is alive and in a good mood.
I have both the u-40 and u-100 syringes. I am not sure where 2.5 would be.
I was reading an old post about the injection site affecting the numbers. Do you think it is partially responsible this is also affecting the swings? This is why I have started adding the injection site to my preshot numbers.

 

[Sue and Oliver (GA)]

Are you using the AlphaTrak meter? If so, you might lower the dose even a little more. Those greens you were getting on 3 units were numbers that definitely qualify for a dose reduction when we are thinking human meter numbers. (A 60 on AlphaTrak would be closer to 35-40 on a human meter). What I am thinking is that it might be best to err on the side of caution until you see exactly what is going on. So maybe even 2 units on the higher ranges. Once you see how low that dose takes him, if he is flatter and higher, then increase slowly?

 

[Spike's Mom]

Yes I am using the Alpha Track. So 2 units at pm dose?

 

[Elizabeth and Bertie]

I was reading an old post about the injection site affecting the numbers. Do you think it is partially responsible this is also affecting the swings?

I've read that some people have had absorption problems when shooting insulin in the scruff.

I've always shot in the scruff and haven't had a problem with insulin absorption. But it has seemed to me that the closer I shoot to the abdomen the faster the insulin seems to start working. So, although I usually shoot in the scruff, if I see high numbers that I want to knock down then I sometimes shoot along the flank. The over all drop seems to be the same though. But your experience of how it affects Spike may be different, and that is what you need to be guided by.

At this point though, and with the variable numbers you're seeing (and the change of diet) I'm not sure it's possible to work out the effects of shooting in various places. It would be easier to work that out if the numbers were more consistent (and hopefully they will be soon... )

I agree with Sue about exercising caution and lowering the dose: That change of food to the lower carb Ziwipeak may drop Spike's numbers also...

Eliz

 

[Blamethecats and Hannah]

I have both the u-40 and u-100 syringes. I am not sure where 2.5 would be.

Here's a LINK to a thread that may help to answer your questions about u-40 and u-100 syringes. Also, here's a LINK to a conversion chart that shows you how to use u-40 insulin in a u-100 syringe. Hope this helps.

 

[BJM]

With the Alpha Trak, you want to keep him above 68 mg/dL at the lowest.

One cause of bouncing is the speed at which the glucose drops. If he is a scarfer and eats all at once, that typically gives you an obvious food spike about +2, which I'm not really seeing.
If you see a sudden drop by +2 to +3, you can give a teaspoon or two of medium carb to slow that down a little, which may help reduce bouncing.

 

[Sue and Oliver (GA)]

Yes I am using the Alpha Track. So 2 units at pm dose?

I think that is what I would try, assuming you have a number in the 300 range. If over 200 but not 300+, maybe a little lower still. My theory is that you can always raise the dose if it proves, over a few cycles, to be not enough insulin, but you can't get the insulin out of the cat if it is too much.

 

[Spike's Mom]

With the Alpha Trak, you want to keep him above 68 mg/dL at the lowest.

One cause of bouncing is the speed at which the glucose drops. If he is a scarfer and eats all at once, that typically gives you an obvious food spike about +2, which I'm not really seeing.
If you see a sudden drop by +2 to +3, you can give a teaspoon or two of medium carb to slow that down a little, which may help reduce bouncing.

He is a scarfer so on 4/18 I started feeding him 4 smaller meals to try and stop the swings. I am currently giving him 1.25 oz of Natural balance turkey,chicken,& gunea fowl mixed with 1oz of the Ziwipeak rabbit & lamb (2.25oz in all) at injection time. I am also alternating 1 oz ziwipeak or the Primal goats milk food 3 hours later. I am hoping to have him only on the Ziwipeak by the first of the month. I will have to measure the 2 to 3tsp to see what that would be in ounces. I know you can't see in the pictures but Spike has lost so much weight that he needs a tummy tuck. He has a large amount of sagging skin since he was around 16 to 17lbs and dropped down to 7.2. He is currently at 10.2lbs.
If I had my choice I would stay on Dr.Lisa's homemade food as it is lot cheaper. Here refuses to eat the ff or friskies low carb food. Right now my daughter in law loves me as every time he stops eating a food I send it home with her.

 

[BJM]

Spreading the canned food thinly across a big plate will slow him down. Putting an upside down mug in the center of dry food slows down the kibble crunch, too.

 

[Spike's Mom]

I've read that some people have had absorption problems when shooting insulin in the scruff.
But it has seemed to me that the closer I shoot to the abdomen the faster the insulin seems to start working. So, although I usually shoot in the scruff, if I see high numbers that I want to knock down then I sometimes shoot along the flank. The over all drop seems to be the same though. But your experience of how it affects Spike may be different, and that is what you need to be guided by.

I had not really been monitoring where I was giving the injection at until I have had so many 500+ readings. When this started to happen I got real worried very fast. I thought about it for a few days after I read the initial post and decided to monitor and find out if it made a difference. I prefer the scruff based on the ease of seeing what I am doing through all the fur. When I looked at my spreadshet and realized the first time we ever hit numbers in the green the injection was given when he was laying on his side and I was forced to inject in the front side of his chest.

Eliz

 

[Spike's Mom]

Spreading the canned food thinly across a big plate will slow him down. Putting an upside down mug in the center of dry food slows down the kibble crunch, too.

I will give the plate a try. We have been off dry food since he was diagnosed. He never really cared for dry food. It was more of a forced food for 13 years. He was very happy to give up the dry.

 

[BJM]

Optionally, add a tablespoon of water. That provides some volume plus the extra water diabetic cats need.

 

[Spike's Mom]

Are you using the AlphaTrak meter? If so, you might lower the dose even a little more. Those greens you were getting on 3 units were numbers that definitely qualify for a dose reduction when we are thinking human meter numbers. (A 60 on AlphaTrak would be closer to 35-40 on a human meter). What I am thinking is that it might be best to err on the side of caution until you see exactly what is going on. So maybe even 2 units on the higher ranges. Once you see how low that dose takes him, if he is flatter and higher, then increase slowly?

I reduced to the 2 units now we are at 207 at +4. It is going to be a long night. I will try to keep my spreadsheet updated so I can get advise on amps again.

 

[Sue and Oliver (GA)]

That looks like a nice slow move down. If you are nervous, plan to get a +6 but it looks pretty good to me. Are you worried?

 

[Spike's Mom]

I will do the +6 for sure. I am mainly worried because of the night. I am already sleepy. I am going to set my alarm and at least lay down for a quick nap.

 

[Spike's Mom]

Well I missed the +6 luckily I woke up at +7. He was at 60. Gave the 1oz (equals about 3tsp) and brought it up 104 within about 40 minutes. Now we are at 208 a good hour past our normal test time.

 

[Sue and Oliver (GA)]

If you can, get at least a midcycle today. It will give you good info about whether the 2 units is okay for a yellow pre shot. Last night looked okay for a 2 unit on a 350, but it may be a little high for a yellow. Remember if he drops below 65 or so, feed him and retest in 20 minutes to be sure he is rising. If still not rising, give him some gravy off higher carb food and retest in 20 minutes again. (For anyone reading this, she uses an AlphaTrak)

Good job making sure he was rising and high enough to shoot this morning.

 

[Spike's Mom]

By midcycle test are we talking at +6 or just somewhere between 5 to 7?
I just tested at +2 we are 265
will follow the hypo at test at 20 minutes in the future

 

[Sue and Oliver (GA)]

Yes, somewhere between 5-7. Either he will have a usual cycle, or he could drop low or he may be high and flat (a reaction to a low last night.). You'll want to know which.

The +2 is probably just the usual rise after food. I know this process is maddening but sometimes it helps to think of it as "data gathering". You're just collecting numbers so you can figure out his patterns. You know how to keep him safe no matter what his numbers might be. If he drops low, you steer it with food. And as someone wise once told me, "remember to breathe"

 

[BJM]

Note: some cats have an earlier or later nadir on ProZinc. It can be helpful to very the test times in this period to see if your cat tends towards an earlier or later nadir.

 

[Spike's Mom]

So I am home today testing is not a problem. When and how often should I test today?
We are at 164 at +4

 

[BJM]

You might test on some half hour increments like +5.5 and +6.5. When I do that, I may either manually color code the result, or join 2 cells together and note it on an inserted line underneath, or over in the notes column.

Another tip: to look for spreadsheet color patterns, zoom out (make the sheet smaller).

 

[Spike's Mom]

You might test on some half hour increments like +5.5 and +6.5. When I do that, I may either manually color code the result, or join 2 cells together and note it on an inserted line underneath, or over in the notes column.

Another tip: to look for spreadsheet color patterns, zoom out (make the sheet smaller).

When I zoom out I see a rainbow of colors. I will have to get some help from my techie son to help with the doc update.

 

[Spike's Mom]

Yes, somewhere between 5-7. Either he will have a usual cycle, or he could drop low or he may be high and flat (a reaction to a low last night.). You'll want to know which.

The +2 is probably just the usual rise after food. I know this process is maddening but sometimes it helps to think of it as "data gathering". You're just collecting numbers so you can figure out his patterns. You know how to keep him safe no matter what his numbers might be. If he drops low, you steer it with food. And as someone wise once told me, "remember to breathe"

Maddening is the understatement of the year. I have been doing a lot of data gathering for the past few months and still can't make heads or tails of where we are going. Although I am optimistic over the changes the past few days. I would love to see Spike regulated with food but at this point I will take stable numbers.
Thank you for your assistance this weekend. If I had followed the vets advise I would have stayed with the 3 units. Currently I not think that would have been a good choice.

 

[Spike's Mom]

You might test on some half hour increments like +5.5 and +6.5. When I do that, I may either manually color code the result, or join 2 cells together and note it on an inserted line underneath, or over in the notes column.

Another tip: to look for spreadsheet color patterns, zoom out (make the sheet smaller).

I am currently following hypo protocol. we were at 96 at 5.5 and 64 at 5.5

 

[Sue and Oliver (GA)]

Let us know if you need any help. You've done this before, so you should be fine.

 

[Spike's Mom]

Let us know if you need any help. You've done this before, so you should be fine.

He is at 80 when do I retest?

 

[BJM]

Typically, every 30 minutes until you are past nadir and you have 2 or more rising numbers.
And feed 1-2 teaspoons of high carb food if the numbers go down.

 

[Spike's Mom]

OK will keep you updated. Guess he wants another reduction in dosage tonight

 

[Sue and Oliver (GA)]

OK will keep you updated. Guess he wants another reduction in dosage tonight

Yep. The trick is how much. 2 units for a 200 was too much, but 2 units for last night's 355 looked like too much too. I think I might be tempted to lower the dose to 1.5 for pinks and 1 for yellows. No shot under 200. You can always raise the dose if, after a couple cycles, it seems like too little. The other alternative would be to just go down to one unit and keep that dose steady for a few cycles and see how that it works. Again, raising if needed after you get some data.

I know this is scary and frustrating, but he is really doing beautifully! Having to continually lower the dose is a great sign that he is responding well to the insulin and to the food.

 

[Spike's Mom]

We went up to 107.
As far as dose reduction I do not think 1.5 would be to low as he is not totally on the ziwipeak food yet. I am still transitioning off the Natural Balance food. Once I remove it completely I am hoping we continue to give less insulin every day until he is .
My son will be home this week to monitor. The good news is he is great with testing and feeding as advised. The sad part is he doesn't post any updates on this site. He leaves all of that to me.

 

[Spike's Mom]

I think we are through the scariest part up to 137 now.

 

[Spike's Mom]

Yep. The trick is how much. 2 units for a 200 was too much, but 2 units for last night's 355 looked like too much too. I think I might be tempted to lower the dose to 1.5 for pinks and 1 for yellows. No shot under 200. You can always raise the dose if, after a couple cycles, it seems like too little. The other alternative would be to just go down to one unit and keep that dose steady for a few cycles and see how that it works. Again, raising if needed after you get some data.

I know this is scary and frustrating, but he is really doing beautifully! Having to continually lower the dose is a great sign that he is responding well to the insulin and to the food.

What about puprle? I wasn't prepared for a 388.

 

[Sue and Oliver (GA)]

Looks like a bounce. Up to you. 1.5 should be safe. He is only 30 points higher than last night when 2 took him down to a green and you got an amps lower than you could shoot, so I would do less than that.

 

[Spike's Mom]

I am going with the 1.5. I can always reduce more tomorrow am.

 

[Spike's Mom]

Looks like a bounce. Up to you. 1.5 should be safe. He is only 30 points higher than last night when 2 took him down to a green and you got an amps lower than you could shoot, so I would do less than that.

Well turns out this was a bad call on my part. I will update my spreadsheet in a few minutes. I stayed with the 1.5because we were at 267 this morning. When I got home at 5pm tonight he was at 45. I immediately fed and he bounced to 290 in 20minutes. I am going to retest in another 10 minutes. Do you ladies think starting allover at .5 is a crazy thought?
At this point I am not comfortable enough to even give a shot right now or even at all tonight. I am in tears because I could have killed him today.

 

[Sue and Oliver (GA)]

He is really hard to figure especially as he seems to drop lower every day. I know this is hard to see as a wonderful thing when you are so worried about him, and logically so. His needing less insulin every day is a good beginning for remission (anti jinx)

I think restarting at .5 is fine. He is likely to bounce higher, t, but if you want a good restful sleep, try the .5. He should not drop low and then you will have an idea in the am Of how things look.

 

[Spike's Mom]

yes he is at 502 right now. sticking with the .5. hopefully it helps