back to a bit of blue - cycle 5, 2.0U kit's switch to modified

JOJI and Kit

JOJI and Kit

Very Active Member
http://www.felinediabetes.com/FDMB/...y-pm-go-up-0-25u-to-1-5u.228363/#post-2559530

We've been doing lots of testing and have been at this with Kit since December, so we're moving on to the modified dosing protocol. One problem area for us will be that the protocol assumes using a human meter, but we're using a pet meter (Alphatrak). We'll need to do conversions for the protocol values to make sense for us. I've looked around for stickies or posts that talk about this. Can you @Deb & Wink or anyone point us to something to refer to? Thanks! joji
 
There are no conversions J & J. There has never been enough solid test data with enough people using the pet meters, to make a valid comparison with the human meters. The time when the BG readings really matter, is when the cat is low. So that is why you will see that 68 BG as the reduction point for the insulin dose, when using a pet meter.

When the Prozinc protocols was rewritten earlier this year, February 2020, it was decided to keep using the human meter values for all the data points in the guidelines. Again, simply not enough test data using pet specific meters to use anything else.

So you go with the BG numbers listed in the MPM protocol, for both human and pet meters.

With the one exception being, lows <68 mg/dL (3.7 mmol/L).

That holds true with lantus insulin also. Pet meter, reduce at a BG of 68 if using TR (Tight Regulation). MPM is basically a version of the TR protocol that lantus members use, with a few tweaks, specific to Prozinc.
 
Deb & Wink said:
There are no conversions J & J. There has never been enough solid test data with enough people using the pet meters, to make a valid comparison with the human meters. The time when the BG readings really matter, is when the cat is low. So that is why you will see that 68 BG as the reduction point for the insulin dose, when using a pet meter.

When the Prozinc protocols was rewritten earlier this year, February 2020, it was decided to keep using the human meter values for all the data points in the guidelines. Again, simply not enough test data using pet specific meters to use anything else.

So you go with the BG numbers listed in the MPM protocol, for both human and pet meters.

With the one exception being, lows <68 mg/dL (3.7 mmol/L).

That holds true with lantus insulin also. Pet meter, reduce at a BG of 68 if using TR (Tight Regulation). MPM is basically a version of the TR protocol that lantus members use, with a few tweaks, specific to Prozinc.
Click to expand...

Oh! That explains things! Thanks again Deb! Photos tomorrow. How's your garden growing?
 
Come back down out of those yellow (200-299 mg/dL) numbers Kit!

p.s. One of our Prozinc users is color blind, so I'm trying to include the actual number ranges from the SS color coding when I mention the color.
 
@Deb & Wink Today we are missing those yellows! We feel like we lost some ground with 2 reductions in fairly quick succession. :( We're planning to give a fat 1.5 tonight and back to 1.75 tomorrow, and continue with the modified Prozinc protocol. We'll be setting some alarms for nighttime testing, or watching series later than usual. We've been watching season 2 of My Brilliant Friend among other things. If there ever was a time to do nighttime testing, it's now during pandemic time!

PS still haven't uploaded garden pics. What a chilly April day today!!
 
Sounds like a good plan J & J. Hope that Kit comes back down with the fat 1.5U dose.

Hated the nighttime testing, but I did what Wink needed at the time.
I'd do it all again, in a heartbeat.
 
kit has been needing a lot of encouragement to eat up both yesterday and today.
encouragement comes in the form of real chick, FF salmon and her personal kitty crack: fortiflora
^jw
 
no signs of tummy upset or other gi issue. and she seems perfectly willing to eat real chick treats!
not sure what’s up...
 
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what's the guidance on how much to eat to be able to shoot?
we've always kind of said "about half" of her plate. but we're having a tough time getting there...
 
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"yellow particles" are the litter
 

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Deb & Wink said:
If she only eats 1/4 of her plate, will she eat more later?
Click to expand...
thanks for the hand holding and expert poop analysis. :bighug:
so is "half the meal" purely in our own heads, or is there some guidance written around the boards?
i have no idea why we feel okay with that amount or if there is "an amount"
^jw
 
There is no specific guidance written anywhere. It's very individualized to your cat and the circumstances, and ECID (Every Cat is Different).

Remember too, that you are not going to see an onset of the Prozinc for a couple of hours. As long as Kit eats before then, she should be ok. It's more knowing your own cat, and if they will eat later, if given the opportunity.

I do think that 1/4 of the normal amount of food is good, but not giving any insulin can have it's own downsides. For example, a cat with a history of ketones, DKA or HL (hepatic lipidosis) needs that insulin shot. A cat that has not eaten much for several days, is at higher risk of any and all of these conditions.

A cat with pancreatitis, may not feel like eating either, but food is important and sometimes people hand feed or syringe feed, or bribe their cats with a food combination to get their cat to eat.
 
Joji here. Kit always had a good appetite, before and after the onset of diabetes. Beginning yesterday she started turning her (very cute) nose up at food. We've been able to tempt and encourage her a bit with fortiflora, fancy feast salmon and some cooked chicken, but still her consumption is down. Any thoughts? This is new, and a bit alarming! Update. She's eating more today since she was so lethargic and not eating. I really thought we'd be headed to the vet today. Could be that she's getting bored with her food. Looking into other food to expand her fare that needs to be low carb, high protein, low phosphorous and not fish. Now considering Tiki After Dark options. No need to respond, just thinking out loud.
 
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This not eating as much, not eating as well has been going on since the 22nd (4/22/20).
Does she sniff at the food, and then walk away?

If so, she may be nauseated. Could be a mild case of pancreatitis.
Is she sitting like a lump, all tucked in tight, like a hunk of meatloaf?
Any thing else seem "off"?

Call and ask your vet for some anti-nausea meds. Cerenia, ondansetron are the 2 most common given.

Is she dehydrated? Do the pull up a fold of skin trick. It should snap right back into place.
Ketones fine?

Is it a particular flavor of food she is rejecting? New purchase of either the FF or the Tiki Cat?
 
Yes, since the evening of the 22nd. Today she is better. But yes, she would eat some, then walk away and we'd lure her back several times for a Fortiflora topper (this turned her into an addict!), a bit of FF salmon or chicken bits. Using these temptations we could get a meal into her for a shot. She seems more normal today, so maybe it was a one-off? I'm still looking into more food diversification for her since she does seem to perk up at different options. Tiki After Dark is in my Chewy cart but I'm still searching for other options.

We've been using this purchase of FF and Tiki for a week or so. But we have another shipment that just came in. Maybe I'll use some cans from that to see if there is a difference. Good thought, Deb!

No, she's not doing the meatloaf, and she is less lethargic today.

We did ketones on the 19th (negative) but I have the box out as a reminder to check again soon.

Thanks for your thoughts Deb! Rainy April day here. Bought a few woodland plants yesterday, some trilliums, Anemonella, Saruma and something else...can't remember.
 
I know a couple of people in the facebook sister site group swear by the Chewy brand Tiny Tiger. Maybe try that for Kit?
Check the batch numbers printed on the cans, to see if they are actually different from the ones you've been feeding Kit for the last week.

Good to hear you think it was a "one off" and she is doing better today, less lethargic.

Had to look up those plants you mentioned, didn't know the saruma. A bit rainy here today too. Inside chores day. Pictures soon?
 
The other plant I couldn't remember is Glaucidium palmatum. Funny, because it's the one I was most excited to get! ha. Yeah, I have to upload photos. my bad!!!

I'll check out Tiny Tiger! Thanks. I've never heard of it.

Joji
 
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kit's appetite and energy were a bit more "vibrant" today. the am meals were "all her" even if they took longer than usual for her to finish up.
as for the pm, we went w salmon to get her going and she's currently accepting additional bribes of real chick and fortiflora. interest in the bird tv channel is strong and she's enjoying the open windows and doors. if i didn't know better i'd say that the spring weather is distracting her from food ....

thinking to the morning about dose. looks like we have to go up as this pm was cycle 6.
the modified guidance says

>If nadirs are more than 200, increase the dose by 0.5u. Dose increases should be made every 3-6 cycles and should continue to increase until nadir numbers begin to come down.

so that would mean 2.25U for kit in the morning.
given her bounce/dive nature going up 0.5U seems like a lot.
and, it brings us to a new high dose.
thoughts?
^jw
 
Protocols are general guidelines.
I wouldn't increase the dose by more than 0.25U, for super bouncy Kit.

Even though you are using MPM, it's a case of "Know Thy Cat" when it's time to increase or decrease the dose.

Bird TV is tempting Kit away from food huh?
 
Deb & Wink said:
I wouldn't increase the dose by more than 0.25U, for super bouncy Kit.
Click to expand...
thank you. that was the feeling, but it's nice to have your confirmation. if the current pm goes as the am did, we will plan for an increase to 2.0U tomorrow. meaning, if she doesn't surprise us with a deep dive or some polite nadir below 200.

Deb & Wink said:
Bird TV is tempting Kit away from food huh?
Click to expand...
yeah. well it's dark here now. so i guess it's confirmed that i'm just being wishful.
she is pretty active tonight though. which is a nice upgrade from the last couple of days.
 
Pretty dark here too, and more rain in the forecast.

Tell Kit that "Bird TV" will be back tomorrow, rain or not. Birds need to eat, rain, snow, sleet, or sunny windy days.
 
monitoring kit today at the new dose of 2.0U. good morning energy and appetite.
amps 400
@3 196
@4.5 127
@5.5 194
@9 438
 
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Hi @Deb & Wink! Tonight will be Kit's 8th cycle and based on modified Prozinc protocol, we should be increasing to 2.25 since her lowest nadirs are still only between 100-200. We've never before shot at 2.25 and thinking we might better first go to a f2, and wait until tomorrow morning for that. What do you think?

Update still dropping at +8.5
 
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My crystal ball says that Kit is going to bounce tonight, because of that drop to the blue (100-199) range today.
When she drops into those blues, she seems to bounce right back up to reds at the end of cycle.

I think she does need a dose increase, at least a fat 2 this evening, IF she is back in the reds or pinks at PMPS.
Then depending on AMPS for 4/30/20, increase to 2.25U since you are around to monitor a bit more in the AM cycle.
 
Yes, if the AMPS tomorrow is >150, time for an increase.
Using MPM, nadirs 100-200 mean increasing the dose by 0.25U.
Looks to me like Kit was clearing a bounce today, which led to those lows mid-day and at PMPS 4/29/20.

Remember, it's mainly the mid-cycle nadirs that determine the dose, not just the pre-shot tests with Prozinc.

Think she'll bounce again in the morning, 4/30/20?
 
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