Bouncing or resistance? PZI

[Wurly]

Hi everyone, all was going well until about 10 days ago. I noticed higher mid day numbers. Since then the vial has been changed and i have proved the meters. Wurlys weight is back to where it should be pre diagnosis and I have now stopped the treats and reduced the calorie intake slightly. At first I thought it was needle depth angle and location as I am using an injector device, this has now been ruled out.
I have increased the dose but it seems to be having less effect each day.
She is good in herself with no physical changes except not sleeping as long during the day due to the numbers.
It looks like resistance to me as there are never any low numbers. I hit the muscle a few weeks ago and could see the low within 3 hours, this was dealt with and all was good after.
Any suggestions as to the next steps? As you can see I am careful with the dosing and err on the side of caution.

 

[Deb & Wink]

Are you tenting the skin before you inject?

What do you mean by an "injector device"?

Without pre-shot tests, there is no way to put the numbers you get during the cycle into context. So it's not possible to tell if Wurly started low and went high, or started high and dropped lower during the cycle. The dosing protocols we use here need those pre-shots as well as some mid-cycle testing, to see if the dose needs to be adjusted.

One housekeeping chore for you. Could you please go into your SS and drag that 2021 tab over to the far left side please? The left most tab is the one that opens for us when we click on the SS link in your signature. Thanks.

You also only have the World version of the SS. There should be a tab for the US also. So those of us living in the USA can understand the BG numbers you are getting.
I can tag someone to help you add that other tab if you like, and fix your SS.

 

[Wurly]

Are you tenting the skin before you inject?

What do you mean by an "injector device"?

Without pre-shot tests, there is no way to put the numbers you get during the cycle into context. So it's not possible to tell if Wurly started low and went high, or started high and dropped lower during the cycle. The dosing protocols we use here need those pre-shots as well as some mid-cycle testing, to see if the dose needs to be adjusted.

One housekeeping chore for you. Could you please go into your SS and drag that 2021 tab over to the far left side please? The left most tab is the one that opens for us when we click on the SS link in your signature. Thanks.

You also only have the World version of the SS. There should be a tab for the US also. So those of us living in the USA can understand the BG numbers you are getting.
I can tag someone to help you add that other tab if you like, and fix your SS.

I have dragged the tab across for you to see.
15.2 AMPS this morning (270)
As my cat is angry I use the inject-ease device to get the needle in to the tent which then drops it to the depth required (about 2/3 total length) and then i inject, I was struggling before I got this device.
The Nadir is always around the 7/8 hour unless the injection is too shallow in which case it is delayed a few hours, or as I have done a few times hit the muscle in which case it is brought forward very rapidly and fast!

 

[Deb & Wink]

Are you ok with me tagging someone to help you fix your spreadsheet (SS)? So it has a US tab also?

Since the 2 of us that help here in the prozinc ISG are both in the US, we speak mg/dL for the BG numbers, not mmol/L.

Thanks for moving that 2021 tab over to the left. Also appreciate your mention of the inject ease device, as I've never heard of that before. Thanks!

Do you give your cat a small treat, as a reward for testing and giving the insulin injection?

 

[Wurly]

Latest update....Flat responses on newly opened vial. Replaced vial and got better results but now it looks like Wurly is experiencing the "Flats" I have lowered the dose for 2 cycles to see if this has any effect and will then go for gradual increases whilst testing. Has anyone seen this type of response before? I believe the way forward is dose increases.

 

[Deb & Wink]

You want lows. You want to see blues and greens in the BG numbers. Only not the bright neon green numbers. Those mean you are close to hypoglycemic territory and need to monitor more closely.

Yes I think you need to increase the dose for Wurly.
Let the sticky for the dosing protocols for Prozinc be a good guide for you.
That and many other useful groups of information can be found at the top of the forum. The "Stickies" are pinned posts, so they always appear at the top of the forum. Good reading for you to learn more.

What was that note about on 8/2/21 mean? "Food switched AM diabetic wet".

 

[Wurly]

She has been in the lows up until a little while ago, something has changed in her body, I am pretty sure it is resistance now she is further down the road. I will give one last lower dose tonight and then start increasing tomorrow after I have tested her AMPS.
I switched the morning meal to a higher calorific one to see if it changed the Nadir, which it did as I do not normally test in the evening or overnight.
I have been reading the posts and your right there is some interesting reading. The information I have found on the web suggests lowering to remove the possibility of rebound not low bounce which I am not seeing and then to increase the dose. In my mind I know she will now require a higher dose to break through the flat responses.
Thanks for looking and the comments, I will keep updating and give an update when things change.

 

[Wurly]

4 lower doses are now showing very odd results, I have an inverse curve where her BG is lower at shot time?. She was at 16 (290) this morning and then mid cycle she went high 20 (360) instead of low! Next test is in 90 minutes, I cannot wait to see what this is going to be!

Found the following:-

When a cat who is used to being well-regulated (in normal numbers for the most part), is given too much insulin (not a huge overdose, just a little too much) - depending on the insulin type, you may see a small drop occur at +2 but typically by +4 and beyond you get a series of BG numbers that are usually within 20 to 40 points (imperial) of each other and is the reason for the term "flats". Sometimes "flats" can occur with a wider spread, as much as 100 points of each other; although this is more common with the longer lasting insulin types. The BG only drops when the shot wears off, somewhere around +9 or beyond depending on the insulin type. This is usually an ongoing thing, happening several shot cycles in a row, where the caregiver sees the higher numbers, and raises the doses in an effort to get the numbers down, resulting in yet another series of “flats.”

 

[Wurly]

Hi, dose increased to 3.5 (nervous about this level) exact same results showing as for a 2.5 dose? All very odd. Now reduced the dose again back to her original safe 1.5 but going to hold for a bit longer to rule out a rebound.
Is it normal for the Prozinc requirement to double or more over a few weeks? No change in appetite although I have seen her drinking a few times which I don't normally.

 

[Deb & Wink]

Would you please go back into your ss and add a row for each date? Trying to see some patterns here, but those missing rows are making it harder. Even if you don't have test data for those dates, we still like to see a row.

The one big piece of information that is missing here? Those pre-shot tests. It's not possible to put the mid-cycle numbers into context, if you don't know what your cat's BG number was before you gave them the insulin.

 

[Wurly]

Hi, the information is in the sheet?

I only put in the days that I test on this sheet, any other day's dose will be as per the day before if not here.

I started noticing from the 31st Jan and since then have added to each day.