Charleston Dosing Thread

[Caitlin & Charleston]

Hi all,

Charleston has been on 2.25U for a little over a week. Looking at his numbers, it looks like he may be up for another .25U increase to 2.5U. I'd love input to see what others think.

Also, is it best to start one dosing thread for Charleston and keep using that until it gets to around 50 messages? Not sure what the protocol is here.

Thanks!

 

[Irish Pat]

Hello Caitlin

As far as dosing goes, im sure someone will be around to give you advice, I wish I could help you out there, just not ready for that yet.

As far as the thread goes, yes...You keep a thread going until it reaches 50 messages and at that point you can copy the thread address and add it to the new thread you create by adding it to the link tab so all the information is there to go back to and review if anyone needs to review all the remarks. You can also change the title of the current thread if you want someone to look at something right away.

If you have any other specific questions about the threads please feel free to ask, im still learning as well but I can try to help you out!!

 

[Deb & Wink]

Looks to me like Charleston could use a bit more insulin. So increase the dose by another 0.25U and that would make his new insulin dose 2.5U.

Start that increase on 5/29/20 with the AM cycle please.

You want to see more BG readings down in the blues (100-199 mg/dL) and the greens (<99 but >50 mg/dL). The 2.25U dose takes Charleston down to the blues occasionally, but not enough.

 

[Caitlin & Charleston]

Hello Caitlin

As far as dosing goes, im sure someone will be around to give you advice, I wish I could help you out there, just not ready for that yet.

As far as the thread goes, yes...You keep a thread going until it reaches 50 messages and at that point you can copy the thread address and add it to the new thread you create by adding it to the link tab so all the information is there to go back to and review if anyone needs to review all the remarks. You can also change the title of the current thread if you want someone to look at something right away.

If you have any other specific questions about the threads please feel free to ask, im still learning as well but I can try to help you out!!

Thank you for clarifying about the threads!

 

[Caitlin & Charleston]

Looks to me like Charleston could use a bit more insulin. So increase the dose by another 0.25U and that would make his new insulin dose 2.5U.

Start that increase on 5/29/20 with the AM cycle please.

You want to see more BG readings down in the blues (100-199 mg/dL) and the greens (<99 but >50 mg/dL). The 2.25U dose takes Charleston down to the blues occasionally, but not enough.

Thanks @Deb & Wink! I've increased him to 2.5U this morning. I'm feeling hopeful right now that his BG levels are trending down. We're moving in the right direction

 

[Caitlin & Charleston]

It's been a dramatic week for Charleston. On Sunday, his BG went down to 57 but he had symptoms of a hypo (legs shaking, difficulty walking, urgent meowing for food). And then last night he went down to BG 49 at +4, but no symptoms. If I am applying them correctly, he's earned dose reductions every day for the last 3 days under the Prozinc SLGS dosing protocols. I'm hoping someone might be able to take a look at his spreadsheet and let me know what they think? Should I have reduced his dose so much so fast? Do I need to start testing for ketones (he doesn't have a history of them, but I have ketostix).

Any insights on his numbers would be greatly appreciated. I know all these blues and greens are probably very good news, but seeing lower numbers also makes me so nervous. Thanks so much!

 

[Deb & Wink]

Should I have reduced his dose so much so fast?

Yes, Charleston has earned 3 dose reductions on the Prozinc SLGS protocol. Anytime you get a BG level < 90 mg/dL, you reduce the dose by 0.25U IMMEDIATELY. Next shot is going to be that reduction. Glad to see that you took all 3 of those reductions. Good job!

He also seems to have a bit of an early nadir, around +3 to +5, so you want to try and test around that time to catch those lows, and bring his BG numbers up with food. Do you know how to do that?

Don't worry too much about the pre-shot tests right now. They are going to be high, as Charleston bounces off those low numbers. The pre-shots are the last to come back to a normal range with Prozinc. So keep that in mind.

Do I need to start testing for ketones (he doesn't have a history of them, but I have ketostix).

Yes, please keep testing for ketones, or start testing if you do not test already. With the fast dose reductions, there is the possibility that ketones could develop. Not enough insulin + not enough food + an infection/inflammation (bad teeth, UTI) can lead to ketone formation which can lead to DKA. And you do not want that to happen, since it's a VERY expensive multiple day stay at a 24 hour vet clinic.

The lows are scary, but Charleston needs to be down in those low blues and even better the high greens, in order to give his pancreas time to heal. This new vial of Prozinc really seems to be making a difference in his BG levels.

Insulin doses are not static, as you are finding out. It was only back on 5/29 that I suggested you increase the dose to 2.5U, and now you are back down to 1.5U. Keep up the good work!!!!

 

[Caitlin & Charleston]

He also seems to have a bit of an early nadir, around +3 to +5, so you want to try and test around that time to catch those lows, and bring his BG numbers up with food. Do you know how to do that?

Good to know about the earlier nadir. I'll make sure to capture his mid-cycle tests around +3 to +5 as suggested. In terms of bringing his numbers up with food, I think I know how, but would like to confirm. When I've gotten numbers in the 50s and 60s (with hypo symptoms), I've given him a little FF gravy lovers and had good luck with getting his numbers to rise. I've also got karo syrup and HC dry food on hand in case I need it. Is that what you mean? Or should I be trying to bring the green numbers up with his regular LC FF pate?

Yes, please keep testing for ketones, or start testing if you do not test already. With the fast dose reductions, there is the possibility that ketones could develop. Not enough insulin + not enough food + an infection/inflammation (bad teeth, UTI) can lead to ketone formation which can lead to DKA. And you do not want that to happen, since it's a VERY expensive multiple day stay at a 24 hour vet clinic.

I haven't tested for ketones yet. To be honest, the idea is kind of daunting. I've read the testing tips, but he won't urinate in anything other that clay/clumping litter and doesn't want me anywhere near him when he is in the litter box. I'll start trying though - I understand it is very important and he does have bad teeth

The lows are scary, but Charleston needs to be down in those low blues and even better the high greens, in order to give his pancreas time to heal. This new vial of Prozinc really seems to be making a difference in his BG levels.

Insulin doses are not static, as you are finding out. It was only back on 5/29 that I suggested you increase the dose to 2.5U, and now you are back down to 1.5U. Keep up the good work!!!!

Getting those low numbers for the first time was definitely scary for me, but also helped build some confidence that I know what to do when it happens. Also glad to hear that about giving his pancreas time to heal! I'm trying not to get my hopes up, but would obviously love to see him go into remission. I had thought about asking my vet to switch to lantus because I've heard it has the best remission rate, but now we seem to be making such good progress on the ProZinc, I don't think I want to switch.

Thanks for all your advice and encouragement!

 

[Deb & Wink]

Or should I be trying to bring the green numbers up with his regular LC FF pate?

You start with using the LC food to bring the BG numbers up. If that doesn't have much effect, then you move along to using MC food, then the HC dry food and as a last resort, HC food with some honey or corn syrup mixed in, or a straight bit of honey rubbed on his gums should bring the BG's up fast. But those sugars wear off fast. So you want some real food in his system, not just the honey.

You might want to see if you can find a HC wet food that he likes.That is because dry food takes longer to be digested, and you want the food to hit his system immediately. Wet food doesn't have to be broken down so much like dry food has to.

 

[Caitlin & Charleston]

You start with using the LC food to bring the BG numbers up. If that doesn't have much effect, then you move along to using MC food, then the HC dry food and as a last resort, HC food with some honey or corn syrup mixed in, or a straight bit of honey rubbed on his gums should bring the BG's up fast. But those sugars wear off fast. So you want some real food in his system, not just the honey.

You might want to see if you can find a HC wet food that he likes.That is because dry food takes longer to be digested, and you want the food to hit his system immediately. Wet food doesn't have to be broken down so much like dry food has to.

Okay, that makes sense. Thank you.

Charleston just earned another dose reduction. He was all the way up at BG 413 at amps and dropped down to BG 55 at +5. I know you said to not worry about the amps/pmps so much with ProZinc since they come back to normal last, but that sure seems like a steep drop. He's acting normal and I'm monitoring him since he showed hypo symptoms at 57 over the weekend. Also watching him like the hawk for litter box use so I can check for ketones. Hope his pancreas is healing!

 

[Deb & Wink]

I know you said to not worry about the amps/pmps so much with ProZinc since they come back to normal last, but that sure seems like a steep drop.

What I meant was not to worry too much if the pre-shots remain high, when the mid-cycle numbers drop low. The pre-shot numbers should come down eventually too, as his body gets used to the insulin and maybe he gets longer duration.

The Prozinc may not be lasting the full 12 hours for Charleston right now. But when it kicks in (onsets), he does drop fast.
50% is what you want to see for a drop. Not much more than that. He's dropping too fast.

Do you have a timed feeder? Or are you available to "front load" the cycle with food and get him to eat something around +1 and +2? Small snacks, not a full meal like he gets after the pre-shot test. So pre-shot test, insulin feed, +1 feed, +2 feed. Would that be possible for you to do?

Charleston just earned another dose reduction (4th day in a row). He was all the way up at BG 413 at amps and dropped down to BG 55 at +5.

YIKES! That is a fast drop.

I get the feeling that he is dropping low somewhere in the cycle, and then bouncing up to those pinks (300-399 mg/dL) and the reds (400-499 mg/dL) at the pre-shot times.

Are you ever able to get a +10 and or a +11 test? That could tell us if Charleston is one of those cats where the BG levels rise really fast in the last 1 or 2 hours of the cycle.

 

[Caitlin & Charleston]

Do you have a timed feeder? Or are you available to "front load" the cycle with food and get him to eat something around +1 and +2? Small snacks, not a full meal like he gets after the pre-shot test. So pre-shot test, insulin feed, +1 feed, +2 feed. Would that be possible for you to do?

I can certainly get a timed feeder and have been meaning to. I also am available to get him to eat something around +1 and +2. He's got a really good appetite, so I am sure he'd be happy for the snacks. I'll start doing that tonight.

Are you ever able to get a +10 and or a +11 test? That could tell us if Charleston is one of those cats where the BG levels rise really fast in the last 1 or 2 hours of the cycle.

I'll get some +10 and +11 tests. It will be hard for the pm cycle since he gets his shots at 6am/6pm, but I will try to get up earlier and can definitely get them for the am cycle. Will get some more data over the next couple days and report back. Thanks again!

 

[Caitlin & Charleston]

I just took a +11.5 out of curiosity and he is only at 185.

 

[Deb & Wink]

I just took a +11.5 out of curiosity and he is only at 185.

Well, it will be interesting to see what the pre-shot is after that +11.5.

A snack is 1 -2 teaspoons. So try that tonight at +1 and +2. Start with the smaller amount, the 1 teaspoon and see what that does.

On those +10 and +11 tests, I did not mean every day, every cycle. But a few here and there over the next few days would be helpful.

 

[Caitlin & Charleston]

Now his BG is 163. I lost track of time so it is more like a +12.3. I'm kind of baffled by him and his numbers right now I'm thinking I will feed him, test again in 2 hours, and then decide whether to shoot or not. What do you think?

Got it on the snack and getting in a few +10s and +11s over the next few days. Thanks Deb!

 

[Deb & Wink]

No need to wait so long to test. Stall for 20 minutes, see if the BG is rising. Shoot if it is.

If you did feed him, then you do need to wait the 2 hours to retest and decide to give him insulin.
If you shoot 2 hours late, that makes the next dosing cycle at least 11 hours later with Prozinc.
Is that possible with your schedule?

 

[Caitlin & Charleston]

Stalled for 20 minutes without feeding, tested again and got 136. I re-tested out of curiosity and got 180. Is it possible something is wrong with my meter or is that a normal margin of error?

Shooting him 2 hours late and then waiting 11 hours would be fine for my schedule. Should I feed him at this point, test in 2 hours and see if he's safe to shoot? Or at this point should I just skip the dose entirely?

 

[Deb & Wink]

Stalled for 20 minutes without feeding, tested again and got 136. I re-tested out of curiosity and got 180. Is it possible something is wrong with my meter or is that a normal margin of error?

15 -20% is the normal meter variance. That is a bit out of whack. Test yourself. It's a quick way to see if your meter is working well.

Shooting him 2 hours late and then waiting 11 hours would be fine for my schedule. Should I feed him at this point, test in 2 hours and see if he's safe to shoot? Or at this point should I just skip the dose entirely?

Your choice. Do what works best for you.

 

[Caitlin & Charleston]

It's been about a week since I checked in on Charleston's dosing. He's had some low pmps preshot numbers and I had to skip a couple doses. I've been able to test him for ketones though (finally found success using a ladle!), and they've come back negative. Previously, he was having low nadirs, and now he seems to be dropping low late. I did start giving him some small amounts of FF around the +1 and +2 mark as suggested.

I'm thinking I should continue holding his current dose, but curious for other's insights based on his spreadsheet. Thanks!

 

[Deb & Wink]

You've skipped two (2) PM shots, since Charleston was too low on 6/15 and 6/16 to shoot insulin. Any insulin is best given 12 hours apart with a diabetic cat.

I think you need to reduce the dose, so you can give Charleston a dose in both AM and PM cycles.
He earned an automatic 0.25U dose reduction to 0.75U on 6/14/20 when he hit that 90 BG. You did not take the reduction and should have.
How about 0.5U for now?

If he doesn't hold the reduction, staying in the good healing greens and blues, then it's easy enough to increase the dose again.

p.s. Ladles are great for catching pee and getting a urine sample for ketone testing! Glad you discovered that trick.

 

[Caitlin & Charleston]

You've skipped two (2) PM shots, since Charleston was too low on 6/15 and 6/16 to shoot insulin. Any insulin is best given 12 hours apart with a diabetic cat.

I think you need to reduce the dose, so you can give Charleston a dose in both AM and PM cycles.
He earned an automatic 0.25U dose reduction to 0.75U on 6/14/20 when he hit that 90 BG. You did not take the reduction and should have.
How about 0.5U for now?

If he doesn't hold the reduction, staying in the good healing greens and blues, then it's easy enough to increase the dose again.

p.s. Ladles are great for catching pee and getting a urine sample for ketone testing! Glad you discovered that trick.

Thanks Deb! This all makes sense. I switched him to 0.5U starting last night and he was high enough for his pm shoot yesterday too.