Curve and dosing

[Breanna H]

Hello all!
I was able to do a curve yesterday and part of one today. I have been trying to be better about before bedtime numbers. I am looking for some updated dosing advice. I'm feeling like Tigger's numbers are pretty wonky and random. One day he was 400 and then he was 99. I get confused when he has a lower one and I don't know how much I should be giving. I am also not sure if my .75u Prozinc dose consistently is good for him or not. The one night I gave it and at a +6 check he was significantly higher! His appetite has been great and he has been eating anywhere from 3 to 4 full cans of wet FF classic pates a day. Urine output is pretty normal as well. Any advice on my dosing? I really am hoping for remission and all I'm seeing is inconsistent numbers which is confusing me on what to do.

 

[Juls and Billy]

A bit of inconsistent numbers is to be expected. A pancreas doesn't heal all at once, which means some days it's going to be producing more insulin than other days. You're getting mostly blue and yellow numbers, so that's a very positive sign. Now, I'm a newbie as well, so take this with a grain of salt. If it was me, I would hold present dose steady, until you begin to see some greens or have to start skipping doses. Then reduce back to .5. I'm sure more experienced members will be in to help as well.

 

[Sienne and Gabby (GA)]

I'm not sure where I see Tigger's numbers as being random. I hate saying this because I know you're trying, but... Without more spot checks it's very hard to see any patterns. Prozinc dosing is based on the nadir. The tests from yesterday show really good numbers. There's no way to know if a flat blue cycle is typical or not.

I tend to think you're holding the dose too long. However, without more data, I'm reticent to suggest an increase. What I can say with a lot of confidence is you need more than pre-shot tests only to low how this dose of Prozinc is working, Realistically, how often can you test?

 

[Breanna H]

What I can say with a lot of confidence is you need more than pre-shot tests only to low how this dose of Prozinc is working, Realistically, how often can you test?

I mean random in the sense that one day he is 400 and then he was 99. Then another day is high 300s and then only 138. I don't know how much I should be giving on the lower days vs the higher days. I don't want him to be unsafe but I also don't want to be skipping shots and having him go high unnecessarily.

I really can only test on the weekends and evenings. I am out of the house Monday through Friday usually from at least 7am to 4pm or 5. So I usually shoot at 6 and 6. I have a camera and an auto feeder to keep an eye on him. When should I be trying to get another check in? A mid day check just really isn't an option for me unfortunately since I am never home then unless it is a weekend and I am there. And I feel by the time I get home from work, a check is pointless because it's almost insulin time again.
And I can get a +4 in the evening but I don't feel like that is telling me his nadir and I have to go to bed after that.

 

[Juls and Billy]

Sienne and Gabby is right. You can't get a good picture without mid-cycle testing, which you are starting to do. You really can't see any trends with only pre-shot tests. You had the 99 and then two skipped doses before you had the 443. Your cat didn't get a dose for 24 hours, so of course the next number is going to be high. That's my best guess with no mid-cycle tests at that time.

Don't try to see patterns in what happened before when you were only testing pre-shot. Keep up the mid-cycle tests. The past two days are giving you better information.

 

[Sienne and Gabby (GA)]

I worked full time (and then some) when I was managing Gabby's FD. I left the house at around 7:30 and my test time was 5:00. That allowed me to get a pre-shot, +1, +2, and sometimes a +2.5 if necessary. I was home to test by 5:00 or shortly thereafter. If you want to stick to your schedule, you can get a test (+1) before you leave. If you are a morning person, you could always get up at 5:00 and get early tests and it sounds like your home by 5. (I opted for the 5:00 shot because Gabby had an early nadir. You don't have to opt for a 5:00 wake up if that's not the case with Tigger.) As you accumulate more data, you'll have a better sense of when Tigger's onset and nadir fall.

Since most of us have to work in order to pay for insulin, strips, and cat food, it becomes even more important to try to get those PM tests in. Whatever you can do to gather data will pay off dividends. If you wake up to use the bathroom, get a test. If you're running errands on the weekend, get an out-the-door and in-the-house test. The more clues you have to how Tigger's cycles typically look, the less nervous you will be while you're at work. Don't assume a +10 or +11 test is pointless. It's only pointless if the numbers are in the 300s. You can come home to a number in the 30s, too.

It's the same idea about the before bed test. It may not tell you when the nadir test is. But, if numbers have been dropping fast from your PMPS, it may tell you to stay up a bit longer and test or to give Tigger some food to slow down the drop. I just commented to some one that I really wish there were hard and fast rules but there aren't. As soon as we think we can predict what our kitty is going to do, they change the rules and throw us a curve.

 

[Breanna H]

Whatever you can do to gather data will pay off dividends. If you wake up to use the bathroom, get a test. If you're running errands on the weekend, get an out-the-door and in-the-house test. The more clues you have to how Tigger's cycles typically look, the less nervous you will be while you're at work. Don't assume a +10 or +11 test is pointless. It's only pointless if the numbers are in the 300s. You can come home to a number in the 30s

I'll keep trying to get them whenever I can. In the mean time, I assume I should just continue my .75 dose for now?

 

[Sienne and Gabby (GA)]

Based on the curve, you can increase the dose.

 

[Deb & Wink]

Good morning Breanna,

Looking at Tigger's SS 2/3/20, looks like you still gave the 0.75U dose of Prozinc insulin. Are you checking with your vet about what they think about raising Tigger's dose? Is that why you stayed at the 0.75U dose?

With Prozinc, cats often shoot much higher later in the cycle. So those +10 and +11 numbers will help to see what that duration is with Prozinc. And how quickly the BG numbers go up at the end of the 12 hour dosing cycle.

It can take a few more BG tests in the beginning of this journey with your diabetic cat. That is because you need to find the nadir (lowest point this particular dose takes YOUR cat), onset (when you start to see an effect from the dose, usually +2 to +3 with Prozinc but varies) and duration (how long the insulin lasts, when the insulin you gave has been "used up" to help process the food.)

ECID Every Cat, Caregiver, Cycle is different. So you need to find what works for you - and your cat Tigger.

Think about your schedule and what changes you can make in finding times for testing, shooting schedule, feeding Tigger and all the 100 other things you do in a day. It can be tough, but hang in there.

You have given Tigger insulin before with a PS (Pre-shot BG test) test of 169 with Prozinc before. This morning you have given insulin with a PS (pre-shot BG test) of 150. Did you leave some food out for Tigger? Or are you home to monitor?

Prozinc usually has a quicker onset, drops the BG's faster, and shoots the BG's up quicker later in the 12 hour cycle than with the longer duration insulins like Lantus/Levimir. Easier to make adjustments in your dosing schedule with Prozinc. Easier to stall for 1 hour and still stay on schedule with Prozinc. No "depot" storage area to contend with. Easier to measure those smaller doses with the U40 syringes you have.

"To each their own."

 

[Deb & Wink]

p.s. Haven't seen many "green" numbers for Tigger, but I've got the gut feeling they have been happening. No way to "see" for sure. Most likely in the PM cycle, but also day time. You've had to "skip" a lot of shots because Tigger is too low at pre-shot to give insulin.

Do you know about the stalling technique?

If you have days when you have not tested or given insulin, we still like to see them on the SS. You have a row for 1/21 and 1/23 but no row for 1/22. I think that was when your sister was trying to test and help you out during your move to your new home.

How is the new place? Settling in yet? Takes forever to unpack things, move the furniture around, get comfie in the new place. Is Tigger settling in and finding places to "call his own?"

Is Tigger any easier to test or is it still a bit of a struggle? Are you using bribes during testing? ( by bribes I mean food treats, brushing, petting, ear or chin scratches,etc) Are there steps in the testing process that are still difficult for you? Do you sing to Tigger while you are testing? Can help to calm you down and not transmit your emotions to your cat.

Let us know how else we may help you and Tigger.

p.s. Just saw over in the facebook group that you travel for work too!!!! Please note that in the Remarks column on the SS. Helps us to see that.

 

[Deb & Wink]

I'm not sure I would raise the dose for Tigger.

Why? Because you have had to skip so many doses with a low BG at pre-shot test.

 

[Breanna H]

Looking at Tigger's SS 2/3/20, looks like you still gave the 0.75U dose of Prozinc insulin. Are you checking with your vet about what they think about raising Tigger's dose? Is that why you stayed at the 0.75U dose?

You have given Tigger insulin before with a PS (Pre-shot BG test) test of 169 with Prozinc before. This morning you have given insulin with a PS (pre-shot BG test) of 150. Did you leave some food out for Tigger? Or are you home to monitor?

How is the new place? Settling in yet? Takes forever to unpack things, move the furniture around, get comfie in the new place. Is Tigger settling in and finding places to "call his own?"

Is Tigger any easier to test or is it still a bit of a struggle? Are you using bribes during testing? ( by bribes I mean food treats, brushing, petting, ear or chin scratches,etc) Are there steps in the testing process that are still difficult for you? Do you sing to Tigger while you are testing? Can help to calm you down and not transmit your emotions to your cat.

p.s. Just saw over in the facebook group that you travel for work too!!!! Please note that in the Remarks column on the SS. Helps us to see that.

I actually only gave .5u this morning, sorry, in my early morning fog I've been so used to typing .75. Since he was lower I dropped the dose a little. My vet wants me to give 1u constantly without checking his sugar. Well on the day he was 99, clearly that wouldn't have been a good idea. My husband actually works from home so I have had him feed Tigger several small meals this morning and he has been monitoring his behavior. He is definitely supportive, but asking him to check a blood sugar isn't really something he is interested in helping with. He would if I really needed him to but it's not an every day thing he would help with.

And I actually didn't move, I was just away for a long weekend. So Tigger is back to normal with his stress. He just wasn't used to my sister and her "handling techniques" so it was stressful for both of them.
I'm really not sure where my 1/22 row got to, as she never skipped a whole testing day. I must have forgotten to add it somewhere.

And Tigger is actually a pro with testing. He just lays upside down in my lap. Sometimes he gets a little angry but holds still long enough for me to get my check. So the testing itself isn't an issue, it's just finding the time to get the checks.

I can stall in the evenings but usually in the mornings it's test, feed, shoot and out of the house. Which is why I'm usually so hesitant to give him anything. I wasn't going to give anything today, but I was thinking I should at least give a partial dose. Maybe poor judgement on my part but my husband said he is fine and eating the food he is giving him.

I will hold the dose at .75 for now and keep trying to get more numbers at various times. Thank you for your advice and input!

 

[Deb & Wink]

The 0.5u dose may be the right one for Tigger. We don't know at this point.

You haven't had a lot of consistency in the dosing and have had a lot of "skipped" shots due to low pre-shot tests.
So, hate to say this, but it's your choice on the dose. It's a toss up at the moment.

So, 0.5U or 0.75U of Prozinc. Do your U40 syringes have the 1/2 unit markings on the syringe barrel? Or are you "eyeballing" the dose more? Guessing what the dose looks like?

It can be really hard to see those tiny insulin doses for our cats.

Timed feeder. Like the Petsafe 5. I think that is one I have heard that other members use here.

These pictures show you U100 syringes (NOT the type you are using. YOU want to use U40 syringes) But you can get an idea of what those tiny doses should look like. It's the positioning of the end of the plunger you are looking for. Try to be consistent with plunger placement with each dose. Be sure to mix the Prozinc well since it's a suspension type insulin.

Pictorial guide using a U-100 syringe marked with half units:

 

[Deb & Wink]

I really wish you could "convince" your husband to test at mid-day for you. About +5 or +6 would have been so good to see for today. Especially with that lower 0.5U dose.

Thinking that 0.5U may be better for Tigger. It's what I would give my cat for a few days.

You want to be able to give insulin consistently each 12 hour cycle. But not at those low pre-shots.

Are you able to get a +11 in the AM cycle? 1 hour before your normal AM pre-shot test time?

It's actually recorded on the SS in the +11 column for the PM cycle from the previous day.

 

[Breanna H]

I really wish you could "convince" your husband to test at mid-day for you. About +5 or +6 would have been so good to see for today. Especially with that lower 0.5U dose.

Thinking that 0.5U may be better for Tigger. It's what I would give my cat for a few days.

You want to be able to give insulin consistently each 12 hour cycle. But not at those low pre-shots.

Are you able to get a +11 in the AM cycle? 1 hour before your normal AM pre-shot test time?

It's actually recorded on the SS in the +11 column for the PM cycle from the previous day.

I actually just got the U40 syringes that have the half markings on them. They are much nicer than just eyeballing it.

I got out of work early today so I got a +9 check and he was 196. So it all turned out okay I guess.

A +10 or 11 check is usually almost always doable for me and I'll work on my husband. Maybe if I make him do some of the PMPS checks he will be more willing with doing the afternoon one.

I can drop down to .5u and see where that gets me as well.

 

[Deb & Wink]

Good to hear. Let's keep Tigger safe.

The "guys" are often a bit reluctant to learn to test. Not sure why that is. But it sure is nice to have a "backup" person to test when you aren't there to test.