To start, I want to let you know if you have anything time-sensitive to please post in the Main Health Forum - as you can see with your other post, the Prozinc ISG forum isn't very active since the majority of the kitties here are on Lantus, but the Main Health is always bustling with helpful people, so try to get eyes on stuff over there as well in case no one that frequents this section is online.
A refresher on the Prozinc SLGS protocol should help you:
How to handle a lower than normal preshot number when following SLGS:
Until you collect enough data to know how your cat will react, we suggest following the guidelines in the
FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
- Below 150 mg/dl (8.3 mmol/L), don't give insulin.
- Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
- a.) give nothing
- b.) give a token dose (10-25% of the usual dose)
- c.) feed as usual, test in a couple of hours, and make a decision based on that value
- Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
- In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
- Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
Keep in mind these are general guidelines, and
they should be personalized to your own cat's response to insulin once you have data and understand your cat’s cycles. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then personal experience should be your guide.
With experience, you may find that lowering these thresholds may work well for your cat. When you have reached that stage, the following guidelines are suggested for Prozinc users following the Start Low Go Slow approach:
If the preshot number is far below usual preshot numbers:
- Do you need to stay on schedule? Then skip the shot.
- Do you have some flexibility with your schedule? Then stalling to wait for the number to rise might be a good option. Don't feed, retest after 30-60 minutes, and decide if the number is shootable.
- Repeat until the cat either reaches a number at which you are comfortable shooting, or enough time has passed that skipping the shot is necessary.
If the preshot number is near kitty's usual preshot numbers:
Look at your data to see what numbers you have shot in the past and decide what would be a safe, shootable number for your cat. Don't feed. Stall until kitty reaches the preshot number you've decided on and then shoot.
We usually don't suggest or recommend shooting a preshot number less than 90 mg/dL when following the SLGS Method. Remember that with SLGS, generally speaking, your goal is to achieve flat numbers that are greater than 90 mg/dL. However, let experience, data collected, knowledge of your cat, and availability to monitor help in making the best decisions for your cat.
When you stall feeding and retest at a low pre-shot, it will be beneficial both to you and the members here if you add it to your spreadsheet. For example, if Dixie's pre-shot is 110 and you stall feeding 20 minutes and she re-tests at 130, you should put in the AM/PMPS cell:
110, 130 (+12.20). You will have to manually color the cell if you do this; I would color it based on the lowest number. You also want to put in the remarks section stalled 20 min, etc etc so YOU can look back and see what you did. It's all about gathering data and basing doses off of Dixie's experience. You're doing good with the remarks so far, just add them to the cells as well so it's easy reading for those looking to offer advice.
As you can see above, numbers between 150 and 200 have three options: stalling and retesting is recommended first if your schedule allows it. I think introducing token doses (which are 10-25% of usual dose, so in Dixie's case of 1u would be .10 to .25u) will help you get the courage to still give insulin when she drops a little lower. Eventually you'll lower the no-shoot number from 200 to say, 180. 150. Etc. I think it's fine that you skipped this morning, though the evening of the 18th it might have been nice to at least done a token dose.
If you DO decide to give a token dose or full dose on lower pre-shots, make sure you're going to be there to monitor and get a +2 in. +2's are great indications of what the cycle is about to do. Try to get one every cycle if you can.
As for Dixie needing a reduction ... hmmm. I am not sure. She's kind of in the middle with those nadirs:
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
- If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
- If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
- If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
I'm going to ask
@Deb & Wink 's opinion on this. I would REALLY like to see you kick the DM dry, if you haven't already. It's high-carb. We use
this chart from Dr. Lisa Pierson to determine low-carb food options for our kitties. Anything under 10% is good, ideally under 5%. We most commonly use Fancy Feast Classics or Friskies Pate but anything under 10% is acceptable. By using dry food (and a high-carb food at that) you're elevating her BG numbers. If you do remove the dry make sure you're monitoring her, as it drops the BG noticeably when it's removed.
Along with that, I recommend getting some emergency medium- and high-carb wet food for potential hypo events. Medium-carb is around 11-17%, high-carb is 18%+ . PM Dry is 18% but dry food isn't helpful in a hypo event, it takes too long to hit the system.
Here is our hypo tool kit, everyone should have one yesterday!
One more question - as indicated by your signature, is Dixie only getting two meals a day? Two meals is very hard on the pancreas, especially diabetics. Small meals throughout the day (mainly at the first half of the cycle) are helpful. Bulk of the meals at breakfast/dinner, then a few "mini" meals, usually at +2 and a couple more times. That includes the night-time cycle.
. It takes a lot of pricks to finally get a good blood sample. I know that we will get better at it.
. Our recent vet said that her gingavitus was bad and that she may need to get teeth extracted although there is no way to tell unless they are actually doing the procedure. I will definitely post on the main forum to get more info though!
. Dixie used to be on the larger side.. maybe 16 lbs. I think she is a ragdoll mix but we have no clue because she was found as a stray kitten. She was on 1-2 cans a day of wet food and unlimited dry food and she ended up losing weight (I guess due to untreated diabetes). Right now she is 10 lbs and the vet said that is a good weight so we have been feeding her 200 calories + freeze dried chicken snacks and she is maintaining her weight. If I were to spread out the meals, I would probably still keep to 200 calories a day because I don't want her getting overweight again!
. From snooping around the forums it seems like these prices are pretty crazy, but maybe it is because I'm in Canada.
. Maybe she was constipated? The vet today said that she had some hard stool stuck in her colon so I will need to just wait and see what happens. The vet said that if this keeps happening then I will need to start sprinkling PEG powder into Dixie's meals.
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