Do Daa's PZ Dosing Thread2

Goose said:
SS Updated. 141.
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Pretty flat. I’d say you are going to see some lower numbers tonight. And he has eaten, yes?

I’d be cautious and test at +3. Just in case that’s his onset time, you don’t want to wait and get a surprise at +4.
 
Marje and Gracie said:
Pretty flat. I’d say you are going to see some lower numbers tonight. And he has eaten, yes?

I’d be cautious and test at +3. Just in case that’s his onset time, you don’t want to wait and get a surprise at +4.
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He is eating some right now. I'll test +3 that's in about 32 minutes. What about a +4 (1am) test?
 
Goose said:
SS Updated.
Down again at 101.
Maybe 6.5u is too much?
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So far, these are great numbers. I know they are scary to you but we strive for normal numbers 50-120.

You can use food to manage his curve and stop or slow down the drop. It’s ok to feed him some more LC and test at +4.
 
Marje and Gracie said:
So far, these are great numbers. I know they are scary to you but we strive for normal numbers 50-120.

You can use food to manage his curve and stop or slow down the drop. It’s ok to feed him some more LC and test at +4.
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They are on the scary side to people new at this. I'd like him to stay in this range sooner than later. It's easier to get use to these lower numbers if there aren't such wild swings, like the 494 he was this morning down to 87, then up to 150, then down to 101. I'd like to be able to count on the fact that he'll stay in a given range.

We'll test at +4 then off to bed. He'll have his typical 1/3 of a cup of CP overnight.
 
Goose said:
They are on the scary side to people new at this. I'd like him to stay in this range sooner than later. It's easier to get use to these lower numbers if there aren't such wild swings, like the 494 he was this morning down to 87, then up to 150, then down to 101. I'd like to be able to count on the fact that he'll stay in a given range.

We'll test at +4 then off to bed. He'll have his typical 1/3 of a cup of CP overnight.
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Until they get regulated, it’s not uncommon to see such unpredictable numbers.

If he’s down at +4, you’ll want to test more.
 
Marje and Gracie said:
I’d give him some karo....on food if he will eat it or put a little in his mouth. Retest in 30.

I’d take his dose back to 6u in the morning.
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He has had some of the karo on his gums but didn't like it, wouldn't eat food with it on it. Retesting in 15 minutes.

Will take him back to 6u in the AM.
 
Goose said:
He has had some of the karo on his gums but didn't like it, wouldn't eat food with it on it. Retesting in 15 minutes.

Will take him back to 6u in the AM.
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Lather, rinse, repeat. If he’s not coming up, give more Temptations and karo. Retest in 30. That’s how we do it until the BG has started up.

Just so you know, in the Lantus/Levemir forum, the longer diabetics’ (+ 1 year) reduction point is a drop below 40. So at 57, he’s still very safe.
 
Goose said:
121 at +5.5

but don't know if it's just the Karo - will test at +6
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That’s good. If he’s still up or rising at +6, you can get a couple hours sleep but karo wears off in two hours so I’d strongly urge you to set an alarm and test to be sure he’s not headed back down. I know it’s hard. You can look at my Gracie’s SS and see how little sleep we got.

I’ll stay awake another 30 for the next test if you like. It will be about 1 am here then.
 
Marje and Gracie said:
That’s good. If he’s still up or rising at +6, you can get a couple hours sleep but karo wears off in two hours so I’d strongly urge you to set an alarm and test to be sure he’s not headed back down. I know it’s hard. You can look at my Gracie’s SS and see how little sleep we got.

I’ll stay awake another 30 for the next test if you like. It will be about 1 am here then.
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If you'd like to. Hopefully he rises faster.
Thanks for your help.
 
Marje and Gracie said:
Great. I’m going to call it at night. Again, I’d suggest you test in two hours so if the carbs wear off, he doesn’t tumble.

Good luck with the reduction. Let’s hope this will kick start him a bit.

Good night!
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SS Updated.
148 at pmps just like last night before all that extra drama....
Gave him 6u again.
 
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Goose said:
SS Updated.
148 at pmps just like last night before all that extra drama....
Gave him 6u again.
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Very good! That’s what I would have done. But because he’s clearing a bounce, he might have a very active cycle. Be prepared.

It looks to me like he might be more carb sensitive than I expected but he also responds slower. Because of the way he popped up so fast last night (great job testing; I know you were tired) and went so high today and then came down, he had some loss of duration mixed in with bouncing.

Your “job” is to figure out his feeding......what works best on controlling his numbers so he doesn’t get too low. You might need to adjust his feeding as well. With Lantus, we often divide the food into mini meals that are fed at PS, +1, +2, and +3 to work with the insulin as it onsets. It’s important that you be open to changing his feeding schedule so he doesn’t take them big dives. Big dives mean big bounces and it becomes a cycle you don’t want.
 
I was checking in and saw Do Daa is dropping today but flattened out in the last hour. It’s important to keep an eye on that BG and feed him if it goes any lower. Please see my post above.

As I said above, it’s important to get the dive, bounce, dive cycle stopped. The way to do that is through managing the curve with food. I am on the way out the door right now but here’s information on how to do that (it was written for lantus and levemir but the same concept applies to PZ; note that PZ has more of a curve like lantus than it does like levemir):

what is meant by using food to manipulate the curve?
simply put, it's a method of feeding used to prevent kitty from dropping too fast and/or too low.
the amount of food usually fed to the cat is broken down into several mini-meals fed throughout the course of the day with the intention of flattening out the curve. lc is normally fed to all numbers except possibly in the case of a significant or fast drop or fed to a drop below 50.

the only time you might want to feed a little higher carb food at shot time is to bump the numbers up so the insulin is starting from a higher number when onset occurs if you're running out the door and will be unable to monitor.

if you're around to monitor, there's no reason to bump the numbers up at shot time. the beauty of lantus and levemir is being able to shoot low to stay low. shooting low is how you obtain the low flat curve with lantus and levemir.

whether you'd want to feed lc, mc, or hc to slow a drop depends on two things:
1. the carb sensitivity or lack of of your particular cat.
2. the point you're at in the cycle. a drop early in the cycle *may* require big guns. a drop at nadir (unless nadir is less than 40) or late in the cycle usually only requires lc to bump the numbers up. however, if you have a carb sensitive kitty, you may not have to use anything except lc to bump up the numbers. "KNOW THY CAT".

why would you want to manipulate the curve with food?
--- bouncers: kitties who drop low and then bounce to the moon benefit from food manipulation. using food to manipulate the curve will tend to flatten out the curve. flattening out the curve helps to prevent huge bounces.
--- carb sensitive kitties: kitties who experience large food spikes when consuming even lc benefit from manipulating the curve with food. strategically spacing out meal times will help flatten out the curve.

why do i want to use food to flatten out the curve ?
--- flattening out the curve allows you to get as much insulin into the cat as safely possible without having kitty bottom out on you.
--- flattening out the curve *usually* allows you to hang onto a dose longer
--- flattening out the curve allows you to shoot higher doses of insulin than you would have been able to otherwise.

why would i want to get as much insulin as possible into the cat?
lantus and levemir are known to have a harder time bringing down higher numbers. more insulin helps bring down the higher numbers in a bouncer's cycle. more insulin will help counteract the spikes in a food spiker. using food to manipulate the curve will flatten out the curve and help keep your kitty safe.

when using food to manipulate the curve, i generally recommend starting with dividing up the normal amount of food your kitty should be eating into 8 mini-meals to be fed at preshot, +1, +2, and +3 of each cycle. however, that recommendation is strictly a starting point. a plan customized for YOUR cat is YOUR goal. frequent testing and learning how YOUR cat responds not only to food, but to the insulin itself will help you tweak the plan.
Edited to add on 11/13/2015:
I was referring to manipulating the curve when using Lantus in the paragraph above.
Levemir typically has a later onset (usually around +4) and a later nadir. To accommodate the difference, when using Levemir one might start with dividing up the normal amount of food kitty should be eating into 8 mini-meals beginning at shot time, +3, +6, and +7 of each cycle. However, that recommendation is strictly a starting point. A plan customized for YOUR cat is YOUR goal. Frequent testing and learning how YOUR cat responds not only to food, but to the insulin itself will help you tweak the plan.

a quote that goes along with this subject from Libby/Lucy found in one of Mocha's Lantus condos:

"carb manipulation is more about learning what your cat's response is to varying amounts of carbs at different times during the cycle, and using that information to your advantage. Learn how many points bump she gets from LC, MC, and HC, both early in the cycle and later in the cycle. Use that information to guide her cycles the way you want them to go. Mocha's AM and PM cycles are very different, so the best feeding times for her might not be the same in each cycle. Take the amount you would feed her over the 12 hour period, divide it into 3-4 meals, and experiment with when to feed them. Whatever changes you make, write them in your spreadsheet and hold it for at least 3-4 days to see if it is changing anything. Mocha drops later at night than she does during the day, so your food schedule might need to be different at night.

Many cats benefit from front-loading the cycle with food. That means feeding at PS, +1, +2, +3 (when the insulin is kicking in) and then NOT feeding after +6 (because for a carb sensitive cat, you would be adding food at the same time the insulin is wearing off, driving the numbers higher). The +9 snack is helpful for some cats when they are trying to go OTJ, because it can stimulate their pancreas. That is more useful if the cat is generally flat, but spikes up just before PS. I wouldn't worry about that yet, until you get to a lower dose."

experimenting is how YOU learn how YOUR cat responds not only to food, but to the insulin itself. no one feeding plan will affect two different cats in the exact same ways. experimenting, testing, recording your observations... these are the things which will help YOU with YOUR kitty because like you'll often hear around here...ECID. :mrgreen:
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Please read and let me know your questions and I’ll check back in later today. If his BG drops and you need help, post the “911” by editing your thread and selecting the “911” button in your subject line. If there’s no one on PZ forum, post on Health. However, you’ve used Temptations to bring him up before and it’s getting later in the cycle so he “might” start up. He might also continue down because he’s in this dive/bounce cycle. I will be back long before your shot time.
 
Marje and Gracie said:
Very good! That’s what I would have done. But because he’s clearing a bounce, he might have a very active cycle. Be prepared.

It looks to me like he might be more carb sensitive than I expected but he also responds slower. Because of the way he popped up so fast last night (great job testing; I know you were tired) and went so high today and then came down, he had some loss of duration mixed in with bouncing.

Your “job” is to figure out his feeding......what works best on controlling his numbers so he doesn’t get too low. You might need to adjust his feeding as well. With Lantus, we often divide the food into mini meals that are fed at PS, +1, +2, and +3 to work with the insulin as it onsets. It’s important that you be open to changing his feeding schedule so he doesn’t take them big dives. Big dives mean big bounces and it becomes a cycle you don’t want.
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SS Updated some.

He's a grazer and usually has at least some food after all of his tests (sometimes every 2 hrs), but I can't feed a cat that doesn't want to eat so frequently, even Temptations is only a temptation if he's hungry.

When he becomes obstinate, we end up putting wet food on his front paws until we think he's had enough or he gets up and jumps off the table.
Also, we have a needless syringe we are going to use for the maple syrup because it is thin enough for the syringe. We'll use it if necessary to bring BG back up. Tested it with .7ml and it works great.
 
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Nice afternoon part of the cycle. It’s really important you keep track of what he ate, when he ate, how much he ate so you can see how it affects his BG at different times of the cycle.

You can teach a cat to eat on a schedule. I did it with Gracie (who had been a canned food grazer) so I could manage her curve with food and also with my two current, no diabetic cats. One of them, I didn’t even try until he was 6 years old.

I’m glad the needless syringe works for syrup. If you used 0.7ml the other night, it was a bit too much. You might need to experiment with that as well.
 
Marje and Gracie said:
Nice afternoon part of the cycle. It’s really important you keep track of what he ate, when he ate, how much he ate so you can see how it affects his BG at different times of the cycle.

You can teach a cat to eat on a schedule. I did it with Gracie (who had been a canned food grazer) so I could manage her curve with food and also with my two current, no diabetic cats. One of them, I didn’t even try until he was 6 years old.

I’m glad the needless syringe works for syrup. If you used 0.7ml the other night, it was a bit too much. You might need to experiment with that as well.
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SS Updated. It was wrong before. He fell to 60 and is now back to 155 due to syrup/temptations/dry food. We used .7ml tonight when he was at 60 to bring him up ....
 
Remember is post 46 above, I stated that in those two hours before shot time, you don’t want to give HC unless he’s in the 30s. Towards the end of the cycle, unless he’s up in the 30s, we just feed low carb as duration is waning.
 
Marje and Gracie said:
Remember is post 46 above, I stated that in those two hours before shot time, you don’t want to give HC unless he’s in the 30s. Towards the end of the cycle, unless he’s up in the 30s, we just feed low carb as duration is waning.
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That must have gotten lost in all the information, (the in the 30's part). As he fell to 60 it didn't dawn on me about the time, only to get the number back up.

I wrote it down this time.

At any rate, he's likely on a sugar high and I don't want to shoot him in the next 15 minutes or so if the numbers we will see will not be accurate.

Especially at night, we get very concerned at PMPS if his numbers are to low. What is the general thought that the lowest level of BG (number) with 6u should be? He's dropped anywhere between 400 points to as little as 100 before.
Nighttime is a lot harder to manage.
 
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Goose said:
That must have gotten lost in all the information, (the in the 30's part). As he fell to 60 it didn't dawn on me about the time, only to get the number back up.

I wrote it down this time.

At any rate, he's likely on a sugar high and I don't want to shoot him in the next 15 minutes or so if the numbers we will see will not be accurate.
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Here is an importang quiz:
If he’s coming back down, what would your options be for shooting tonight?

If you are worried he might still have a food spike, what would your option be to still shoot tonight?
 
Marje and Gracie said:
Here is an importang quiz:
If he’s coming back down, what would your options be for shooting tonight?

If you are worried he might still have a food spike, what would your option be to still shoot tonight?
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I added to my post above.

I get concerned about shooting him at even 150 with 6u. It did a number on him at 6.5u just recently at 150. Food play a large role it seems once it kicks in and if you can even get him to eat or eat on que.

I don't know. We will test at 9pm pmps to see.

Just tested he's at 256. 100 point climb in 45 minutes - so a false number due to sugar? (do I add to SS?)

Can we test again at 10pm and see if his numbers are down and shoot say 3u? or a noticeably lower dose?

Or not shoot him at all tonight....
 
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Goose said:
Especially at night, we get very concerned at PMPS if his numbers are to low. What is the general thought that the lowest level of BG (number) with 6u should be? He's dropped anywhere between 400 points to as little as 100 before. Nighttime is a lot harder to manage.
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There is no “rule” other than the lowest number that anyone shoots and that depends on what method of regulation they are following. As an example, with Lantus and Levemir, we don’t shoot below 50.

For the most part, it seems a lot of PZ users use Start Low Go Slow which would mean not shooting below 90. It’s up to each member to understand their cat’s pattern enough to know what number they can safely shoot, what number they shoot a half dose with, etc. Obviously, it can make it more of a challenge when he’s diving and bouncing. Flat numbers are easy to shoot because they often stay flat.

When did you last give syrup? +10? If so, I would not feed him, I’d retest in 30 minutes, and if he’s still on the way up, I’d give 6u. If he’s down, you can stall up to one hour total but you could then choose to give less insulin. PZ does not have a depot like Lantus and Levemir so you don’t have to contend with that.

By and large, skipping shots that are above the cutoff you are using is for the caregiver, not the cat. There are extenuating circumstances but what you are dealing with now is very routine.
 
Marje and Gracie said:
There is no “rule” other than the lowest number that anyone shoots and that depends on what method of regulation they are following. As an example, with Lantus and Levemir, we don’t shoot below 50.

For the most part, it seems a lot of PZ users use Start Low Go Slow which would mean not shooting below 90. It’s up to each member to understand their cat’s pattern enough to know what number they can safely shoot, what number they shoot a half dose with, etc. Obviously, it can make it more of a challenge when he’s diving and bouncing. Flat numbers are easy to shoot because they often stay flat.

When did you last give syrup? +10? If so, I would not feed him, I’d retest in 30 minutes, and if he’s still on the way up, I’d give 6u. If he’s down, you can stall up to one hour total but you could then choose to give less insulin. PZ does not have a depot like Lantus and Levemir so you don’t have to contend with that.

By and large, skipping shots that are above the cutoff you are using is for the caregiver, not the cat. There are extenuating circumstances but what you are dealing with now is very routine.
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He was given syrup at +10 (7pm) .5ml

We ran out of everything HC and had to go to the store.... we tested when we got back from the store, 155, and he was given food then also. This was 8pm and he finished at 810pm then tested at 845pm at (256). Which is not listed in the SS as not accurate due to HC... we believe.

It's 920pm, 1/2 hour past shooting time ...
 
Goose said:
He was given syrup at +10 (7pm) .5ml

We ran out of everything HC and had to go to the store.... we tested when we got back from the store, 155, and he was given food then also. This was 8pm and he finished at 810pm then tested at 845pm at (256). Which is not listed in the SS as not accurate due to HC... we believe.

It's 920pm, 1/2 hour past shooting time ...
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You should put the 256 on the SS. It’s a test and it is accurate even if it is HC influenced. Data is data. You can put comments in the “Remarks” column.

Please test and see where he is and decide what you think is the best option. (I will let you know if I agree :p).
 
Marje and Gracie said:
You should put the 256 on the SS. It’s a test and it is accurate even if it is HC influenced. Data is data. You can put comments in the “Remarks” column.

Please test and see where he is and decide what you think is the best option. (I will let you know if I agree :p).
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I'll test in 10 minutes, that will give us 10 minutes to agree :D
 
Marje and Gracie said:
You should put the 256 on the SS. It’s a test and it is accurate even if it is HC influenced. Data is data. You can put comments in the “Remarks” column.

Please test and see where he is and decide what you think is the best option. (I will let you know if I agree :p).
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297 at 951pm. pmps +1

Do you think this is still being influenced by the HC food even though he finished at around 810pm?
 
Goose said:
297 at 951pm. pmps +1

Do you think this is still being influenced by the HC food even though he finished at around 810pm?
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Nope. I’d shoot 6u.

ETA: It looks now like loss of duration. He might also be starting a bounce. We will know when he onsets tonight. If it’s just loss of duration, he will come back down tonight fri where he is now.
 
Goose said:
SS Updated.
Done. We'll test him at +4.
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You’ll want to record his BG like this all in the PMPS column:

256 @ +11.75; 291 @ +13

That way we know you shot at +13 (an hour late).

You’ll also want to put in the remarks that you gave HC at +10.
 
Marje and Gracie said:
You’ll want to record his BG like this all in the PMPS column:

256 @ +11.75; 291 @ +13

That way we know you shot at +13 (an hour late).

You’ll also want to put in the remarks that you gave HC at +10.
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SS Updated.

A large bump from 147 to 448 - he had food at +9 (quite a bit) and nothing until pmps. At pmps he ate 1/2 a can of FF. The FF that he gets the most is beef, chicken and turkey pate.

Most, 95%+, of his dandruff is gone, at least for now. He is eating more wet food and drinking a lot less then before. Kentone is negative still.
 
Goose said:
SS Updated.

A large bump from 147 to 448 - he had food at +9 (quite a bit) and nothing until pmps. At pmps he ate 1/2 a can of FF. The FF that he gets the most is beef, chicken and turkey pate.

Most, 95%+, of his dandruff is gone, at least for now. He is eating more wet food and drinking a lot less then before. Kentone is negative still.
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He is dropping on you somewhere to have those black numbers. I would suggest you try and catch him. I know you don’t like getting up but if he’s down at +4 tonight, I’d check him again at +7 since he likes to tumble towards the end of the cycle.

That’s great that he’s doing better! We’d love to see a photo of him if you wanted to load an avatar.
 
Marje and Gracie said:
He is dropping on you somewhere to have those black numbers. I would suggest you try and catch him. I know you don’t like getting up but if he’s down at +4 tonight, I’d check him again at +7 since he likes to tumble towards the end of the cycle.

That’s great that he’s doing better! We’d love to see a photo of him if you wanted to load an avatar.
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Catch him and do? We'll do the +3 and try and get a +7. His coat looks really nice. I'll see if I can find a pic, otherwise I'll take a new one sometime soon.
 
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