Do Daa’s PZ Dosing

MrWorfMen's Mom said:
You hit the nail on the head when you said it's cat dependent. Around here we often say every cat is different (ECID). If this is a case of glucose toxicity, you increase until you find the dose that gets Do Daa into better numbers and then the dose will likely drop again but if Do Daa happens to be a kitty who needs a little more insulin than average, then the 5u or whatever the dose is at the time, could be what he needs going forward to keep him regulated. There is no way to predict timing or dose or whether a cat will go into remission or not. We'd all love to have a crystal ball but unfortunately we don't. Some cats get regulated relatively quickly and others take a while. Best to take this one day at a time and make the goal to get his numbers down to keep him healthy and safe.
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I figured as much, I just thought I'd ask others opinions.
 
Marje and Gracie said:
I’d also like to add that it’s not uncommon for a kitty to go up and down around a good dose. Sometimes they hit test dose, stay at it a bit, earn a dose reduction, then fizzle, and have to go back up. We just take it in stride and don’t get attached to a dose.

I’m glad he’s doing well.
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SS Updated.
Thanks, he is doing better than 500-600 that is for sure.
Ok, I have no attachment to a dose, just looking for him to do better with Yellows.
 
That was a very flat cycle today but great it was all yellow for a change. Flat yellow cycles often suggest the next cycle could be an active one so make sure you get tests tonight so if he does drop more you hopefully catch it. I think you may need to increase again but perhaps by 0.25u this time but I'd hold judgement on that till we see what he does tonight. Fingers crossed tonight is another better cycle.
 
Goose said:
SS Updated. 3 Yellows in a row today!

Today is the end of day 3 on 5u, should we hold or increase?
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Great!!!!

I agree with Linda that he still needs an increase and all that yellow is good to see. However, consider the following:

  • when the dose is lower (less than 5u) but nadirs are above 300, we increase by 0.5u until we start seeing nadirs in the 200s and that’s what we’ve done and made progress;
  • once the dose hits 5u and nadirs are still not in the 100s, we increase by 10% as it keeps the increases relative to the size of the dose. That means that it would be consistent with what we typically do to increase his dose to 5.5u in the morning unless you miraculously see a low 100 number
As long as you keep up with testing, if he’s flat yellow tonight, I would suggest increasing to 5.5u tomorrow understanding that we might be starting to approach doses which get him lower which means some additional testing will be necessary to keep him safe. But...isn’t that the goal....to get him well-regulated.
 
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MrWorfMen's Mom said:
That was a very flat cycle today but great it was all yellow for a change. Flat yellow cycles often suggest the next cycle could be an active one so make sure you get tests tonight so if he does drop more you hopefully catch it. I think you may need to increase again but perhaps by 0.25u this time but I'd hold judgement on that till we see what he does tonight. Fingers crossed tonight is another better cycle.
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Marje and Gracie said:
Great!!!!
I agree with Linda that he still needs an increase and all that yellow is good to see. However, consider the following:

  • when the dose is lower (less than 5u) but nadirs are above 300, we increase by 0.5u u til we start seeing nadirs in the 200s and that’s what we’ve done and made progress;
  • once the dose hits 5u and nadirs are still not in the 100s, we increase by 10% as it keeps the increases relative to the size of the dose. That means that it would be consistent with what we typically do to increase his dose to 5.5u in the morning unless you miraculously see a low 100 number
As long as you keep up with testing, if he’s flat yellow tonight, I would suggest increasing to 5.5u tomorrow understanding that we might be starting to approach doses which get him lower which means some additional testing will be necessary to keep him safe. But...isn’t that the goal....to get him well-regulated.
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So a test at +7 would be helpful to make sure he doesn't go down past 100? If for some reason there is a low 100 number (how low?) - keep him at 5u until I post numbers and we all talk about it tomorrow at some point?

Tonight meaning +7? .. as he's had all his test already until tomorrow amps.

So recap, 5.5u in the AM if the +7 is still in the Yellow, 5u if he goes into the 100's? Does it matter how high or low in the Yellow or Blue to shoot him with 5.5/5u? What number is to dangerous to give him insulin at this point? 100? 80?
 
Goose said:
So a test at +7 would be helpful to make sure he doesn't go down past 100? If for some reason there is a low 100 number (how low?) - keep him at 5u until I post numbers and we all talk about it tomorrow at some point?

Tonight meaning +7? .. as he's had all his test already until tomorrow amps.

So recap, 5.5u in the AM if the +7 is still in the Yellow, 5u if he goes into the 100's? Does it matter how high or low in the Yellow or Blue to shoot him with 5.5/5u? What number is to dangerous to give him insulin at this point? 100? 80?
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There are never any guarantees that he won’t drop after +7 but if you tested at +7 and he was in the 100s, you’d want to test again in an hour or two to make sure he was headed up. So, yes, tonight a +7 since he’s had his first all yellow day and he’s flat.

Yes, if you get a number in the 100 range at all, I would hold off on a dose increase until we can chat tomorrow and see how low it was, when in the cycle it was, etc., unless one of the other two ladies below posts something different as they are better versed in the nuances of PZ.

@FurBabiesMama and @MrWorfMen's Mom: with the Ls, we hold the dose at least ten cycles when first seeing nadirs in the 100s. Same with PZ or not since there is not a depot?

If all you see is yellow tonight and in the morning, I’d suggest 5.5u as long as you are willing to test a bit more if you get a low yellow AMPS. That’s just based on using 10% of the current dose (as we typically do) and has nothing to do with the type of insulin.
 
Marje and Gracie said:
I’d suggest 5.5u as long as you are willing to test a bit more if you get a low yellow AMPS.
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Overnight he has his dry food available so that would probably help with him falling to low if in fact he did. Karo is on hand also. If we get a low Yellow AMPS, additional testing (a couple) during the early daytime would be helpful, correct? ... in addition to the usual afternoon time.. (additional testing times will include him having had food, we have tried really hard to have no food before all tests because they were spread out during the day - so the food may alter the results I'd imagine.)
 
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With ProZinc, if nadirs are in the 100s then I'd hold the dose for a week and re-evaluate.

The only tests you need to be concerned with having no food influence is the pre-shot tests. Otherwise it doesn't matter. It helps though if you could make a notation like +4 (type/amt. of food) in the remarks if you know Do Daa has just eaten shortly before a test.

If you can, moving the night testing around a bit would help too. When testing at +7 every night, it's possible we could miss a lower reading. If periodically you could grab a +5 or +6 instead of always at +7 at night, it would fill in some unknowns. Do Daa's BG hasn't been moving substantially but it looks like nadir might be occurring a little before +7 and we want to try to grab tests at the lowest point in the cycle.
 
MrWorfMen's Mom said:
If you can, moving the night testing around a bit would help too. When testing at +7 every night, it's possible we could miss a lower reading. If periodically you could grab a +5 or +6 instead of always at +7 at night, it would fill in some unknowns. Do Daa's BG hasn't been moving substantially but it looks like nadir might be occurring a little before +7 and we want to try to grab tests at the lowest point in the cycle.
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hi,
I know it's possible that a reading could be missed, but we'll just need to test a little longer and try to figure it out as best we can. Randomly getting up at those hours is affecting sleep cycles too much, so some of the unknowns are likely to remain unknown.
 
MrWorfMen's Mom said:
With ProZinc, if nadirs are in the 100s then I'd hold the dose for a week and re-evaluate.

The only tests you need to be concerned with having no food influence is the pre-shot tests. Otherwise it doesn't matter. It helps though if you could make a notation like +4 (type/amt. of food) in the remarks if you know Do Daa has just eaten shortly before a test.

If you can, moving the night testing around a bit would help too. When testing at +7 every night, it's possible we could miss a lower reading. If periodically you could grab a +5 or +6 instead of always at +7 at night, it would fill in some unknowns. Do Daa's BG hasn't been moving substantially but it looks like nadir might be occurring a little before +7 and we want to try to grab tests at the lowest point in the cycle.
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Thanks for posting!
 
MrWorfMen's Mom said:
I think you may need to increase again but perhaps by 0.25u this time but I'd hold judgement on that till we see what he does tonight
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I agree with increases of .25 unit at this point, barring some totally unexpected numbers from last night, now that there is some movement. You can always continue to increase every fourth day, if/as needed. I would just be concerned about increasing by too much each time at this point.

Is there ever a day when you could do a curve? (Test before AMPS then every two hours until PMPS.) It would be helpful to have a better idea of when his nadir (lowest point in cycle) is.
 
FurBabiesMama said:
I agree with increases of .25 unit at this point, barring some totally unexpected numbers from last night, now that there is some movement. You can always continue to increase every fourth day, if/as needed. I would just be concerned about increasing by too much each time at this point.

Is there ever a day when you could do a curve? (Test before AMPS then every two hours until PMPS.) It would be helpful to have a better idea of when his nadir (lowest point in cycle) is.
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Hi,

SS Updated. He was higher as Linda had suggested he might go for the +7 and amps.
As per an above post I increased his dose to 5.5U this morning.

Should I have not done that?
 
FurBabiesMama said:
I agree with increases of .25 unit at this point, barring some totally unexpected numbers from last night, now that there is some movement. You can always continue to increase every fourth day, if/as needed. I would just be concerned about increasing by too much each time at this point.

Is there ever a day when you could do a curve? (Test before AMPS then every two hours until PMPS.) It would be helpful to have a better idea of when his nadir (lowest point in cycle) is.
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I had him increase to 5.5u due to our consistent dosing advice that once we hit 5u, dose increases need to be done by 10%. As an example, a cat at 2.5u gets a 10% increase of 0.25u. A 0.25u increase at a dose of 5u is only a 5% increase. That’s too low for that high of a dose and a cat still seeing these higher numbers.

Goose...you correctly increased. The guidance above has nothing to do with the specific insulin but the dose.

I do agree a curve would be a great help. Insofar as when the next increase would occur, let’s see how he does for six cycles.
 
Marje and Gracie said:
I had him increase to 5.5u due to our consistent dosing advice that once we hit 5u, dose increases need to be done by 10%. As an example, a cat at 2.5u gets a 10% increase of 0.25u. A 0.25u increase at a dose of 5u is only a 5% increase. That’s too low for that high of a dose and a cat still seeing these higher numbers.

Goose...you correctly increased. The guidance above has nothing to do with the specific insulin but the dose.

I do agree a curve would be a great help. Insofar as when the next increase would occur, let’s see how he does for six cycles.
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Hi,

I'm glad we didn't give him to much insulin! So we'll stick to the 5.5u (3days) Saturday - Monday and reevaluate then. As for the Curve, I can't make any promises, but we'll try to do that sooner than later.
 
Marje and Gracie said:
I had him increase to 5.5u due to our consistent dosing advice that once we hit 5u, dose increases need to be done by 10%. As an example, a cat at 2.5u gets a 10% increase of 0.25u. A 0.25u increase at a dose of 5u is only a 5% increase. That’s too low for that high of a dose and a cat still seeing these higher numbers.

Goose...you correctly increased. The guidance above has nothing to do with the specific insulin but the dose.

I do agree a curve would be a great help. Insofar as when the next increase would occur, let’s see how he does for six cycles.
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SS Updated.

Tested at +6 and he was 156 .... what to do ?
 
Goose said:
SS Updated.

Tested at +6 and he was 156 .... what to do ?
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Just saw this but it’s at +6 so I’d do your normal feeding and test in 30 mins after he eats. If he doesn’t eat, I’d test in 30 mins. We want to be careful about feeding too much after midcycle.

this is exciting!!!:woot::woot:
 
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Goose said:
My apologize. Do you want me to test him now? I know it's a little late, I got sidetracked...

I was going to test him at 6pm anyway....
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Actually, I wanted you to test him a while ago to keep him safe. For example, perhaps it “looks” like he dropped 100 in three hours. In actuality, he could have dropped 100 in the last hour and continue to drop.

So, yes, please test him now. Thank you. And just a note.....once you start getting into numbers in the mid to low 100s and below, FD is not “set and forget”. You have to test appropriately.
 
Marje and Gracie said:
Actually, I wanted you to test him a while ago to keep him safe. For example, perhaps it “looks” like he dropped 100 in three hours. In actuality, he could have dropped 100 in the last hour and continue to drop.

So, yes, please test him now. Thank you. And just a note.....once you start getting into numbers in the mid to low 100s and below, FD is not “set and forget”. You have to test appropriately.
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SS Updated I put the 543 in the +8.
Tested at 533pm. Result was 543.
He did eat at 3pm just after the test.
 
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Next time you get a test like the 156, you might want to retest just to be sure it’s valid.

For a cat to go from 156 to 543 in two hours, that tells me the following:
  • carbs from the meal were too much and completely halted his duration
  • he dropped kind of fast from somewhere and has started a bounce
Any time we see such a huge skyrocket, it’s typically loss of duration and it’s amplified by a bounce likely starting. However, without the loss of duration, I doubt you would have seen numbers do that.

I would continue with the 5.5u dose.

Thanks!
 
Marje and Gracie said:
Next time you get a test like the 156, you might want to retest just to be sure it’s valid.

For a cat to go from 156 to 543 in two hours, that tells me the following:
  • carbs from the meal were too much and completely halted his duration
  • he dropped kind of fast from somewhere and has started a bounce
Any time we see such a huge skyrocket, it’s typically loss of duration and it’s amplified by a bounce likely starting. However, without the loss of duration, I doubt you would have seen numbers do that.

I would continue with the 5.5u dose.

Thanks!
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If we get a test like or similar to the 156, we'll test twice to make sure it's valid. He did eat quite a bit of wet and dry, he was hungry. As the insulin has increased, so has his appetite.
We'll continue with the 5.5u through Monday.
 
Also...I was reading back through this as I missed a couple days and I want to clarify that New Dose Wonkiness does not exist when using insulins that do not have a depot. In other words.....we only see it with Lantus and Levemir, not PZ.
 
Marje and Gracie said:
Also...I was reading back through this as I missed a couple days and I want to clarify that New Dose Wonkiness does not exist when using insulins that do not have a depot. In other words.....we only see it with Lantus and Levemir, not PZ.
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Ok.
SS Updated.
On 11/25/19 we tested him at pmps and then we tested him again 1 hour later and he went from 399 to 596 based solely on food. So food seems to effect him quite a lot.
 
Goose said:
Ok.
SS Updated.
On 11/25/19 we tested him at pmps and then we tested him again 1 hour later and he went from 399 to 596 based solely on food. So food seems to effect him quite a lot.
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You would expect that to happen as the insulin is at the end of its duration. If you give him high carb dry food, it’s going to really raise his BG towards the end of the cycle.
 
Hello, Marje asked me to stop in. I had a kitty that needed larger doses too.

Goose said:
It just doesn't seem like the numbers are lowering with any amount of insulin.
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Looks like you are starting to see a response to the insulin. :) I am glad you went with a 0.5 unit increase today. At this size of dose, you need to get their attention with the larger increases, unless you are seeing some greens. Which you will one day.
 
Wendy&Neko said:
Hello, Marje asked me to stop in. I had a kitty that needed larger doses too.


Looks like you are starting to see a response to the insulin. :) I am glad you went with a 0.5 unit increase today. At this size of dose, you need to get their attention with the larger increases, unless you are seeing some greens. Which you will one day.
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SS Updated.

Hi and thanks! Who's attention am I getting? No, definitely no Greens, it's hard enough to get consistent Yellows.
 
Goose said:
SS Updated.

Hi and thanks! Who's attention am I getting? No, definitely no Greens, it's hard enough to get consistent Yellows.
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Da’s attention :) And the diabetes. Wendy is our high-dose expert. Da is not quite there yet but at 6u he will be.
 
Marje and Gracie said:
There are two ways you can approach it:
  • Increase to 6u as long as you don’t see any numbers below 120 tonight
  • Do a curve and then increase to 6u because he needs it but curves are always great to have
At 6u, we recommend you test for high dose conditions. Your vet draws the blood according to the instructions and sends it in.
Insulin autoantibody (IAA)
Insulin Like Growth Factor (IGF-1) for acromegaly
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SS Updated. Curve was done 12/17/2019 amps - pmps.

What's next for dosage? We are still using the original bottle of Prozinc. There is a day or so left. (80 days with this bottle) So, has it lost it's effectiveness and that is a factor with his numbers, or?
 
Great job with the curve. Those black numbers make me wonder if he dipped down a little bit last night. Still, it wouldn’t have been enough to negate the need for a 0.5u increase. I would raise the dose to 6u in the morning.

I doubt there is an issue with the insulin. Does it have any weird floaties in it or has it changed appearance?
 
Marje and Gracie said:
Great job with the curve. Those black numbers make me wonder if he dipped down a little bit last night. Still, it wouldn’t have been enough to negate the need for a 0.5u increase. I would raise the dose to 6u in the morning.

I doubt there is an issue with the insulin. Does it have any weird floaties in it or has it changed appearance?
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Ok. 6u in the am Wed-Fri.
There is no change in the insulin.
 
Marje and Gracie said:
Great job with the curve. Those black numbers make me wonder if he dipped down a little bit last night. Still, it wouldn’t have been enough to negate the need for a 0.5u increase. I would raise the dose to 6u in the morning.

I doubt there is an issue with the insulin. Does it have any weird floaties in it or has it changed appearance?
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SS Updated. Virtually no change in numbers :(

Old bottle of Prozinc is done, new one starts tomorrow morning. Maybe there will be a difference....
 
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Goose said:
SS Updated. Virtually no change in numbers :(

Old bottle of Prozinc is done, new one starts tomorrow morning. Maybe they will be a difference....
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Thank you. You might want to grab just a few more tests tomorrow just in case it is the insulin.
 
Just a curiosity....what kind of food did Do Daa eat 2 hours before PMPS last night? That is an interestingly large rise in BG.
 
MrWorfMen's Mom said:
Just a curiosity....what kind of food did Do Daa eat 2 hours before PMPS last night? That is an interestingly large rise in BG.
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He has had no change in his food. 1/4 of a can of FF pate at best, and maybe 15 or so individual pieces of Clean Protein Chicken. Amps and Pmps he is hungriest, usually 1/2 can FF and the same amount of CP.

I have no idea why that number went up so much.
 
Goose said:
Hi,
Which extra time/test would be helpful? Preferably daytime.
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I was just suggesting you test around onset to be sure there isn’t a big drop from new insulin. So +3 or so. If there is a big drop, you’ll want to test again sooner rather than later.
 
Marje and Gracie said:
I was just suggesting you test around onset to be sure there isn’t a big drop from new insulin. So +3 or so. If there is a big drop, you’ll want to test again sooner rather than later.
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SS Updated. A couple other tests were done. Still mid to high 300's with that 600 there.
 
I have to wonder if Do Daa dropped lower in the early hours of last night's cycle and that red reading later in the cycle and black this AM is a bounce. It's great you got that +7 last night, but grabbing at least a before bed test is important too. Last night it might have shed some light on those later higher readings and it also gives you a clue as to what Do Daa's cycle is looking like (active or not) so you know whether to monitor earlier than +7.
 
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