Hello Meghan! *waves* So sorry about Dolo's sister, DKA is very hard to recover from.
A couple questions:
Are you using a human or pet meter?
What food are you feeding?
Are you feeding any sort of dry food?
When was Dolo diagnosed?
With Prozinc there are two different dosing protocols used. Start Low, Go Slow (SLGS) and Modified Prozinc Method (MPM).
Link to both here.
If you are using any dry, you cannot use MPM.
That said, SLGS has you holding the same dose for 7 days, and then re-evaluating the dose, either by doing an all-day curve, or if by having at least two tests done between pre-shot tests each cycle and looking at the data to decide if an increase is needed. SLGS also has reductions earned if Dolo drops below 90 at ANY point in time. Reductions are typically done by 0.25u each (as are increases).
MPM has you re-evaluating every three days, and you need to be getting at least two tests in between pre-shots every day. Reductions are earned if BG drops below 50.
Once you pick a protocol, it's important that you stick to the guidelines, but you can always switch to the other if the current protocol isn't working for you (just don't flip-flop between the two, try to stick to just one).
Looking at it from a SLGS perspective, Dolo would have earned a 0.25 u reduction on the 19th with that 62, and again the next day, but it took you a couple days to reduce. That said, you reduced from 1.5u to 1u, and we really recommend sticking with the 0.25 increase/decreases. You seem to be flip-flopping the dose a lot based on pre-shot. Here's the information pasted from the link above about lower-than-average pre-shots.
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.
I do not know what your schedule is like, but if possible it will be beneficial to get a +2 every cycle (even at night). This number is often indicative of how "active" the cycle is - ie a noticeable dip at +2 is a warning to "keep watching" and be able to intervene if necessary BEFORE there is a hypo crisis. Hypo numbers don't necessarily mean hypo.
Testing Recommendations:
+2 every cycle (if possible)
One "before bed" test
Alternate your testing times. Day 1: +4, +6 | Day 2: +3, +5, +7 (these are loose guidelines, you basically want to be filling in the gaps in your spreadsheet)
Meal-time Recommendations:
Mini meal at +2
A couple more mini meals before nadir - possibly +4 and +5, depends on what Dolo's nadir is
This advice is for BOTH cycles ... a lot of people forget about night-time feeding, but kitties drop lower at night and a kitty in low numbers will seek out food. Make sure there is some available.
Unless Deb has a different recommendation, I would suggest trying 1.25u a few days. Get those tests in so we can see all of what Dolo is doing on the dose. Do not be tempted to give MORE insulin if pre-shot is higher. That's like thinking if you put more gas in the car it'll drive faster. It doesn't work that way.
