? Dose for Kit Kat

Suzanne & Darcy said:
I wish you would not let him give Kit Lat back to back Convenia injections like that. We have had cays die from severe anemia after repeated Convenia injections.
If you are not going to be home tomorrow then there’s not much you can do about the high numbers for the time being. After that, we can see what to do.
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I do have an appt., but I don't have another for a little while. My appt. is @ 1:15 p.m., so we will be home in the evening. I do not know what has changed, could the high numbers still be from the low numbers the other night. I will not let him give Kit Kat another Convenia for a while. I did give his shot at 7:30 p.m.
 
When I took his BG it was 331 @7:30 and @9:30 it was 333, maybe I'm wrong maybe it's coming down. I guess tomorrow will tell.
 
Teresa & KitKat said:
It will, I have to have a visit ever so often, because every 90 days he gives me a nerve block.
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I just got a Ketone test and it looks like trace to me.
Teresa & KitKat said:
It will, I have to have a visit ever so often, because every 90 days he gives me a nerve block.
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I got BG @4hrs and it was 240, yesterday it was lower. If possible would you be around late this afternoon or early evening so he could get his shot @7:00 and if possible we could discuss his dose. He has already peed twice today and on Saturday and Sunday he only peed once and that was after I went to bed. I don't want to put you in a bad position, but I do not want his ketones to get higher.
 
Teresa & KitKat said:
I just got a Ketone test and it looks like trace to me.

I got BG @4hrs and it was 240, yesterday it was lower. If possible would you be around late this afternoon or early evening so he could get his shot @7:00 and if possible we could discuss his dose. He has already peed twice today and on Saturday and Sunday he only peed once and that was after I went to bed. I don't want to put you in a bad position, but I do not want his ketones to get higher.
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Okay. Be calm. Trace ketone is okay. I am not happy with the higher numbers either.
 
Suzanne & Darcy said:
At least he was only in yellow so far today. That is a little bit better.
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He was on 1.50 but we let him have 1.25 because his number was low to start amps and then we ran with that until sunday night because of me staying up almost all night we dropped down to 100 and he had not been on 100 until Sunday night. then on Monday morning I gave him 100, just because I was afraid he might go low. It is a big drop from 1.50 or 1.25 to .75. i know all we can do is raise his dose, but I do not want to make you mad at me or cause trouble. i am getting all of his stuff for PMPS together because his shot time is 7, so what should I do.
 
I think that you can shoot one unit tonight, but we can’t just go changing the dose every few days when following SLGS. We need to hold this dose for seven days unless a reduction is earned or his ketones go above trace.
 
Suzanne & Darcy said:
I think that you can shoot one unit tonight, but we can’t just go changing the dose every few days when following SLGS. We need to hold this dose for seven days unless a reduction is earned or his ketones go above trace.
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I can change to the modified Prozinc and change every 3 cycles, and if you look where they first start talking about Prozinc, they say when you first start hold for 3 days, then after that you can change when ever you want because it is an in and out insulin, not like the others.
i don't know what happened this week-end, it has had something to do with his tooth, if we had not lowered his dose it could have killed him. I have different times looked at different cats SS, and people lower the doses all the time. I know that you can not approve of that, but it happens every day. Some go back and forth. The idea is to be what is best for the cat and we know holding the dose @.75 or @ 100 is not what is best for KitKat.
 
Yes, but the reduction point for the Modified ProZinc Method is 50 instead of 90 like it is with SLGS. The target BG range is 50-120 instead of 90-149. I will be back with you in a little while when I get home.
 
I, too, see a lot of spreadsheet. I see people who are floundering around giving different doses all the time - to the detriment of their cats. That’s not usually the people who post on this forum for help however. I see people who are inexperienced and are constantly changing the dose and frequently not giving enough insulin and their cat goes too high.

I have also helped quite a few ProZinc users get their cats into remission, if that is their goal. I have also helped quite a few members here get their cats very well-regulated. It’s not easy. Cats don’t get diabetic overnight and it takes time for their bodies to adjust and to heal. It’s hard on the caregivers as well. It’s a huge commitment.

Anyway— you mentioned that you look at a lot of spreadsheet….. I also see a lot of things on spreadsheets. I see people who do not understand the dosing protocols or do not see any need to follow them. I am not saying that I don’t customize things to each cat because, over time, we will customize things as long as it’s safe to do so. That is why, tonight, I recommend increasing KitKat’s dose back up to 1 unit without waiting the full 7 days (although you notice today his numbers have come down.)

When helping FDMB members, I also have to take into consideration the situation of each caregiver….. their schedule, job, home situation, health status, mental health status, as well as their goals for their cat. If KitKat were my cat, I would not have reduced his dose back to .75 to begin with, but it was not in your best interest to potentially stay up another night… so we decreased the dose. I would have suggested MPM, but you have already indicated that you prefer blue numbers and not green. I understand that greens are scary to caregivers when they are new to them.

I am certainly not going to allow Ketones to build up in KitKat, but so far, he has not had any ketone level above Trace that you have tested in his urine. The protocols were developed and studied over a long period of time. They have safety features built into them. Perhaps @Marje and Gracie can explain this better than I am.

You have mentioned things from the dosing methods. I will copy and paste some things here that relevant to your comments this evening:

Quote
  • PZ typically lasts 10-14 hours in most cats, and one cycle affects the next, so when changing dose, it can take a few cycles before you really see the impact of the change. It’s not uncommon for the first cycle after a dose increase to be a little higher. If this happens, try not to get discouraged. Wait a couple of cycles, collect data, and see what the BG does.

  • After the initial adjustment period, subsequent doses should be held for 3-6 cycles and data collected to determine next steps. Changing doses faster than that, or trying to use a sliding scale, nearly always results in bouncing and wild unpredictable variations in blood glucose, or BG getting stuck high and flat as if nothing is happening. Small steady dose changes work best.

Have a great night, Teresa.
 
Suzanne & Darcy said:
I, too, see a lot of spreadsheet. I see people who are floundering around giving different doses all the time - to the detriment of their cats. That’s not usually the people who post on this forum for help however. I see people who are inexperienced and are constantly changing the dose and frequently not giving enough insulin and their cat goes too high.

I have also helped quite a few ProZinc users get their cats into remission, if that is their goal. I have also helped quite a few members here get their cats very well-regulated. It’s not easy. Cats don’t get diabetic overnight and it takes time for their bodies to adjust and to heal. It’s hard on the caregivers as well. It’s a huge commitment.

Anyway— you mentioned that you look at a lot of spreadsheet….. I also see a lot of things on spreadsheets. I see people who do not understand the dosing protocols or do not see any need to follow them. I am not saying that I don’t customize things to each cat because, over time, we will customize things as long as it’s safe to do so. That is why, tonight, I recommend increasing KitKat’s dose back up to 1 unit without waiting the full 7 days (although you notice today his numbers have come down.)

When helping FDMB members, I also have to take into consideration the situation of each caregiver….. their schedule, job, home situation, health status, mental health status, as well as their goals for their cat. If KitKat were my cat, I would not have reduced his dose back to .75 to begin with, but it was not in your best interest to potentially stay up another night… so we decreased the dose. I would have suggested MPM, but you have already indicated that you prefer blue numbers and not green. I understand that greens are scary to caregivers when they are new to them.

I am certainly not going to allow Ketones to build up in KitKat, but so far, he has not had any ketone level above Trace that you have tested in his urine. The protocols were developed and studied over a long period of time. They have safety features built into them. Perhaps @Marje and Gracie can explain this better than I am.

You have mentioned things from the dosing methods. I will copy and paste some things here that relevant to your comments this evening:

Quote
  • PZ typically lasts 10-14 hours in most cats, and one cycle affects the next, so when changing dose, it can take a few cycles before you really see the impact of the change. It’s not uncommon for the first cycle after a dose increase to be a little higher. If this happens, try not to get discouraged. Wait a couple of cycles, collect data, and see what the BG does.

  • After the initial adjustment period, subsequent doses should be held for 3-6 cycles and data collected to determine next steps. Changing doses faster than that, or trying to use a sliding scale, nearly always results in bouncing and wild unpredictable variations in blood glucose, or BG getting stuck high and flat as if nothing is happening. Small steady dose changes work best.

Have a great night, Teresa.
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I am positive what you say is in the ProZinc sticky's. But, if you look at what I said it is also in the Prozinc sticky's. In some of the ProZinc sticky's they speak of a cycle as one injection not one day. I am not trying to do tit for tat, only trying to do what is best for my cat. And staying at a low dose when there is a possibility of Ketones is not what is best for KitKat.
 
You are taking the prozinc stickys out of context. You must take the full counsel of the sticky notes. I referred specifically to the dosing method and not just the getting started sticky.
Teresa & KitKat said:
And staying at a low dose when there is a possibility of Ketones is not what is best for KitKat.
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Exactly. That is why I recommended increasing to 1 unit tonight
 
One cycle can affect the next. That is a fact.

And yes. … I think everyone knows that a “cycle” is a 12 hour period in which one injection is given. I don’t even know why we are talking about the definition of a cycle, as that has never been an issue. A cycle is 12 hours. There are two cycles per day. Two shots per day. And one cycle can affect the next. This is established.
 
So I don’t know why we are even discussing this. You asked me what I thought. I recommended increasing to one unit tonight. You increased to 1 unit. So far so good.

I know you will keep close tabs on Kit Kat. I know you love him and are trying your best to help him.
 
Teresa & KitKat said:
And staying at a low dose when there is a possibility of Ketones is not what is best for KitKat.
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And why do you even say this? Why are you being so combative? I suggested a dose increase tonight — even when he was in numbers lower than he has been for days! I would have asked you to do it before except you said you were concerned because he had a vet appointment one day and the next you had an appointment — so I understood the need to wait. If it weren’t for that, I would have kept him at 1 unit for a while because the numbers he got on the evening of January 26 were lovely numbers, many of which were in the normal BG range for cats. After that night, he also appeared to be bouncing and it was best for us to wait until his numbers came down, which they did today. I have already stated that I will be more aggressive if ketones are present. My own cat had DKA and was hospitalized for one week. I have helped many others with both ketones and recovering DKA kitties. I take high ketones very seriously. You are the one who wanted the decreased dose so you could get some sleep (which I definitely understood and I tried to accommodate you.) I have inquired about the ketones. I have not criticized you, and I don’t understand your antipathy toward me all of a sudden. It’s as if you think I am against KitKat or something, which obviously I am not, or I would not even be on this forum.

I think there must be a misunderstanding between the two of us. I admire and respect your dedication to getting Kit Kat better. I am sorry you seem to think I am incompetent and that I am against you and Kit Kat. I will leave it at that. If I have offended you, I apologize.
 
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Suzanne & Darcy said:
And why do you even say this? Why are you being so combative? I suggested a dose increase tonight — even when he was in numbers lower than he has been for days! I would have asked you to do it before except you said you were concerned because he had a vet appointment one day and the next you had an appointment — so I understood the need to wait. If it weren’t for that, I would have kept him at 1 unit for a while because the numbers he got on the evening of January 26 were lovely numbers, many of which were in the normal BG range for cats. After that night, he also appeared to be bouncing and it was best for us to wait until his numbers came down, which they did today. I have already stated that I will be more aggressive if ketones are present. My own cat had DKA and was hospitalized for one week. I have helped many others with both ketones and recovering DKA kitties. I take high ketones very seriously. You are the one who wanted the decreased dose so you could get some sleep (which I definitely understood and I tried to accommodate you.) I have inquired about the ketones. I have not criticized you, and I don’t understand your antipathy toward me all of a sudden. It’s as if you think I am against KitKat or something, which obviously I am not, or I would not even be on this forum.

I think there must be a misunderstanding between the two of us. I admire and respect your dedication to getting Kit Kat better. I am sorry you seem to think I am incompetent and that I am against you and Kit Kat. I will leave it at that. If I have offended you, I apologize.
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I do not think you are incompetent and I do not think you are against me and Kit Kat, also you have not offended me. I guess I thought when you lowered the dose because of low numbers, you just went back to where you were before the low numbers. I was afraid that if his insulin dose went lower he stood more of a chance of ketones. I was afraid if he got sick that I could not take care of him. At this time I am having a lot of health problems and I am having trouble doing what I am doing. The last time his dose was 100, he still had the bad tooth. This time I believe he is doing better. I apologize for anything that made you think I took this personal. I did not. The problem here is, I am afraid I cannot take care of any more of his health issues. He is doing fine.
 
Teresa & KitKat said:
I do not think you are incompetent and I do not think you are against me and Kit Kat, also you have not offended me. I guess I thought when you lowered the dose because of low numbers, you just went back to where you were before the low numbers. I was afraid that if his insulin dose went lower he stood more of a chance of ketones. I was afraid if he got sick that I could not take care of him. At this time I am having a lot of health problems and I am having trouble doing what I am doing. The last time his dose was 100, he still had the bad tooth. This time I believe he is doing better. I apologize for anything that made you think I took this personal. I did not. The problem here is, I am afraid I cannot take care of any more of his health issues. He is doing fine.
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@Suzanne & Darcy,
 
I do hope he will do better on the 1 unit, but if he’s not, we can increase. There were just a lot of things going on (tooth, appointments, sleepless nights) going on. We have to try to balance it all out. I understand worrying about whether you can take care of him. Just the diabetes is a lot. Your own health was one of my concerns after the sleepless nights.
 
Suzanne & Darcy said:
I do hope he will do better on the 1 unit, but if he’s not, we can increase. There were just a lot of things going on (tooth, appointments, sleepless nights) going on. We have to try to balance it all out. I understand worrying about whether you can take care of him. Just the diabetes is a lot. Your own health was one of my concerns after the sleepless nights.
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KitKat's vet did a lot trying to halt his diabetes because of me, he put him on a very strict diet for about 3 months, put him on a diet for diabetics. He went from almost 15 lbs. to 10 lbs., I am hoping that he gains some weight back and his back legs get stronger. Finally, he decided that he at least needed to be on Vetsulin once a day. After a week or two on Vetsulin, I asked him to put him on ProZinc and he did. One of my problems is I am older than when Buddy was diabetic and it was rough back then, but now the all nighters are almost impossible for some one my age. I just want Kit Kat to be well again and regain strength in his back legs. Tonight at PMPS he was 408. I don't if he is just high or it is a bounce. I hope he is not that high. Good Night.
 
KitKat's AMPS 396, I am hoping this is a bounce. Last night @PMPS 408. He is having high BG numbers, hoping they are a bounce.
 
I looked at his spreadsheet earlier and noticed this. I think it’s a reaction to the lower number yesterday. I don’t know how long that will last. I hope he will come down lower today.
 
If you want to switch to MPM, go ahead and bump him up to 1.25 units after today’s morning cycle (so this evening) or whenever you feel ready. I would understand if you wanted to wait until a morning cycle to do the increase.
 
Suzanne & Darcy said:
If you want to switch to MPM, go ahead and bump him up to 1.25 units after today’s morning cycle (so this evening) or whenever you feel ready. I would understand if you wanted to wait until a morning cycle to do the increase.
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Thank you. I appreciate that. I will see how he does today and then decided.
 
Teresa & KitKat said:
, I am hoping that he gains some weight back and his back legs get stronger.
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hi Teresa

I also hope KitKat regains his weight and his back legs get stronger. I have a couple of ideas about the legs if @Suzanne & Darcy agrees.

probably some of his weakness is from muscle loss in his legs. A good diet and doing the best you can with his diabetes will help him regain some muscle. Three additional things you may want to check:
Many diabetic cats have low potassium levels due to shifts in potassium out of the bloodstream and into cells as a result of insulin use. You may want to see what his last potassium level was and if it was a while ago consider getting another one to see if he needs a potassium supplement. Low potassium can also cause constipation.

You may also want to consider using B-12–it needs to be a certain type, I will try to find it but people have mentioned it on the forum so Suzanne may know about it. Diabetic cats sometime have nerve damage to their legs and some say this certain type of B12 helps.

Finally if KitKat hasn’t had his thyroid checked recently you might consider having that checked. Older cats often have overactive thyroids which can cause weight loss and weakness. They probably did a test for this when he was diagnosed but you may want to make sure.
 
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SmallestSparrow said:
hi Teresa

I also hope KitKat regains his weight and his back legs get stronger. I have a couple of ideas about the legs if @Suzanne & Darcy agrees.

probably some of his weakness is from muscle loss in his legs. A good diet and doing the best you can with his diabetes will help him regain some muscle. Three additional things you may want to check:
Many diabetic cats have low potassium levels due to shifts in potassium out of the bloodstream and into cells as a result of insulin use. You may want to see what his last potassium level was and if it was a while ago consider getting another one to see if he needs a potassium supplement. Low potassium can also cause constipation.

You may also want to consider using B-12–it needs to be a certain type, I will try to find it but people have mentioned it on the forum so Suzanne may know about it. Diabetic cats sometime have nerve damage to their legs and some say this certain type of B12 helps.

Finally if KitKat hasn’t had his thyroid checked recently you might consider having that checked. Older cats often have overactive thyroids which can cause weight loss and weakness. They probably did a test for this when he was diagnosed but you may want to make sure.
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In the latter part of December i took him to a different vet, because his vet does not board and this one does. She ran a test on him that would show if he had anything wrong and he did not, except he had unregulated diabetes. So I suppose his potassium was alright. I know his vet checked his potassium in November. He is using B12 that contains something they say it needs to help his back legs. When he goes back to the vet I will mention the potassium and ask him to check his thyroid. Thank you, for telling me about these different problems, i will have his vet check them out.
 
The thyroid test isn’t part of a regular panel so you might want to ask the cost but I think you have pet insurance. I just don’t want you to be surprised by the charge. I hope you get some good sleep and KitKat improves—you and Suzanne are doing so good for him
 
It would be wonderful if you could get copies of his bloodwork so you could know for sure if his potassium was checked. Low potassium can definitely cause hind leg weakness (actually general weakness and lethargy as well, but it really depends on how low the potassium is.)

In a Senior cat, it’s always a good idea to get a “Senior Panel” done periodically. If your vet used the IDEXX lab, they have a “Total Health Plus Profile” panel that includes a T4 (thyroid) test. I always get this one for my senior kitties as you get more information for the price (although lab prices have gone up A LOT) in recent years.
 
Suzanne & Darcy said:
You are using the correct type of B-12 (methylcobalamin) for Kit Kat. I don’t know if you have had a chance to add on the folate yet.
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Honestly, I have not been feeling very well and I forgot about the folate. I did see where someone posted that not everyone got the folate and the B12 still worked. This morning his AMPS is 492, I have new test strips, so I thought I would wait an hour or two and recheck him. I bought more than 1 box of test strips, so I got the other box out. If that does not work, guess I will be going after a new bottle of insulin. I have noticed him urinating more. On 12/23/24 I took him to see a different vet because they board and his vet does not. She ran a test on him that shows everything about him, she said only thing wrong was he had unregulated diabetes. I see all kinds of things on this report, it is called a Senior Profile. It cost $300.00 and my insurance only pays for illness and accidents. I do not see anything that says thyroid, unless it is listed as something else. I have had a couple of cats that had thyroid problems and I don't see anything at this time that stands out about to make me think thyroid. I will ask his vet the next time I take him in, I take him in a lot.
 
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