Dose increase

Lmiller86

Lmiller86

Member
Hello all,
Hoping for a little dosing assistance, please. See link pasted below, my signature link keeps messing up. So yesterday Baby went to the vet, which for some reason always produces lower BG (Monday the 7th was also vet visit). Anyways, he looked at her info thus far and recommended an increase to 4 units. She had just started 3 Friday morning and I've been trying my best to go slow. Well, as you can see I kept her at 3. Compared to how it's been going, she had a good Amps number today so I definitely didn't think an increase was in order this morning. Well... Today's numbers so far are horrible (high). It seems that the 3 units (other than the vet visit) doesn't seem to be having a big enough effect. I feel like an increase is in order, but an entire unit scares me! Would those of you who know prozinc recommend that a 0.5 increase is acceptable with the data I have?

Thank you!!!!
@FrostD

https://docs.google.com/spreadsheet...v07PYZd4MDMTYP5luT979lWTxHk/edit?usp=drivesdk
 
Last edited:
Ah sorry didn't get the tag! FYI when you edit your post, or tag as part of an edit, it usually breaks the tag notifications.

She definitely needs an increase, but not to 4, yikes.

Here is where you kind of have to figure out what works for you -
- per the guidelines, you're following SLGS because of the dry food. That means 0.25U increases only.
- on the flipside, you usually test enough to catch any issues - BUT - the dry food can be unpredictable. I worry a bit about her kidneys, and ketones as well Those blues on the 15th give me a bit of pause, and there are cycles missing tests, but I still think it would be ok to go to 3.5U, provided you can get at least one test in near nadir each cycle. <This advice deviates from the dosing methods as written>
 
FrostD said:
Ah sorry didn't get the tag! FYI when you edit your post, or tag as part of an edit, it usually breaks the tag notifications.

She definitely needs an increase, but not to 4, yikes.

Here is where you kind of have to figure out what works for you -
- per the guidelines, you're following SLGS because of the dry food. That means 0.25U increases only.
- on the flipside, you usually test enough to catch any issues - BUT - the dry food can be unpredictable. I worry a bit about her kidneys, and ketones as well Those blues on the 15th give me a bit of pause, and there are cycles missing tests, but I still think it would be ok to go to 3.5U, provided you can get at least one test in near nadir each cycle. <This advice deviates from the dosing methods as written>
Click to expand...

Thank you!
 
Lmiller86 said:
Thank you!
Click to expand...
FrostD said:
Ah sorry didn't get the tag! FYI when you edit your post, or tag as part of an edit, it usually breaks the tag notifications.

She definitely needs an increase, but not to 4, yikes.

Here is where you kind of have to figure out what works for you -
- per the guidelines, you're following SLGS because of the dry food. That means 0.25U increases only.
- on the flipside, you usually test enough to catch any issues - BUT - the dry food can be unpredictable. I worry a bit about her kidneys, and ketones as well Those blues on the 15th give me a bit of pause, and there are cycles missing tests, but I still think it would be ok to go to 3.5U, provided you can get at least one test in near nadir each cycle. <This advice deviates from the dosing methods as written>
Click to expand...

Yes, the jump to 4 seemed a bit much. Tonight I went to 3.3 units (so 0.3 increase) and so far it's holding her down after her meal which is good, and I will set an alarm for a nadir. I wish I didn't have to leave dry (it's kidney formula as well) but she won't eat wet food if it's sitting. Very picky girl. And I have been testing for ketones, so far negative. And I pray it stays that way! I very much appreciate your thoughts and time you put into this page. You are so wise and helping us more than you could ever know!
 
Oh geez your SS opened with the time column visible and I about fell out of my chair thinking you went up to 7U :eek: now that my heart has effectively rebooted...

Glucose toxicity. Because she used to the high numbers, her body tries to maintain that as her normal. Just have to keep increasing until you break through. Most cats break through by 3-5U...once they hit 6U it is pretty much guaranteed there's an underlying condition, but we'll talk about that if you start to get to 5U.

Remember the Novolin was very harsh - so it basically overwhelmed his poor body every shot, but then his body panicked, so big swings. I'm not sure if youve ever had BG issues personally, but the swings feel like going from lightheaded to getting slammed into a wall.
 
FrostD said:
Oh geez your SS opened with the time column visible and I about fell out of my chair thinking you went up to 7U :eek: now that my heart has effectively rebooted...

Glucose toxicity. Because she used to the high numbers, her body tries to maintain that as her normal. Just have to keep increasing until you break through. Most cats break through by 3-5U...once they hit 6U it is pretty much guaranteed there's an underlying condition, but we'll talk about that if you start to get to 5U.

Remember the Novolin was very harsh - so it basically overwhelmed his poor body every shot, but then his body panicked, so big swings. I'm not sure if youve ever had BG issues personally, but the swings feel like going from lightheaded to getting slammed into a wall.
Click to expand...

Hmmm OK. For a cat who shows this glucose toxicity, is slowly raising the dose still the choice recommendation? I think I read if kinda flat and nadir above 200, dose increases by half a unit.
 
Lmiller86 said:
Hmmm OK. For a cat who shows this glucose toxicity, is slowly raising the dose still the choice recommendation? I think I read if kinda flat and nadir above 200, dose increases by half a unit.
Click to expand...
You did read that for MPM, the catch is that requires a completely low carb/wet diet (I understand your constraints). The trouble with the dry food and higher carbs is they tend to hang around and affect cycles unpredictably. So MPM would have you increasing every 3-6 cycles, possibly up to half unit, but that's not quite enough time for the dose to settle in.

This is very much do what you feel is right for your situation. I think you understand the risks well enough to make an educated decision.

So - official guidance is 0.25U increases once a week per SLGS.

My personal thought is 0.25U increase every 4-5 days is ok. If no blue numbers, I think 0.5U increase ok but I'm a little hesitant on that just because of unpredictability. Once you start seeing blues though it's for sure only 0.25U
 
And any guidance on how to proceed tonight would be appreciated! Do I jump right back to the full dose of 3.4? Obviously, numbers pending but I am anticipating high
 
Wow! Almost made me eat my words - also what I meant about predictability. So now you actually need to reduce your normal dose down to 3.2 (I think that's the next lowest on your syringes) because he went below 90. If you are around and see this I'd get another test right now just to be safe, got some extra long duration from last night's shot.

I suspect the combination of these lows plus the skipped shot (right thing to do btw) he'll be sky high tonight, so you'd give the new dose
 
Hi @FrostD! When you have a chance, could you give me preshot guidance? At one point, due to early drops I think you advised giving a full dose at 400. I've gotten brave and done full doses in low 300s but today I panicked a little and cut her dose from 3.2 to a fat 2 because at hour 13 she was still going down. 240 at 13. She's 499 tonight, so I suspected I should have given a larger dose? Too bad it was a work day!

Additionally, how early do you recommend giving a dose? I've done a few doses (when she was high) up to a hour early and nothing crazy happened. Just curious for getting back on track after stalls die to low nadirs.

See chart here: https://docs.google.com/spreadsheet...S7Fkl2bDM9mcAKwEI4ucxaCaoos/edit?usp=drivesdk
 
Lmiller86 said:
Hi @FrostD! When you have a chance, could you give me preshot guidance? At one point, due to early drops I think you advised giving a full dose at 400. I've gotten brave and done full doses in low 300s but today I panicked a little and cut her dose from 3.2 to a fat 2 because at hour 13 she was still going down. 240 at 13. She's 499 tonight, so I suspected I should have given a larger dose? Too bad it was a work day!

Additionally, how early do you recommend giving a dose? I've done a few doses (when she was high) up to a hour early and nothing crazy happened. Just curious for getting back on track after stalls die to low nadirs.

See chart here: https://docs.google.com/spreadsheet...S7Fkl2bDM9mcAKwEI4ucxaCaoos/edit?usp=drivesdk
Click to expand...


Also remember when my vet said go to 4 units?! Your recommendation of 3.2 has been great. Also remember purple column 2 is my u100 measurement
 
Hey all data is good data! Glad it's been working for you.

So yes you know 3.2 is good 350+ (usually, it leaves a nice safety margin for if she happens to swing lower on a given day).

I think today was a combination of the bounce plus the reduced dose, but you really had no way to know that was coming. 2U was a pretty safe bet.

Here's my thoughts (and this is a bit of a crapshoot, just best guesses):
300+ - try 3.2U if you can monitor. This should still leave safety margin (remember down to 68 is safe for AlphaTrak).
250-299 - try something like 2.5-2.75U if you can monitor
200-249 - 2-2.5U if you can monitor
Below that I think you'll have to take a bit of a guess. I would skip anything below 150. Above that...around 1U?
 
FrostD said:
Hey all data is good data! Glad it's been working for you.

So yes you know 3.2 is good 350+ (usually, it leaves a nice safety margin for if she happens to swing lower on a given day).

I think today was a combination of the bounce plus the reduced dose, but you really had no way to know that was coming. 2U was a pretty safe bet.

Here's my thoughts (and this is a bit of a crapshoot, just best guesses):
300+ - try 3.2U if you can monitor. This should still leave safety margin (remember down to 68 is safe for AlphaTrak).
250-299 - try something like 2.5-2.75U if you can monitor
200-249 - 2-2.5U if you can monitor
Below that I think you'll have to take a bit of a guess. I would skip anything below 150. Above that...around 1U?
Click to expand...

Thank you so much! That is so helpful!!!
 
Hey @FrostD!

Just when I thought I had this figured out... Last night was my third time shooting in the yellows. After what I looked like trace ketone results, I have been really concerned with Baby staying in highs all day. (BTW Since then I got a negative result.) Well last night, shooting in the yellow, I must have gotten too aggressive. I thought since the past two doses in the yellow did not impact her much (they were decreased doses), I'd be safe to go a little more. Whelp... She dropped way too fast and those numbers are with me being up super late feeding her and giving some honey :( She did not look happy!

Do you have any different guidance going forward with the data I have now? Seems like 3.2keeps her in 300sbut a fat one nadirs late and thus the situation of 200s at 12 hour.

https://docs.google.com/spreadsheet...0a4ejJG6mkWuTc71uSjBcu23iuo/edit?usp=drivesdk
 
Lmiller86 said:
Hey @FrostD!

Just when I thought I had this figured out... Last night was my third time shooting in the yellows. After what I looked like trace ketone results, I have been really concerned with Baby staying in highs all day. (BTW Since then I got a negative result.) Well last night, shooting in the yellow, I must have gotten too aggressive. I thought since the past two doses in the yellow did not impact her much (they were decreased doses), I'd be safe to go a little more. Whelp... She dropped way too fast and those numbers are with me being up super late feeding her and giving some honey :( She did not look happy!

Do you have any different guidance going forward with the data I have now? Seems like 3.2keeps her in 300sbut a fat one nadirs late and thus the situation of 200s at 12 hour.

https://docs.google.com/spreadsheet...0a4ejJG6mkWuTc71uSjBcu23iuo/edit?usp=drivesdk
Click to expand...
Link in your post says I don't have access...I went back a few posts and tried to open that one but says deleted
 
I've been staring at it for awhile now...I think it's a mix of the high carb/dry food, but also bounce.s I think that hang in low yellows Sunday AM led to a bounce overnight, which she then broke yesterday AM cycle for a long slow slide down (same also happened Saturday AM/PM). So she was still dead flat at PMPS, and for whatever reason didn't bounce.

So it makes it hard to predict, but also is progress (shrug?)?

I think perhaps stick to the 2.6 in that situation just to give you more wiggle room since the bounce isn't predictable. Those numbers were perfectly safe btw, we actually save high carb for under 68 on an AT (unless it's a big fast drop with some time til nadir), and honey under 60-ish m. Was she snacking on the wet or dry last night?
 
She wasn't eating on her own for first 3 hours, so that's when I started holding the wet food up to her. I used the honey to slow her dropping. It scared me. I was worried if it would last till hour 6 or 7 and if it kept dropping at that pace, it'd be scary. I am glad the dropping lost its steam, but I believe it would have been way worse if I hadn't been shoving food in her face and adding honey. She didn't get up and do anything until after that 130 read. And yes, I've been more pleased with her numbers! I love not seeing blacks! Hoping I don't get one tonight. Thank you as always!
 
The thing to remember is her nadir on a normal cycle is about +4/+5, it's those bounce breaks where it's later.

Also a thought, when were her last labs, and when are her next ones?
 
FrostD said:
The thing to remember is her nadir on a normal cycle is about +4/+5, it's those bounce breaks where it's later.

Also a thought, when were her last labs, and when are her next ones?
Click to expand...

Last blood work was within 2-4 months... I think I have to get a copy from vet. Kidneys get checked often. Crea was 2.4 and bun 60 something I believe. She had raised sodium levels (vet said probably from sub qs) , and cholesterol but other than that most everything same or normal.
 
Lmiller86 said:
Last blood work was within 2-4 months... I think I have to get a copy from vet. Kidneys get checked often. Crea was 2.4 and bun 60 something I believe. She had raised sodium levels (vet said probably from sub qs) , and cholesterol but other than that most everything same or normal.
Click to expand...
Ok good!

Just sometimes like like anemia can also make things a little wacky
 
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