Dosing advice appreciated

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lmcfrld

lmcfrld

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MIsha has been on Prozinc since 11/26/12. I have adjusted his dose a couple of times (see spreadsheet). Currently, for the last few days, his numbers have been in the mid-100's to mid-200's range. I shared the spreadsheet with my vet, and she wants me to continue the .5 unit once a day dosage. From posts here, it seems it is better to shoot two doses of Prozinc rather than just one. I tried to get u100 syringes at the pharmacy the other day, and the pharmacist confused me with her talk about why the u100 wouldn't work for what I wanted to do (measure .25u, or .6 with the u100 according to the conversion chart).

Misha got .25u (me eyeballing the u40 syringe) last night, and I full expected his BG to have spiked this morning, but it is only 192. I will be at work all day so I can't stay home and monitor him. (I was home sick yesterday which is why I was able to do a curve yesterday). Should I give him .25u?? Or skip it since it's under 200? It seems that the advice around here is not to shoot if under 200, but if Misha's overall BG range is decreasing, do I need to start thinking about shooting under 200?

Thanks so much for your help!
Lora
 
If you could be around, I would definitely say to go with the .25 and monitor. But since you won't be around, I think either skip or give a drop. (to give a drop, put the .25 in the syringe and then push down just a bit until you get a droplet out. Or two if you can see that a drop might be left. This is tricky and if you can't get it to work, then skip). You might practice the drops tonight when you have time with water and mark the syringe as a guide for next time.

If you decide on the drop, leave food out for him.

You have skipped before and he only went up to the low 200s, so skipping should be okay too. It's only one shot and you can get him back on track.

Go with your gut - what feels safest to you.
 
Thanks Sue. Do you have any advice as to my other questions? Do I need to start thinking about dosing him when he's under 200? This is so new to me, and it seems like his numbers are dropping very nicely, but I'm not sure how to keep up with that. :)
 
Yes, I think you could start dosing under 200, but it would be best if you can monitor. Most people have a number like 150 - 180 that hey are willing to shoot. The most important times are around +3 to see how he is responding (so you can feed and raise a low number if you need to) and then at around +6 for the same reason. The U100 needles will help with that, although if you are giving drops, you can do that with your U40s.

This forum is not as busy as Health, so if you need immediate help, go there. But you should get some dosing advice here.
 
Lora, here is some info on mini dosing:
When your cat is consistently in numbers too low to shoot at shot time and in numbers in the 100 range and below during the cycle, you can consider micro dosing. This process should be guided on the forum by experienced members and will require more frequent testing.

You may be shooting at times other than the 12/12 schedule, when the blood glucose levels rise enough to require a small dose of insulin. You will need to pick a number somewhere near the 150 range at which you will plan to shoot, being sure that the number is indeed rising. The dose at these low numbers will vary with each cat and its patterns, so advice should be solicited. But you may be considering doses below .25 and even considering a “drop” of insulin. At this point, U100 needles and the conversion chart will be necessary.

It is important during this period to offer small frequent meals. You may want to experiment with the lowest carb foods to help bring down the numbers, staying away from seafood more than once or twice a week.

And giving drops of insulin:
Giving insulin by drops: http://felinediabetes.com/FDMB/viewtopi ... 24#p360982

And here is Catannc's spreadsheet. She was one who dosed by drops and tiny amounts so you can get some idea of how it can be done. Other people use that 180-200 number and never dose until it reaches that, regardless of when it is - and it is often off the 12/12 schedule. You'll need to think about what will work for you and your life and your comfort level.

https://docs.google.com/spreadsheet/ccc?key=0AmNJBvQd8oAkdHRrOE5HNWpYS2xQOGt2dWNYU1NfS0E#gid=0
 
Sue has outlined a good plan for you. It all comes down to what you are comfortable with doing as far as "how low do I shoot?" goes. The other big factor is whether you can be there to check the BG afterwards.

You basically decide "OK, if he's above X, then I will give him insulin". You don't want to give him shots closer than 12 hours apart, but you would most likely be giving shots further than 12 hours apart.
Like if you see a 100 at +12, you would just wait until you saw a number higher than your line-in-the-sand, and shoot at that time. The downside to that is that if you stall on giving the shot, you also have to stall on feeding, because the food is going to raise the BG, and you don't want to give insulin on a BG number that is only high because he just ate an hour or two ago.
That shoots your schedule all to hell though. The bright side is that once you get to the point where you're doing this, it usually doesn't take long before you have the real possibility that he's going into remission.

The key is "know your cat". You have to have an idea of what a dose will do before you give it. You have to be able to look at it as "alright, he's at 150, I can give him .2u" and feel that it won't drop him too much if you can't be there 3 or 4 hours later to test him. It can be pretty stressful. I never had to do this with Bob. The way I did it was to change the dose based on the preshot numbers, but kept the shots 12 hours apart. My schedule wouldn't have allowed me to alter his shot times too much (although I was on a "give or take an hour" routine for most of the time Bob was on PZI.)

Like Sue said, you'll get Prozinc specific advice posting in this forum, but if you need an answer quickly, post on the Health forum where it will be seen more quickly. Of course, if it's an emergency, add the 911 icon to your subject line.

Carl
 
I will be on vacation for three weeks beginning this saturday (I work in the school system...christmas vacation), so it sounds like that would be a good time to start trying to dose under 200. That way I'm home and can keep an eye on him and check his BG on a regular basis. Thanks for all your advice and tips.
 
Lora,
If you haven't already, it might be a good time to buy the U100 syringes and print out the conversion chart. It will help with tweaking these tiny doses.
Carl
 
Sorry Sue...the link still doesn't connect to anything. I get a 'Page not found" message.

Update....Misha has not had any insulin in almost 48 hours. Got home from work a bit early today so I tested him at +8 and he's 125. I haven't picked up the u100 syringes yet, and I'm not comfortable yet with giving "drops". Not sure what to do...if anything?
 
Hmmm. It works for me: http://felinediabetes.com/FDMB/viewtopic.php?f=10&t=34424#p360982 It's a thread and has pictures of what drops look like a few posts down.

It sounds like he is doing real well on his own. You skipped at 185 and he brought himself down. This is a good thing! I would test when you can and if he gets up in the 200s, consider pulling up the .25 and let a couple drops out, then shoot the amount left? It certainly isn't precise.

A kitty, off insulin, who ranges from 40-120 with the majority of the time in double digits is in the remission range. Misha is still in that 120+ range part of the time, but I love that he comes down without insulin.

Are you doing the small frequent meals?
 
That latest link works! Thanks! The previous ones had "..." in the middle that must have been missing necessary code.

I have not been able to do the small meals with Misha, as I work and am gone from 7:30-4. I've been feeding and shooting at 5:30am/pm. I'm still feeding at 5:30am/pm, just not shooting as much. :-D I'm on vacation the next three weeks though, should I start feeding 4 times/day?

I looked at the link regarding drops...curious how that drop on the end of the syringe actually gets injected? Wouldn't just fall off at contact with the skin?
 
The drop at the end is for practice, so you get a feeling for how much a drop is in the syringe. (Disclaimer - I have not done drops; I have just tried to help people do it.)

Four times a day is fine - small meals between the two regular preshot time meals. When you go back to work, a timed feeder can be wonderful. I love my PetSafe5. It has 5 compartments, is easy to program and my cats have not been able to get into it. You can find it online at Amazon and at PetSmart.
 
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