? Dosing advice for Billie. Is this a bounce?

Giddymoon & Billie

Giddymoon & Billie

Member Since 2020
Hi,
I'm new to the forum. Just reading the entries in the forum has been so helpful and supportive. Thank you!
Also, I wasn't sure who to include as a participant, so if there's another way to do this, please let me know.

We've been trying to get Billie's insulin dose regulated since the beginning of November. It's not been easy. We've still not found the right dose and we're using ProZ, 6.75u 2x/day. This seems very high to me, but my vet assures me that it's not unusual. Sometimes I think that we should start all over again. I've tested randomly, but after reading the suggestions on the forum, I've started using your SS which has helped. I've posted it on my signature.

Yesterday we had some blue times, today at +6 she went into the green, but at +9 she's at 475. I'm not really sure, but from what I've read this could be a bounce??

Also, She gets anxious, very vocal and almost panicky when her blood sugar starts to go down into the lower numbers, meowing and doing everything she can to get food. I gave her a little bit of Tiki chicken (no carbs) which settled her a bit, but she needed some tender care before she was able to calm down and go to sleep. We had one other time, about 2 weeks ago when her blood sugar dropped to the blue level then the next day went to 37 at about +5. Instead of being drowsy she was panicky at that time too. I lowered her dose to 6 and we've been working our way back up again.

I've spoken to the vet about this, but without the SS, I didn't have consistent enough data for her. Would it be helpful if I entered data I collected from earlier in the month?

Any insights and guidance would be appreciated. Thank you again.
 
Hello and welcome. I'm not a Prozinc user, but I'm sure one will be along soon. And thanks you for using the spreadsheet. It is very helpful.

What food are you feeding Billie? Over 6 units is not common if you are feeding an all low carb wet or raw diet. What dose did you start on and how were the decisions made to increase? If you saw a 37, that definitely means the dose is too high and needs to be lowered. What dose were you giving that day? Could you put the information for that day in the spreadsheet?

If cats are used to higher numbers, their body gets panicked when it sees lower numbers. Only once they've spent more time in normal numbers does their body get used to it.
 
Hi Wendy & Neko,
Thanks so much for your response. I'm feeding Billie Tiki Luau that has 0 carbs. It's mostly chicken or chicken and fish or egg. When she was diagnosed in late October she was eating Origen low fat dry food and another canned food. We started with Tiki at the end of November. We started at 3u and I did some simple BG testing, mostly at +3 and/or +6, but I wasn't consistent and only did one or two/day if any. I was pretty overwhelmed by everything and didn't understand the importance of keeping closer track. Her high numbers at this point were in the mid 300's (AlphaTrak2). The lows I have recorded were in the low to mid 200's, but as I said, I don't really know what her lows were. She seemed much better at the beginning and she's lost strength over time. After on a particular dose for a week with no obvious improvement, I'd consult with the vet and usually increase the dose by 1u. We were up to 7u at the end of the third week of December. I'll add my data to the spreadsheet. I have to admit that medical things are not a strong point for me, so the learning curve has felt steep. I wish I'd found the forum earlier.

Makes sense about the body panic with lower numbers.

Should I be posting on the ProZinc section of the forum or start in the general forum?
 
Hello Giddymoon and Billie! I'm a newbie, so I'm not going to try to give you dosing advice. I just wanted to say that you can absolutely post an introductory post and ask some questions on the Welcome/Main forum. People visit it more regularly than this section.

How much is Billie eating each day? How many times a day are you feeding her? She might need a little more if she's begging. You could also try some zero carb treats such as cooked chicken breast, or Halo freeze dried chicken. My big boy Billy loves the freeze dried chicken.

My vet wanted us to only feed twice a day, but I knew that wasn't good enough when one is trying to regulate blood sugar levels. Just like human diabetics do better with many small meals through the day, cats often do better that way too. I feed Billy whenever he's hungry, and make sure I don't give him anything for 2 hours before his shot time, so I can be sure he's hungry enough to eat when he gets his insulin. My fat boy is even losing some weight, despite all the feeding. The low carb wet food makes all the difference.
 
First comment, thank you for putting more values in the spreadsheet. We are all rather data driven here and it does help. It looks like the number of units given are missing in the evenings at the beginning? That's the U column, which is blank for a bit. Did you just give one dose a day?

You can get help either here or in the Feline Health forum. New people needing help with food, testing, and setting up the spreadsheet tend to start in Health, but it looks like you've got those basics covered already. :) Second, it's really important to get a test before every shot, in order to make sure it's safe to give the shot. That's what we call our preshot test.

One of the people who helps with Prozinc dosing @MrWorfMen's Mom just lost an older kitty, but she may be around again to help.
 
Any data that you have from earlier BG (blood glucose) testing would be appreciated so thanks for putting that in there. The SS helps us to see what is going on. Immensely helpful.

p.s. @Giddymoon & Billie started a Conversation with me and I asked her to start in the forum she wanted and to just copy what she had said in the PM to a public post. That is why it mentions "including participants" at the top of her post. So glad to see you found your way here!
 
Not a Prozinc user either, but I can make some general observations that apply to most of the in-and-out type insulins.

1. Testing before every shot helps to know if the BG is high enough to give your cat insulin. Highly recommended, because for example, what if one of your pre-shots had been that 37 you got at +5 on 12/26?
2. Hypo range for an Alphatrak meter starts at 69. It's when you have to start paying attention to the numbers, watch for mild to moderate to severe hypoglycemic symptoms and help to get the numbers back up with food.
3. Do you have the hypo instructions and a hypo toolkit ready?
4. The 6.75U dose is too much. You want to keep the BG nadir around 90-100 if using a human meter, a bit higher than that for a pet specific meter like the Alphatrak 2 you are using.
5. Looks like you are 'eyeballing' the amounts to get some of those doses. Do your U40 syringes have 1/2 unit markings or are you using U100 syringes with the conversion chart?
6. Looks like your cat Billy nadir's around +4 to +7 timeframe, which is pretty typical. It's good to know that.
7. When you got some of those low BG readings did you feed to bring the numbers back up? Asking because it would help us understand the sharp rise in BG's. For instance, on 1/15/20 AM cycle, did you feed when you got that 83 BG? Any notes about that in the remarks column would be useful.
8. Great testing on the AM cycle. Are you around to get a reading in the PM cycle? Maybe before you go to bed/ head off to work? If you don't test much in the PM 'you are missing half your data' as someone else on the board frequently says.

Let us know what is possible for you. We all have life commitments, work, family, aging parents. We'll try to brainstorm to work with you and what you can do, proposing different ideas.

Did you find this already BEGINNER’S GUIDE TO PROZINC/ PZI INSULIN FOR DIABETIC CATS

p.s. Are you ok with us using your first name in a public post?
 
First, I'm Linda... I'm happy to use my name in a public post. Thank you all for all the good help and support.
I've taken your advice and started testing prior to each shot. I'm surprised at how much the spreadsheet helps and I'm becoming a convert. I've finally found the sweet spot for taking the BG's in Billie's ear, so it's much easier than originally. We live on the west coast in Washington and work from home so I have a lot of flexibility and opportunity to test. My husband works from home tool, but he's more squeamish about testing so hasn't learned how as yet. That will be necessary since I'll be more regularly spending a couple of weeks at a time with my elderly parents are on the East Coast. I'm using ProZinc with U40 needles. There is a half unit mark, but I have to eyeball for smaller increments.

When Billie's BG was low I fed her, at first only treats, but when her distress continued, I gave her some of her regular wet food. I will certainly take a closer look at the Hypo material and prepare a hypo toolkit. I liked Juls & Billy's suggestion of spreading her eating times out over the day and since I'm mostly at home, I could do that. I'll check my notes and add anything that seems relevant to the SS.

A few things:
1. In your experience when would you increase/decrease the dose? If 6.75 is too high, what would be more appropriate, 6 or 6.5? My vet helps with this, but it seems from looking at the forum that people make micro-adjustments as needed. I'm not sure how this works.
2. Deb, you mentioned keeping the BG nadir around 90-100 or a little higher with AlphaTrak. We haven't consistently been in that range. Is there anything else I should be looking at on the SS?
3. Yes, I did find the Beginner's guide to ProZinc. Thanks. I'll take another look. I'm sure there's material I missed the first time around.
4. I started testing once before I go to bed. Our feedings/shot times are 6:15 am and pm, so I can get a +3 and sometimes +4 reading. Early to bed, early to rise...
5. Food. Billie gets 6oz of wet food in the morning and evening. She was still hungry when I fed her less. Too much? She's not losing or gaining weight so it seems okay. I'm thinking of distributing that more throughout the day as Juls & Billy suggested.

You all are great!
Got to go.
 
Giddymoon & Billie said:
First, I'm Linda... I'm happy to use my name in a public post.
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Someone the other day had an issue with giving their first name, so that is why I asked. First time I ever ran into that here. My first name really is Deb.

I may be repeating things you already know or do, so please bear with me.

Having minions, I mean assistants, to help with the testing and shots is truly helpful. People work late, something unexpected happens and you need that support system. Hope your husband can get over his squeamishness.

Preshot test, good. Try to pick up the food 2 hours before the AMPS and PMPS so you get a non food influenced reading. Eventually those pre-shot BG readings will get lower and you don't want them too low at shot time. SS, glad you are a convert. Standardized format so we can take a quick glance and see issues quickly. Looked at a few over the years, that's how I was able to pick out some things I saw and give you feedback.

Sweet spot and ear warming help with testing, as do bribes (pure protein treats). Schedule flexibility is good but we all need to sleep sometime! Thanks for the syringe confirmation. Not everyone knows that the U40 syringes are available with half unit markings. Helps with the smaller dose adjustments.

Having a cat that lets you know vocally when the BG's are low is a treasure. Many cats show no symptoms when BG's are low.

Feeding is better done in the first half of the insulin cycle (12 hours being a cycle), before +6. That is because the insulin starts to 'wear off' and if you feed after that, the BG's can spike back up quickly. So, yes spreading out the meals to a few earlier in each cycle is fine. A lot of people use timed feeders to do that, if they are away at work or at night while they are sleeping.

Keep working closely with your vet. Some vets are not used to people home testing so may only adjust doses with a one time office visit test. Share your SS with your vet.

Feel free to confirm anything we say with your vet. We are lay people that know a lot about feline diabetes (and sometimes other conditions). Day to day experience with managing diabetes can be valuable but ask your vet if you are in doubt. I do try to keep current with the latest feline diabetes vet journal research. I'll be happen to pass some of that along to you.
1. In your experience when would you increase/decrease the dose? If 6.75 is too high, what would be more appropriate, 6 or 6.5? My vet helps with this, but it seems from looking at the forum that people make micro-adjustments as needed. I'm not sure how this works.
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I said the dose is too high because you dropped to that 83 mid-cycle on 1/15 using an Alphatrak meter (pet meter). That mid-cycle number raised a red flag to me. Dropping to anything under 100 on a pet meter is what we would call an "automatic dose reduction". We'd suggest reducing by either 0.25 u or 0.5 u at a time. Down to 6.5 or 6.25 is the question. I'm not sure on that. You hold the syringe, you are there to see how Billie is doing. Your choice.

Increasing the dose? Not sure when. This is where my inexperience with Prozinc comes in. Other people are better with the micro-dosing. I'm not as confident with Prozinc. Have used some of the other in-and-out insulins and help people with those.

2. Deb, you mentioned keeping the BG nadir around 90-100 or a little higher with AlphaTrak. We haven't consistently been in that range. Is there anything else I should be looking at on the SS?
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You are not likely to see nadirs down below 100 consistently yet. But when you do see one, it's time to think about reducing. Better regulation is needed before you get more consistent numbers.

Duration. Looked pretty decent on the curve you did on 1/13. Do you do your own curves at home?

3. Yes, I did find the Beginner's guide to ProZinc. Thanks. I'll take another look. I'm sure there's material I missed the first time around.
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So much information here it's difficult to take it all in.

4. I started testing once before I go to bed. Our feedings/shot times are 6:15 am and pm, so I can get a +3 and sometimes +4 reading. Early to bed, early to rise...
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Define early? 9:15 my time is 6:15 your time. Cats often drop more at night because they are more active then. Those drops can lead to bouncing, but you don't know about them because you are not testing. Catch-22. If you ever happen to wake up at night around +6, you could do a test. I think of it as more clues in the puzzle.

5. Food. Billie gets 6oz of wet food in the morning and evening. She was still hungry when I fed her less. Too much? She's not losing or gaining weight so it seems okay. I'm thinking of distributing that more throughout the day as Juls & Billy suggested.
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12 oz a day total. Is your girl at Ideal weight? Too skinny? Too chunky? Vet should be able to tell you. That food amount was about the same quantity as what mine was eating at first. Unregulated diabetic cats are always hungry. Can't process all the food properly. Ideal weight is what you are aiming for with your Billie girl.

That's all I have for now. We are a peer reviewed message board, so if someone spots something wrong in what I said, they will let you know. If we ever ask for too much, please feel free to push back and say 'No can do'.
 
Deb, This is so valuable. You don't (well, maybe you do) know how edifying it is to be able to share in the wisdom of all you generous people managing feline diabetes on a day to day basis.

I was planning to get a few more days of testing (I do all the testing at home) and then share the spreadsheet with my vet and powwow about the next steps.

I hadn't read your post when I did the first shot this morning, but I'll bring the dose back down to 6.5u tonight. Maybe we need to spend more time at a dose to get a better sense. I'll speak to my vet about this when she can see more data.

It will be a happy day when we get more consistent nadirs in the below-100 range.

I'll try testing sometime in the middle of the night. Might not happen right away.

Our Billie girl runs a little heavy. She lost a lot of weight before she was diagnosed, but has stabilized now at the lower weight. She's not as active in the winter as in the summer either when she's outside a lot more. When I spoke with the vet earlier, she wasn't concerned about her weight. That she's not properly digesting her food sounds about right.

One other thing I forgot to mention, she was diagnosed with diabetes after having two steroid shots this summer for allergies to grasses she's recently developed. I think she was susceptible to diabetes anyway, but that may have been the last straw. I wonder how long it takes for the steroids to be cleared from a cat's system?

Lots to digest for me. I'll report back.
 
Hi Linda,

Could you put some information in your "signature" for us please? See those tiny bits of information at the end of my posts? That is the kind of information we like to see. Go to your user profile to change things. You could shorten the name for your SS link also while you are there. Something like Billie's SS.

Do you know how to do those 2 things? Some folks are more computer savvy than others.

Having info like your first name, kitties name, Dx date, insulin used, meter used, allergies, steroid shots, etc. in the signature will help us to see things at a glance. It gets 'magically' attached to all your posts.

Steroid induced diabetes can sometimes respond to treatment more easily. She may have been pre-diabetic before the steroid shots and then that in combination with a little bit of excess weight just tipped her over the edge into diabetes. Keeping the weight at an ideal weight helps to manage the diabetes.

Playtime in the winter when they can't go outside. Even with my screened in porch, it's just too darn cold for my cat to be outside this time of year. Too many coyotes and cars around to risk her being outside to freely roam. My little girl loves her heated cat bed. Or when I turn on the space heater for her.

The ultimate goal is to get your cat feeling better. Treat the whole cat. ECID Every Cat is Different. Every Caregiver is Different.

p.s. People here helped me when I had a diabetic cat. Paying it forward.
 
I just updated my signature. I was wondering how all that info magically appeared after posts. I used your profile and Wink's as models.

I'll check again with my vet about Billie's weight. She's eating a no-carb diet (Tiki Luau) with freeze-dried treats and her weight seems stable right now.

Billie always finds the warmest place in our house, which is usually in my favorite chair upstairs where the heat rises;-) She will occasionally go outside to watch for creatures, which is great. The focus of stalking does a lot to get her ya-yas out.

ECID. Love that.

Update: Billie's PSPM was 239 (AlphaTrak2) and so I decided not to give her a shot. I'll get a BG reading before I go to bed and then see what her numbers are in the morning.
 
Looks to me like you have chosen 250 as your No-shoot threshold number for now. Skipping that large dose will certainly lead to a bounce this morning at pre-shot test. (AMPS). Don't panic if you see HI on your meter. It simply means the BG is over the highest value it can interpret.

You could have stalled for a bit also last night. Stalling is an important technique if BG is not yet high enough at test time to shoot insulin.

Please keep your SS (spreadsheet) updated as much as possible. I always open it first, to see any updates before replying to people.

PMPS (PM for evening, PS for pre-shot) We do use a lot of slang terms here, and abbreviations. Glossary here with a lot of the terms we use.

Changes to signature will appear in all future and past posts. Software behind the scenes is doing that, making the connection between data in your profile and your posts. Might as well call it 'magic'.
 
BG not as high as expected, 429, this morning.
I read about stalling just after I had fed Billie. Next time I'll know. That would have been a preferable route.
Yes. PMPS, not PSPM, oops!

Enjoy your day.
 
Since Billie has been eating raw food, her numbers have been better, mostly blues in the midday and not so high at AM and PMPS. At PMPS yesterday, her BG was 213, so I didn't give her insulin. I'm wondering if giving her a smaller dose would be okay so as not to lose the momentum. After talking with my vet, we've been maintaining her at her 6.5u to let her diet change take effect and see if that impacts her numbers. Any thoughts would be welcome. Thanks.
 
Here's my thoughts, and I'm not as experiences as Deb & Wink. I would hold steady for now, and expect that bounce next reading. If you test for ketones, now is the time. A skipped dose can sometimes cause ketones. Next time your number is under what you want to shoot, you can absolutely do a half dose, but I would try stalling for 20 minutes without feeding first, if your schedule allows. If you do a half dose, you might want to do a BGL test at +5 and +7 just to make sure BGL is where it should be. Billie seems to be doing well on the current dose, but if you get to a point where you are skipping more, or shooting half doses more, then try dropping the dose by .25 of a unit. Then wait 3 12-hour cycles and see what's happening and re-evaluate. Today, you are getting some bounce numbers from the skipped dose, and that's to be expected. Don't worry about those pinks. You and Billie are doing awesome. Keep doing what you are doing and keep up the home testing.
 
Thanks so much, Juls and Billy. Those pinks are a little alarming in the middle of her cycle, I had not considered it was a bounce... I'm just a nervous Nellie these days. A half dose feels about right. I appreciate the input and the hand-holding!
 
For the note on the SS in the remarks column, if you could note that was for the AM shot, that would be helpful. A month from now, we might not remember. Today we know, because you haven't tested for the PM cycle or given insulin - yet.

With the skipped dose, expect a bounce. Probably take about 3 days to clear. I'd suggest lowering your 'shoot/no-shoot number to 225. Yes, I see you are using the Alphatrak, but you have some wiggle room to go lower at mid-day. What do you think? Are you comfortable doing that?

You are getting some good test data now, testing before each shot at both AM and PM. Getting those PM cycle tests before bed is great too.

I still think Billie is dropping low somewhere in the PM cycle and you are not catching it. Wait 3 days for the bounce to clear, then we'll reassess. You know what I'm going to ask for next? Any way to get a test in now and then later than the +3 or +4 PM test? Maybe you get up in the middle of the night for something else, like a drink of water? Tell me to 'go fly a kite' if that later test around +6 or +7 is impossible. Or less kind words if you want.

But I think that Billie may need a dose reduction back to 6U, but it's hard to tell.

How are the 5 P's (peeing, pooping, purring, playing, preening) and Billie's appetite? How your cat is doing with those 6 things gives us a good sense of how he's feeling, a good visual assessment. Our cats are not just a bunch of BG numbers.

p.s. You are doing well Juls & Billy, very well. Linda, you are doing very well too!
 
I just added the AM note on the SS.

Haha! No need to go 'fly a kite'... I was thinking I needed to do the same, and it doesn't hurt to get a little nudge. Do you think it would be best to do some late-night tests after the bounce clears?

A dose reduction would be great. Maybe with a little more data it will be clearer.

The 5 P's: Peeing has gotten more toward normal since we started feeding her raw food. She's pooping regularly, but with raw food, the volume has decreased. She does seem more playful these days and is enjoying some outdoor time. Her appetite is monstrous, even with the lower numbers. She loves the new food but wants more and more and yowls a lot. It's like she's got a big tiger inside that wants to be fed. That may be due in part to my having given in to her and feeding snacks and now I have to walk it back. She's getting about 8 oz of raw food a day. I've ordered an automatic feeder. Maybe more feedings will help. We'll see. Yes...not all numbers.

This has been a quick note, so I'll review later to see that I didn't miss anything. Thanks for the pats;-)
 
Just thinking about your comment about Billie's insulin dose being too high. I've noticed that when her BG level drops Billie gets more restless and frantic for food instead of more lethargic. She seemed immensely satisfied with her food and the amount when we first started raw food. It's been about a week and now she's acting as if she's still hungry after meals and her BG has been more often lower than before. Tonight at +3 her BG was at 119 and she was meowing constantly for food. I gave her some and she's quieted. I'll test her again tonight at +4 and +5. After doing her AMPS, I may do 6u in the morning and see if that helps.
 
That's a good catch. If her BGL is getting low, or even if it's falling nicely into the green and her body isn't used to it, it could make her really hungry. You might consider feeding her some extra on those days. You can always cut the food back down when she gets better regulated and has less bounce going on.
 
Good idea. She'll be happier and feel better with more food. I was reluctant to give in to her food requests since she's always loved her food. But maybe she wasn't getting what she needed nutritionally either and was letting me know. Billie thanks you and Billy.
 
Hi Linda! Looking at your spreadsheet, it appears you've missed a couple dose reductions lately. From what I've read and been told by more experienced members, anytime you get a reading below 90, it's time for a decrease (0.25 units). If my cat had your same numbers at the moment, I would reduce to 6.25. Just my two cents! :)

You're doing a great job!
 
@Giddymoon & Billie YOU NEED TO DROP THAT DOSE NOW!!! Sorry to "yell" at you, but Billie girl is coming down the dosing scale and we need to let her. Raw food may be having an impact.

Suggest dropping to 5.75U from the 6.25U you gave this morning. For the PM shot tonight, 1/25/20

Are you around today to test at mid-cycle? I sure hope so, or you left some extra food out for her. Did Billie show any hypo symptoms last night, beyond begging for more food? She knew she had low BG and she let you know it. Alphatrak numbers <80 mean you need to feed a bit of food to bring those numbers back up. Not in hypoglycemia but headed there.

Billie prone to ketones? Please test her anyway.

Giddymoon & Billie said:
I just added the AM note on the SS.

Haha! No need to go 'fly a kite'... I was thinking I needed to do the same, and it doesn't hurt to get a little nudge. Do you think it would be best to do some late-night tests after the bounce clears?
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You wanted a little Nudge did you? Well, Wink's full name was Wink Wink Nudge Nudge. Affectionately came to be called Nudgie Boy.

Yes, some late night tests after the bounce clears would be good. (Just read the SS, and you got some late night tests last night that show me Billie is due for another dose reduction. I'd like to see it dropped by at least 0.5U for the PM shot tonight. 1/25/20. I thought he was dropping low at night, and those late night tests showed you that.)

More normal pee amounts (from oceans to lakes, to small ponds, to .......) is great, Less poop because on raw food is expected. More playful is fantastic!
Her appetite is monstrous, even with the lower numbers.She loves the new food but wants more and more and yowls a lot. It's like she's got a big tiger inside that wants to be fed. That may be due in part to my having given in to her and feeding snacks and now I have to walk it back. She's getting about 8 oz of raw food a day. I've ordered an automatic feeder. Maybe more feedings will help.
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Unregulated diabetic cats are extremely hungry. Their body can't process the food correctly without the correct amount of insulin. DO NOT try and feed Billie less to control the BG numbers. That does not/will not work.

How big is Billie? Weight ok, too skinny, just right, too fat?

Wink was eating about 11 oz wet food a day at his peak and that decreased over a couple of months to 6-7 ounces for a 11-12 pound cat. He lost a lot of weight in the beginning and needed to gain a couple of pounds back. He wasn't convinced that wet food was even edible (charter member of DFAA - Dry Food Addicts Anonymous) and it was hard to get him to eat the wet food and stop the dry food. My point is that 8oz of food may not be enough for Billie right now.

Two articles written by members here that may be of interest to you on the food amounts. Both can be found in the Health Links/FAQS forum. Look in the first sticky post, the INDEX to find lots of other articles. Take it slow, there is a LOT there and I don't want you to feel overwhelmed.
Feed Kitty As Much As They Want?
Feeding Lowest/Zero Carb vs Lower Carb Foods

Notes in the Remarks column on the 5 P's can help you (and those of us that read Billie's SS) see her progress over time.

Lowering shoot/no shoot threshold? Maybe? Never MIND!!!! Billie is diving off the highest platform into the swimming pool. You need to keep your current 250 shoot/no-shoot threshold. Elevator headed from the penthouse suite to the hotel lobby.
 
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I just saw your note. Yikes. I'm listening. I lowered her dose tonight to 6.0 and will lower it again in the morning to 5.75. I fed her several times last night and she seemed good after my last test, sleeping. She was very hungry again in the morning. I fed her more again. Tonight I fed her as much as she wanted and she seems satisfied now. Good to hear that it's okay just to feed as much as she wants now. I'll test at +3 and get some later night tests as well. She lost quite a lot of weight in the beginning but seems to have stabilized at around 12 lbs. The raw food diet has changed everything. Reading the articles you sent next. Have to test for ketones.
 
Ok, glad that you saw my note. Where's that smiley face with wiping the sweat off the brow? Here's a big one for you. upload_2020-1-26_8-30-54.jpeg


She's bouncing, so don't be surprised to see some higher numbers for a good 3 cycles or more.
So yesterday 1/25/20 AM Billie went from 415 to 185 so that is a 56% drop. Bouncing is very likely with that big of a drop.
Still think you should take the dose down to 5.75U for now. You can increase/decrease after that when the bounce has cleared.

With an Alphatrak and Prozinc, the "need to take action, keep a closer eye on your cat" BG number is in the 100 to 120 range. If you see that, you might want to take another test within a hour to see which direction the numbers are headed. Hopefully up, but if they are headed down then you might need another test or try giving a bit of regular food.

With an Alphatrak and Prozinc, the "need to take action, more testing needed, closer monitoring, headed for a possible hypo" is if you see a BG number of 69. And if it happens early in the cycle, you may be hours trying to bring the BG's back up with some food, simple sugar like corn syrup or honey, maybe some medium carb food.

If that ever happens, the <69 mg/dL with an Alphatrak, use the 911 prefix and post that 911 on the Feline Health Main and Welcome forum. Lots of people may not have Prozinc insulin experience specifically. BUT lots of people do know how to walk you through feeding and testing if your cat has low numbers and can guide you through that process.

"If you need help with a hypo, post right away on the PZI forum and on the Health forum with the title: 911 HYPO - Need Help ASAP to get the maximum guidance to help you steer your cat back to safer levels. If hypo symptoms are severe (seizure/loss of consciousness, etc.) go to the nearest ER vet clinic immediately."

With Prozinc, you want to see about a 50% drop from pre-shot to mid-cycle tests. Don't worry so much about the BG readings later in the cycle, as the insulin is wearing off and you'll likely see them rising.

I'll keep my eye out for you, but I can't always be here. Have to sleep sometime and I'm in EST timezone and you are in PST timezone. I've probably gone to sleep before you've even had dinner. Plus my cat Dancer gets 'needy' and starts meowing at me and she tells me "GET OFF the computer mom and pay attention to me. NOW."
 

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p.s. Housekeeping chores. When you get chance, please update the tab on your SS to say 2020. Hoping Billie isn't here long, but some cats go off and then back on insulins. So in the future, you may find yourself back here at some point and want a SS tab for each year.
 
Phew! This stuff gets scary and overwhelming at times. I gave Billie a little canned food with some carbs last night along with her raw food snack. I've been testing so much I ran out of strips, hence only one test last night and one this morning. I'm expecting a delivery today, so it's visual monitoring until they come. I'll give her a little food around her usual dip times, +4/+5. Good to have those AlphaTrak/Prozinc number guidelines.
You are the best:bighug: Thanks for keeping an eye on us, it's appreciated. But, we all need our sleep;-)
 
Phew! This stuff gets scary and overwhelming at times.
Click to expand...
It can get intense at times. For us as well as you. I always liked to have an extra vial of test strips when I had a diabetic cat. They can surprise you, like Billie is doing to you now with those lower numbers at mid-cycle. Whenever you change the dose, you unfortunately need to test a bit more. "We try to keep kitties safe."

Deep breath, hold, release, deep breath, hold, release. Doing my "Mindfulness breathing" to decompress.

New person over in main health forum right now, that is a bit of a complicated case to get him the best recommendations and suggestions on how to proceed. He has a newborn girl/boy human baby also plus cat had pancreatitis and possibly DKA. Plus he got really low numbers with an Alphatrak, changed food to low carb, stopped insulin, uses Prozinc and wants to know what to do. At least he finally put info in his signature and has a SS up and running. We're not vets, but we do know a lot about feline diabetes.

Yes, those Alphatrak test strips aren't available everywhere. Not like a human glucometer. Might be worth it to get a good human glucometer and strips to have as a backup.

Link to some info on BG meters. It's a bit dated, but it's the best we have available. Human glucometers read lower than the Alphatrak.

Blood Glucose Meter Ratings, Comparisons, and Recommendations
 
Deep breaths. Amazing how much that helps when I remember.

Backup strips are on my list. Thanks for the extra info on différent types.

I feel for the new person with the baby and kitty with feline diabetes. This forum is a blessing. We’re all fortunate that you and others like you as so willing to share your wisdom. I can imagine how intense it can get for you though trying to keep our kitties safe.
 
Thanks for asking. She seems less "bouncy" after reducing her dose to 5.75u, although her AMPS & PMPS numbers are still high. You indicated that it would take a few cycles for her to even out though, so I'm encouraged. She slept well and was less restless in the early morning before her AMPS and feeding. I plan to do +4, +6 tests this morning and again at about +5 in the pm. I hope we're on the way to settling into some more consistent numbers.
 
Good morning Deb, Billie's AMPS numbers are very high this morning, 520. Is this still part of the bounce? Billie also has been chewing at her feet more since the decrease in dose. Wondering if I should up it to 6.0 and hold there?
 
Yes, I think this is still part of the bounce.

Time to put those patience pants on and wait until the bounce is cleared in 6 cycles. This morning is only cycle 5.

Are you able to get some tests in during the day today? between +4 and +7 is most helpful in adjusting Prozinc doses. PM cycle tests too if you can manage it.

How is Billie doing on the 5 P's and appetite?
 
Okay. Putting patience pants on. Also, this morning's dose is from a new bottle of ProZinc, so that may make a difference too. I'll be around and was planning tests. Will do a few tonight as well.

Billie has been a little restless and chewing her feet more, although she's sleeping well. Her appetite isn't quite so ravenous, but she's asking for food after I've fed her in the morning. I was going to wait until I tested her at +4 to give her a little more. She's always been a foodie. This morning she's been drinking a lot of water, more than usual. She had been tapering off. I do give her extra water on her food. She's always needed a little extra to keep from being constipated. So, ample pee's but not huge lakes.
 
Restless, chewing her feet more? Hummm............
Does she have litter caked in between her paw pads?
Do her nails need a trim? Could she have pulled out a toenail, partially or fully?
Do you think her feet are itchy?
An injury to the paw pad? Do you BG test using the pawpads?
Infection in paws?
Will she let you touch the paws normally or does she flinch away?
Are the pads swollen and inflamed at all?
Is she limping?
Bleeding paws because she is chewing them so much?
Can the miliary dermatitis affect her paws?

Any recent vet visits?
Is she still off the steroids? Or does she need to go back on them for the miliary dermatitis?

Brainstorming here, for some things you could check at home. May be worth a vet visit.
 
It's probably due to being outside some during the days when it's warmer here. She does have some sort of allergy to the grass. She doesn't have any of the symptoms you mention. Sometimes she seems to do it from anxiety sometimes too. And especially when she was very hungry and I didn't think I should be feeding her. Distinguishing between anxiety and allergy is the thing. She's been just hanging out and sleeping quietly this morning after her breakfast. Honestly, I'm more anxious this morning about the high numbers, so maybe it's that more than anything. She's off steroids and we don't want to go back to them. But we'll see how she is next summer when it's the worst.
 
Good to know. Was trying to wrack my brain to think of a cause. Anxiety sounds possible too. Yours more than Billie's it sounds like as the higher BG readings have you worried.

Billie, your mom is really worried about you. Please stop chewing on your paws and making her worry more. She is taking the best care of you that she knows how. Teach her how a cat relaxes, and tell her it's ok to get a nap until +6 or so.

My civie Dancer does the 'chew on the paws' routine to trim her own toenails sometimes. Even though I trim them about once a week for her, she's telling me I don't do a good enough job.

If Billie does need to go back on the steroids, than she needs to go back on the steroids and you adjust the insulin dose around that. Treat the whole cat and multiple medical conditions when needed. Too soon to worry about that now.

Nice that Billie gets to go out on warmer days. Our current warm day here is 38 F, totally cloudy. Typical end of January day in New England.
 
Thank you Deb. I'm sure it's my anxiety. Billie's just sleeping comfortably now. I'm a wreck. Some days I become so hypervigilant and everything gets out of perspective. A little cat nap might be just the thing about now.

It is nice that the Bill wants to go out on these warmer days. It's still rainy most of the time, but she can sit on the porch and observe the world from there without getting wet. I know those end of January New England days. 38 F is pretty balmy;-)
 
My Billy has allergies and asthma. I absolutely think steroid shots are part of what gave him diabetes. I wanted to ask if you have talked to your vet about alternative treatments for allergies? Billy takes half a Zyrtec tablet once a day, and occasionally uses a non-steroid rescue inhaler. This cut his steroid shots from once a month, to 2-3 a year. I am now being more proactive, and giving him his Zyrtec everyday instead of when he seemed to need it, to try to cut those last steroid shots out. I don't know it this would work for your kitty, but it might be worth asking the vet about, if you haven't already.
 
One of my cats Clover gets an allergy in the spring with watery eyes, red around the eye area and if untreated it spreads more to other areas like the feet.
I give her 1/2 Zyrtec each day and it is very effective. In the early days she was on it daily for ages but now I only give it as soon as it appears and it settles it down quickly.
 
Can someone help me understand what is going on with Billie's BG numbers? I've increased the dose to 6u after her bounce and her numbers are getting higher.
Thanks.
 
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