Dosing Advise for Maggie

hoanguyenngo

hoanguyenngo

Member Since 2022
Maggie 7 yrs old. Diabetic since January 2021. He’s currently on Prozinc 3 units twice a day. I have a hard time to find a right dose for Maggie. I can not keep him on the same dose for 7-10 days since he either get too low or too high within 3-4 days. I also reset his insulin to a lower dose but still can not regulate him. Can Admin help to look at Maggie spreadsheet and see if i missed something here ?

https://docs.google.com/spreadsheet...x2JlX9RTOw/pubhtml?gid=1923986863&single=true

Thanks
 
What food does he eat? Any other health issues or medications? Checked ketones lately?

Couple of things:
  1. I would hold the 2.75U. You want to give each dose a minimum of 3-4 days, depending on diet and BG numbers. Often you may need to hold closer to 5-7 days.
  2. Give the same dose AM and PM, we adjust dose based on nadir not the preshot (except in very special cases, but Maggie doesn't quite qualify yet).
  3. Dose changes are typically done in 0.25U increments - I'll expand on this once I have the answers to the questions above.
 
Maggie food: Weruva Truluxe Glam N Punk with Lamb & Duck and Weruva Cats in the Kitchen La Isla Bonita Mackerel & Shrimp plus lots of water in food
7 am - 1 can 3 oz of Glam N Punk
11 am - 1 can 3 oz of La Isla Bonita
4 pm - 1/2 can 3 oz of Glam N Punk
7 pm - 1 can 3 oz of Glam N Punk

No other health issue and this point, no keytones, no teeth issue. no change in food or any activity.
 
Ok thanks.

You'll want to read our dosing methods, explained here - https://www.felinediabetes.com/FDMB/threads/prozinc-dosing-methods.225629/

The main differences are:
Start Low Go Slow - you would reduce by 0.25U any time he goes under 90 (or you can reasonably infer he went below 90 - we can help with that). You would hold each dose for one week, then determine whether to hold the dose or increase by 0.25U. Continue to test the way you're testing.

The benefit to SLGS is it typically is the better/safer option for those who can't test often. The downside is that it lets them stay in higher BG numbers longer.

Modified ProZinc Method - you would reduce by 0.25U any time he goes below 68 on an AlphaTrak. Now because we let the BG get into a lower range, more testing is often required - but you're already testing very well, especially when he goes into the lower numbers. You would increase the dose by 0.25-0.5U every 3-7 days, depending on his BG (the guidelines for how much to increase and when are in the link above).

The benefit to MPM is you can adjust the dose more quickly and get them into better ranges more quickly. It does have a higher chance at remission, but that is never guaranteed for any cat. The downside to MPM is the lower range requires more active/frequent testing and sometimes food intervention. .

Now some other housekeeping -
A hypo kit if you don't already have one. Ideally you want some wet foods in the 10-15% carbs range, and some in the 16-20% range. I also like to keep just a few in the 20%+ range. If you let me know what country you're in, I can find the appropriate food list for you. - https://www.felinediabetes.com/FDMB/threads/jojo-and-bunnys-hypo-tool-box.2354/

Getting a signature set up - https://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/
 
Thank you FrostD. I do have everything needed. I am trying to hold the dose at least 3 days but everytime Maggie’s number jump across several band of colours make me worry Maggie will end up with keytone if i don’t increase insulin. Is there a way you can help to look at Maggie existing data and be able to tell what her dose should be? I need a second eyes to view and see if i need to do something else different to help her curve more steady in a lower number range ?
 
In my first post I advised to hold the 2.75U for a few days, regardless of the preshot number. You would reduce if she earns a reduction.

Since you're already on a few days of 3U just continue with that dose for 2 more days.

Jumping the dose around inconsistently and/or too quickly tends to "shoot you in the foot" more often than not. His body needs time to adjust to a dose, and have to make sure he's not swinging too low then causing a spike (I don't think this is the case).

Insulin needs can and do change over time. I suspect your reset was too drastic, so now you're fighting some glucose toxicity. At some point you'll hit a breakthrough dose and BG and dose should come down.

Just check ketones 2-3 times a week. If you get a trace or higher result let us know; trace we can usually be proactive at home, but higher than that is emergency.

The only other thing I would do is keep out for other signs of illness or dental problems, those are the usual culprits for increased BG.

If you want to post every few days asking for advice, I can certainly take a look and see if dose needs adjusted.
 
Hi FrostD, Maggie number start going down. He was 148 before shot. I still give 3 units and i gave him extra can of food he asked for the safe side. Should the pm number go down to 2.75 or just keep going and wait for him to get below 100 to go down on insulin?. Thanks
 
Can you get your signature set up when you get a chance? It will just make it easier for me (and others) to find what I need.

You would hold the 3U unless he goes below 90 (or you think he might have gone below 90).
 
Do you have a link to where i can set up the signature ? I don't see the setting or place that i can edit my information from my profile below. it's read only

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Hi FrostD, it’s been the same 3 units for Maggie but do you know why sometime the number high and sometime it low? Should i go to 3.25 tomorrow? Thanks
 
Maggie got diarrhea last night and this morning. Maggie did not finish the 1 can breakfast. Usually when Maggie is in hypo or about to go hypo then diarrhea/loose stool will occurred but not to the point of not finish food. Then why bg number higher than other day ? Why bg number keep fluctuate up and down on different days even with same dose?

I still give Maggie 3 unit this morning and will treat diarrhea if it continues during the day. Nothing change in daily activity and foods/water intake
 
Hold the 3U at least 3 more days. You want a nadir (the lowest BG) between 90-120, and he did that the other day.

Numbers bounce all over the place when they are unregulated and getting used to the insulin. He hit a lower number than he's used to, so now his BG is fluctuating a lot. I would expect it to come back down a little in the next 24-36 hours.

Unfortunately I'm not sure what the diarrhea issue might be.
 
Maggie seem to eat less than before. Maggie eat 3/4 can for breakfast at 7 am on 6/7 and just a spoon for lunch at 11 am then ate again 3/4 can at 4 pm. Did not bother to eat dinner as usually at 7 pm. I still give 3 unit insulin at PM shot. Nadir for pm shot at 1 am is 142 then at 3 am 115. Worry his sugar continue to go down so i get him up to eat 3/4 can of food at 3 am in the morning 6/8. I guess he still full so does not want breakfast at 7 am as usually. continue to give 3 units insulin at AM shot. At lunch he does not want his usual food so i gave him tiki cat and he eat some of them. He very alert and playful even in the morning with no food. I check his sugar and 200 + and 300 +

Was your cat change in the food consume as well. Maggie is now start eating like 2 cans total per day instead of 3.5 cans as before. Is this sign of him getting regulate ?
 
he went to 142 at +9 and want to eat so i give him couple spoon on his normal food. I hope to hold him of so he can eat at 7 am and 7 pm (insulin shot). Is it ok if he does not want to eat at his shot time ? as long as i monitor him closely then it should be ok to continue to give shot when he's not eat at his shot time right? do i need to adjust him so he can eat at shot time or let he eat whenever he want ?
 
You could try to adjust your schedule so he's more hungry at shot time. You want him to eat at least 2 tablespoons of food usually before giving the shot. If he doesn't eat or eat much, you have the option to do a one-time reduced shot (10-50% of your normal dose) or potentially skip depending what his BG is.
 
For this last 2 days, If he eat about 1 can (3oz) then he won't eat another can until 10 hours or so after. Will try to give him small amount of food for now when he ask so he can adjust him back to eat at shot time but

What is the rule for "one-time reduced shot (10-50% of your normal dose) or potentially skip depending what his BG is"
For example:
If pre shot is in 100-150 range and he still full and does not want to eat at shot time then i can skip or give 2 units ?
If pre shot is in 150-250 range and he still full and does not want to eat at shot time then i can give 2.5 unit?
If pre shot is in 250-350 range and he still full and does not want to eat at shot time then i can still give 3 units ?

Is there a rule of what his BG is to determine how much insulin he needs without food at shot time ? Of course i'm monitoring him closely and BG test every 2-3 hours anyway but just want to understand how this thing work

Also how do we make a decision how to increase or decrease insulin ? Do we base on Nadir as well for Prozinc ? since sometime his Nadir is not his lowest number. Sometime his lowest is before Nadir or after Nadir :(
 
It might take him a little while to get used to a different food schedule. You could try smaller meals - half can in the morning, half can midday, etc.

Dose is always based on nadir. By definition nadir is the lowest BG in the cycle, so what I think you mean is that his nadir moves around a bit - very normal! He's in the +6 to +8 range which is fairly common for ProZinc. If he goes below 90, that's a 0.25U reduction. As long as his nadir is consistently between 90-120 on cycles he isn't bouncing, you'll hold the dose. So he's looking pretty good right now. We'll watch him another few days for the next bounce break and decide if he needs an increase.

Unfortunately I can't give you solid guidance until you actually end up in the situation and try a dose lol so for now, I would err on the side of caution. Here's what I suggest -

If he's below 150, skip insulin.

If he's 150-175 and you can monitor, I'd try close to 25% of your normal dose. If you can't monitor, I'd go 10%.

If he's 175-225 I would try 25-50% of your normal dose based on whether you can monitor or not.

225-300, 50-75% of your normal dose.

Above 300, full dose.

Ultimately you hold the syringe, it's what you're comfortable with trying.
 
Thank you FrostD for the explanation. I always thought the nadir is the mid cycle (+6) where it will show the lowest point but it seem to be the lowest BG number in the cycle of the day. so it can be +4, +6, +8. Usually i see him got into hypo before was most of the time is +4 or +8 :rolleyes:

He's bounce again today :(. He was at 225@+10 and 231@+11 but then certainly bounce to 569@+12 before shot this morning and very hungry started at 6 but i hold him of until 6:45 so he get food at the shot time. He eat 1/2 of 3oz can his normal food. Insulin still 3 units for AM shot. should i give 2 spoon or so of food so he won't bounce this hard next time and still can eat a gain at his normal shoot time ?

So if the nadir consistently everyday between 90-120 without the bounce then will hold the dose. Does this mean his right dose ?
If the nadir some day between 90-120 like (6/3, 6/4, 6/8) and someday not (6/9) because of the bounce as his situation right now then what i need to do ? When he bounce, it goes really high across several bands color within an hr.

He's in the 9 days holding at 3 units and still bouncing. I wonder when he keep bouncing like this because his body not get use to the lower number or is it too much insulin ? What should i do if he continue bouncing like this ? Also i noticed whenever he bounce he got loose stool and if he's steady then he does not get loose stool
 
He will bounce no matter what you do with the food, since it is his liver causing the bounce. It will take some time for him to get used to lower numbers, so he will probably continue to bounce for at least another month (or two). But what you'll see is he'll start to spend more time in lower numbers before bouncing, and not bounce as long/high. Nothing to do during a bounce unfortunately! Just continue to shoot your normal dose.

Yes, for now, this is his right dose. Insulin needs can and do change over time, so you'll see the "right dose" fluctuate. The hope is that over time, insulin needs continue to decrease.
 
Thank you FrostD. I will continue to keep him on 3 units for now and see if he stay around for more yellow and blue number before he bounce again.
 
That is a PERFECT cycle, oh my gosh I am so happy to see that. If you can monitor and have a hypo kit handy, yes give the full dose. I suspect he'll get a reduction to ight or very soon.
 
Thank you FrostD for you quick reply. Let me give him his shot and continue to monitor him. Yes i do have hypo kits and know how to handle him
 
He just bounce again . 139 after 6:30 pm He ate 1 can at 7 pm and i just curious check him before i give ínulin. He already 329. At least he does not bounce in red or black zone this time
 
Yes he díd well today. First time he has a flatter curve in a lower range. Hope was part of food contribution since he just ate 30 mins ago
 
Maggie got hypo - 33 at 2:15 and back up to 58 at 2;40. He’s earn a dose deduction. I will give him 2.75 at his am shot then ?
 
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I'm sorry I meant 2.5U, so a total of a 0.5U reduction from the dose that brought him so low.

Hold it for at least 5 days. If he doesn't go below 120 we'll think about increasing. If he goes below 90 it's a 0.25U reduction. If he goes really low, it's a larger reduction.

He's definitely on a mission so vigilance is key!
 
Hi FrostD, Maggie drop again to 65@+11 after pm shot. Do i still need to keep give him 2.5 units or
Should I reduce to 2.25 ?
 
He is bouncing. Let's see what happens when he clears the bounce, so for now keep giving 2.25U
 
It looks like she might have cleared the bounce with the 187 the other night then bounced again, but it could have also been a "partial clear". Let's see where she goes tonight and tomorrow, and increase by 0.25U if she doesn't see anything below 120
 
So will keep 2.25 tonight PM dose and 2.25 tomorrow AM dose and if no number below 120 today and tomorrow then tomorrow night start with 2.5 PM dose ?
 
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