? Dosing for tonight?!

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William's Mom

William's Mom

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William has been getting into nicer numbers lately and today had a nice drop. PMPS is really nice for him, too, but today he had a drop of around 60% so I'm a little scared I'll drop him way low if I stay with my current dose. Also don't want to miss this great chance to get on a good streak! Should I reduce at all or just shoot the same amount and monitor? Eek!
 
Well, I don't really have any advice on this, but I noticed no one had replied so I thought I'd stop by and see what you decided? Did you lower the dose a little? Looks like you have a lot of good data on William so I'm sure you made a good decision!
 
Thanks! There are so few prozinc users around in the evenings! After I fretted about what to do, I had to retest and he was high enough to warrant the full dose. Checked him a few hours later and he seems to be on a similar cycle as today so it's safe and sound.
 
I often struggle with this exact dilemma. I have an unwritten rule that if Nicky drops 50% and I am not home to test, I will lower him a little. If I am home to test or at least can get home to test close to NADIR, I will keep the dose the same. Now each cat is different, and so far I have been lucky with no hypos, that know of. It really gets nerve wracking the lower the glucose values are at pre dose. It looks like you have a good handle on Williams numbers are are doing a fantastic job. I swear a lot of it is gut feeling.

Sincerely,

-Luann
 
Sorry, Vanessa! A lot of the times, we're all not around later in the evening. I think the dose you shot was fine. Since you were home to monitor and steer him if needed, and you knew he was rising, I think it was a good decision.
 
I am glad you went for it, Vanessa. The 50% drop is one gauge for a cycle, Especially in the beginning to see if the insulin is sure working at higher numbers. (So if a new cat is in the 500s at preshot but drops to 250 - he is still way too high but you know the insulin is indeed working). William has been in very safe nadirs, so he seems to have room to drop more. The best guide is the nadir - is he in safe ranges. As long as his nadirs are higher than 50, the dose is good.

The gradual lowering of William's numbers is very nice. If you want guidance on daily dosing and getting him lower, post daily. We'll get used to watching for you and will help.

The blood in his urine a few days ago. Did he have a UTI?
 
Thanks all! @Sue and Oliver (GA) I will probably pop my head in more often for dosing advise. I had to stay away from looking at the forum and researching for a while because I was losing my mind. I actually gave him a teensy bit more today (3.5u eyeballed on u100). We'll see. He didn't do well on that dose at all a month or so ago. Was high and flat. I reduced it to 3u and he started to show improvement and since then I've increased slower and in smaller increments which seems to work better for him. Honestly, it felt like it would never get better for a while and his body still seems to want to resist getting better and staying better, but he's closer.

As for the blood in urine, he's had a lot of pee problems since the diabetes. He developed idiopathic cystitis (no crystals, stones, blockages as of July test) and has had a UTI in the past, but I couldn't afford to take him in for testing again. Clavamox has helped him in the past for the inflammation with and without infection, so we put him on a course, but it's not my favorite thing to do. Honestly, it didn't help at all, so it was likely just inflammation. Homeopathic and herbal remedies, SQ fluids, and the reduced stress of being in healthier BG ranges seem to be the magic combination.
 
Glad to hear he's feeling better! I know those UTIs are a pain...we've been there at my house. Sigh.

What kind of home remedies do you use, if I can ask?
 
UTIs are SUCH a bummer! So hard to get rid of. I use a Cantharis made by Boiron (the little vial of sublingual pellets). My vet told me to give 3 pellets dissolved in the smallest amount of water possible 1-3 times per day until it clears up. I use the little dropper from an old Rescue Rememdy to put it (kind of) under the tongue. Also, slippery elm bark which I began using primarily for constipation is supposed to soothe the inflammation of cystitis, and provide general GI relief from inflammation and irritation. His condition, all around, seemed to improve with the slippery elm.
 
I believe I've read glucosamine may be helpful for idiopathic cystitis, as well as D-Mannose. You might look into those and discuss them with your vet.
 
Hey Vanessa, I'm also a ProZinc & AT 2 user, so I feel safe giving some advice if you need it. I'm usually around in the evenings ( tho not the past few weeks as my dad has been very ill, he's better now) so feel free to ask. I don't like to offer advice to anyone using a different insulin that I know nothing about or if they use a human meter as I could never make those numbers work in own head.
 
I can tell you what my vet told me, I trust him completely as he's really well educated in treating feline diabetes.
1. Don't shoot if below 100 on AT2
2. Keep to same dose (unless BG is way high or way low) for one week, because with ProZinc it takes some time for the body to learn to work with that dose.
3. Change dosage by .5 (half unit) at a time. Again, unless BG is way high, then call your vet and ask which way to go.

I'm not a vet so I'm always a little leary of offering too much advice. I hope you have a really good vet, if not, do some shopping and find one well trained in FD.
 
Hi Tammy,

We spent quite a while developing a protocol for ProZinc, for which we had consensus. We spent several days on a Think Tank thread getting everyone's viewpoint and consolidating those ideas. One of our guiding principles was that Every Cat is Different and over the years, we have certainly seen many different responses to the insulin. So we tried to offer options and no blanket statements except for hypo numbers and other safety situations. The protocol is at the top of this page.

While your vet's guidelines might have worked well for your cat, we like to err on the side of safety and feel"first do no harm" is a wise standard.

As this is a peer reviewed board, I disagree with your vet's ideas

Our usual standard is not to shoot under 200. Then after you have lots of data, you might lower that number to 150-180, on a cycle you can carefully monitor. We have had a very few people who found it necessary to shoot under 150 - after they had months of data - and could monitor very carefully. Those people are only shooting drops of insulin by that point.

There have been lots of cats who have done well with the same dose for a week, but there have also been cats who do well with the sliding scale. That's why we advocate both approaches.

As it states in the protocol, we do suggest increasing by .5 units at a time, IF the cat is in high flat ranges and definitely seems to need more insulin But if the cat is in lower ranges and the levels are not varying by much, an increase of 0.25 may be a much safer increase and might, in fact, be the perfect dose that cat needed. Many cats here right now are in lower ranges and are increasing by 0.1 Again, we feel strongly that ProZinc is an insulin that can be adjusted to fit the cat, and that ECID.

We are always looking for people to join our little PZI/ProZinc family and we'd love to have you post. But I would ask that you use the FDMB and PZI guidelines that are most likely to keep someone else's cat safe: Remember that your cat and his response was unique and so is everyone else's kitty. And be aware, first and foremost, that you want their cat to be safe and so, offer advice that will first, do no harm.
 
Sorry to hijack your thread, Vanessa. What a nice green last night! I think that is his first one in a long time. I wouldn't let it make you nervous (tho it is always nerve wracking to see after so many pinks). It was a high green so he still has room to drop. And it was a very safe green.

Are you thinking hold the dose this am? I imagine he will bounce. I'm sure his body was surprised by the green too. I like your dose (3.5 or 3.4)
 
Hi, Vanessa - nice (& safe) green # there last night - that's great! I agree with Sue: William may bounce this morning, but is not unusual after a drop of more than 50% ... and I like the idea of holding his dose @ 3.4-3.5 for now. Good job!:)
 
@Mogmom and Goofus - Tammy, while I know you're sincere in trying to help out here :bighug:, I must say "ditto" to Sue's remarks above.
We do not recommend deviating from "no shot below 200" unless there's plenty of data to support that; and I must say that for a vet to recommend shooting at at BG as low as 100 really blows my mind. (Alarming enough when using an AT2, would be even more so if using a human glucometer.) Keeping our kitties safe at all times is our #1 priority here @ FDMB, so please - and this goes for everyone here - do not offer your own vet's recommendations to other members, as there are countless examples on the threads of members' encounters with vets who are not well versed in treating diabetic cats; vets who either give too little information to cat caregivers or even dosing recommendations that could put a kitty in danger of a hypoglycemic event. Again, I know you had the best of intentions, so please don't think I'm discouraging you from posting, as we all need one another's support! :bighug: - Robin
 
Vanessa and William - Way to go! It seems that since 9/2, he has been showing a lot more blues and a few greens as well. Slow and steady seems to be working for him.

Regarding the vets suggestion of shooting over 100. I would be very leery of anyone following that protocol and especially if they were using the AT2. Also, changing doses by .5 may be too much for some kitties. I know that I could never do that for Merlin as he is so sensitive to the insulin. I am glad that Goofus has done well. It would have been interesting to see what his nadirs were when you were shooting those low numbers.
 
Yay! Vanessa and William, things are going great! I'm glad to see those numbers getting lower, and I know you are too.

Yes, I'd NEVER shoot as low as 100. That's extremely dangerous. You'd be almost certain to go hypo. The 0.25 dose changes worked for my Gypsy best too. It's best to go with the smaller changes at lower numbers since you just might skip the optimum dose otherwise!
 
Goof never once went any where near hypo, never.
Sue and Oliver (GA) said:
Hi Tammy,

We spent quite a while developing a protocol for ProZinc, for which we had consensus. We spent several days on a Think Tank thread getting everyone's viewpoint and consolidating those ideas. One of our guiding principles was that Every Cat is Different and over the years, we have certainly seen many different responses to the insulin. So we tried to offer options and no blanket statements except for hypo numbers and other safety situations. The protocol is at the top of this page.

While your vet's guidelines might have worked well for your cat, we like to err on the side of safety and feel"first do no harm" is a wise standard.

As this is a peer reviewed board, I disagree with your vet's ideas

Our usual standard is not to shoot under 200. Then after you have lots of data, you might lower that number to 150-180, on a cycle you can carefully monitor. We have had a very few people who found it necessary to shoot under 150 - after they had months of data - and could monitor very carefully. Those people are only shooting drops of insulin by that point.

There have been lots of cats who have done well with the same dose for a week, but there have also been cats who do well with the sliding scale. That's why we advocate both approaches.

As it states in the protocol, we do suggest increasing by .5 units at a time, IF the cat is in high flat ranges and definitely seems to need more insulin But if the cat is in lower ranges and the levels are not varying by much, an increase of 0.25 may be a much safer increase and might, in fact, be the perfect dose that cat needed. Many cats here right now are in lower ranges and are increasing by 0.1 Again, we feel strongly that ProZinc is an insulin that can be adjusted to fit the cat, and that ECID.

We are always looking for people to join our little PZI/ProZinc family and we'd love to have you post. But I would ask that you use the FDMB and PZI guidelines that are most likely to keep someone else's cat safe: Remember that your cat and his response was unique and so is everyone else's kitty. And be aware, first and foremost, that you want their cat to be safe and so, offer advice that will first, do no harm.
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Im thinking you must've missed the last sentence in my post? I never suggested that she shoot at 100.
 
Yes, that I, "I", would. But only because I knew Goofs numbers and how he reacted to the dose of .50. But, if you read the last sentence, I suggested she talk to her vet about dosing questions. Vannesa never stated what William's BG was, why would I offer dosing advice with out knowing that? I wouldn't. I didn't.
 
Sorry if that sounded nasty, I didn't mean it to. But I will say this, I highly doubt that I'll ever give my opinion again, I'm going to leave that to those who know a lot more than I do. Ok, that sounded nasty too, again, I didn't mean it to.
 
No problem. Just verifying what the vet said as it is very different. Hope you post again. :)
 
Thanks to everyone for the suggestions and the precautions. I have been on a time consuming job and hadn't seen what was going on in this thread! I do hope you post again @Mogmom and Goofus. I think you were one of the first people to welcome me on this site months ago, so your support is helpful and appreciated! I know that everyone has the well-being of our kitties in mind, and I know you do, too, or you wouldn't be hanging out here!

And about little William's numbers: Before anyone gets too excited... they got crappy(ish)! I haven't updated my spreadsheet or been able to get as many mid-cycle readings for the past few days, but I'll get back on track with that. Anyway, it's not super high, but maybe it's a bounce. I'll be able to get a clearer idea in the next few days. Every time things start looking better, there's some wrench in the mix. It's challenge, that's for sure!

Thanks you guys!
 
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