Dosing help needed

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Case

Case

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Hi everyone :)

My cat Sookie was started on 2u prozinc 2x a day a little over a month ago. She seemed fine on it for awhile but I understand the dosing needs can change. When I did a curve the vet thought we needed to increase so we went up to 2.5, which ended up being too much. We went back down to 2 after that and stuck with it for about another week. Turns out she was starting to go too low at with that, dropping really quickly. The vet thought she may have been in remission at this point and said her high pre shot numbers were due to bouncing from midday lows. She recommended I stop insulin for a few days and see how she does on her own. We tried it and she stayed in the 300s. Went back to 1 unit and we've been stuck in the 200-400 range. I went up to 1.5 after a week and we're still stuck.

So confused as to what's going on. One week 2u was too much and now it seems we're on our way back there. :confused: Was she just sensitive to the insulin after the initial increase, so the 2 looked like too much when it reallly wasn't? Should I be holding the 1.5 dose for a little longer? Maybe the few days without the insulin threw it off. I'm sorry if I don't make sense I feel so jumbled up about it right now. Still trying to figure out how this all works. :bookworm:

I have the u-40 syringes (no half unit markings) so I don't think I could go up by the usually recommended .25. If someone with experience could take a look at her spreadsheet and give me some advice I'd really appreciate it. I realize we're still really new here and I may just be impatient. I'm worried about her hanging out in the high numbers for too long (No history of ketones though). I have a lot to learn but am so grateful for this site and everyone here. Thanks for your time!
 
Hi Case! Sounds like you've had a lot of ups and downs this month!

Insulin needs do change, so at this point, i wouldn't worry too much about what happened a couple of weeks ago regarding the dose being too much/too little. What hour are you in your cycle today? If you haven't passed +7 yet, could you grab a mid-cycle so we can get a peek as to what's going on in the middle at this dose? It looks like you need to increase, but I want to be sure first.
 
Hi Djamila, thanks for the response! Yup lots of ups and downs so far, hard to keep up lol. +7 for us would be in about a half hour but unfortunately I'll be stuck at work until at least her +9. I try to get the mid cycles when I can which isn't super often, but at least always on the weekends. I know that's not super helpful!
 
JanetNJ said:
Could try 1.75 a couple of days see what it does and if it's not enough go to 2.
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Thanks Janet, I would try the 1.75 just don't know how to measure it in the u-40 syringes. I've been thinking about getting the u-100 but my vet said to never use them. I'm sure she doesn't want me to mess up the dose (which is smart) even though I know about the comparison chart here. In my state I need a prescription and I highly doubt she will give it to me for the u-100.

If I do change the dose how long do you advise holding it if the numbers aren't going down enough?
 
Suki doesn't drop enough so I think a slightly higher dose would be needed.
I couldn't see any evidence of Suki going into remission and stopping insulin for few days did not help, it slowed down her dropping down a little.
 
One thing you might try is taking a U-40 syringe, and playing with some colored water (or plain water works too - just easier to see if it has some food coloring). I found that on my syringes, using the top or bottom of the black stopper, I could pretty consistently figure out what to call .25, .5, and .75. It just took a little experimenting. And as long as you're consistent in how you draw it, that's the important thing more than if it's precisely .25u Does that make sense?
 
Marlena said:
Suki doesn't drop enough so I think a slightly higher dose would be needed.
I couldn't see any evidence of Suki going into remission and stopping insulin for few days did not help, it slowed down her dropping down a little.
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Thanks Marlena! I should've mentioned that Sookie had been throwing up a lot before she went low on the 2u. The vet thought she was vomiting from going too low during the cycle and was thinking it was because of the somogyi effect. So she believed she was producing her own insulin and therefore causing her major drops. I'll admit I thought it was a little too good to be true that she may not need insulin, but I trust my vet and wanted to follow her instructions. Now I'm starting to see how complicated this all is.
 
Djamila said:
One thing you might try is taking a U-40 syringe, and playing with some colored water (or plain water works too - just easier to see if it has some food coloring). I found that on my syringes, using the top or bottom of the black stopper, I could pretty consistently figure out what to call .25, .5, and .75. It just took a little experimenting. And as long as you're consistent in how you draw it, that's the important thing more than if it's precisely .25u Does that make sense?
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Makes perfect sense, I think I'll try that. I'm imagining that just under the 1u line would be 1.25 or just above the 2 line would be 1.75. I'm still getting used to the measuring, I have to triple check when doing the half units that's it's really in the middle of the unit markings.
 
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Any data you can get is super helpful, Case! Get mid cycles when you can...and you've been doing great at getting some before bed tests which is very helpful! Just do what you can and it'll help us to help you! :)
 
Case said:
Hi Djamila, thanks for the response! Yup lots of ups and downs so far, hard to keep up lol. +7 for us would be in about a half hour but unfortunately I'll be stuck at work until at least her +9. I try to get the mid cycles when I can which isn't super often, but at least always on the weekends. I know that's not super helpful!
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Ah work! This would all be so much easier if none of us had to work! :rolleyes::smuggrin: Like Rachel said, you just do the best you can. You have been doing great on the before beds!
 
Thanks Rachel and Djamila! I will keep up with the testing. I'm so lucky Sookie's gotten used to it already, wasn't sure if she ever would :D

This weekend when I'm home I'll raise her dose by what looks like .25 and go from there. I know she shouldn't drop too fast or too low but what numbers should I be aiming for her nadir?
 
Got it. So if we start getting those good numbers, and it's not a fast drop, I would hold that dose for as long as needed and presumably her pre shot numbers would also start going down? Just trying to figure out how this works..
 
Case said:
Got it. So if we start getting those good numbers, and it's not a fast drop, I would hold that dose for as long as needed and presumably her pre shot numbers would also start going down? Just trying to figure out how this works..
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That would work. However, cats often have their own ideas about all this and they don't tell us what they are. :confused:
 
Yeah, I'm sure I'm in for a few surprises during this journey. Thanks to all of you for helping me begin to figure this out.
 
Case said:
Thanks Marlena! I should've mentioned that Sookie had been throwing up a lot before she went low on the 2u. The vet thought she was vomiting from going too low during the cycle and was thinking it was because of the somogyi effect. So she believed she was producing her own insulin and therefore causing her major drops. I'll admit I thought it was a little too good to be true that she may not need insulin, but I trust my vet and wanted to follow her instructions. Now I'm starting to see how complicated this all is.
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Case, it can be really complicated unfortunately but if we keep reminding ourselves that ECID (every cat is different) and every cycle is different and that we still don't understand fully how body works maybe it will be easier to accept the difficulty and lack of total control. When diabetic people have a permanent blood glucose monitor attached they see how much (it is really ridiculous) glucose level fluctuate every day for no apparent reason! I have been doing doing this sugar dance for 3 years now and I still get very upset and frustrated when things go funny. But you might be lucky and your kitty might recover with your help so keep being positive because you're doing such a good job! We will be here for you when you need some guidance.
Case said:
Thanks Marlena! I should've mentioned that Sookie had been throwing up a lot before she went low on the 2u. The vet thought she was vomiting from going too low during the cycle and was thinking it was because of the somogyi effect. So she believed she was producing her own insulin and therefore causing her major drops. I'll admit I thought it was a little too good to be true that she may not need insulin, but I trust my vet and wanted to follow her instructions. Now I'm starting to see how complicated this all is.
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Case, Sookie could have been throwing up for some reason and that itself could have caused her to go too low.
 
Case said:
Got it. So if we start getting those good numbers, and it's not a fast drop, I would hold that dose for as long as needed and presumably her pre shot numbers would also start going down? Just trying to figure out how this works..
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When kitty drops to nadir you want this number not lower than 50% of the preshot number so if preshot is 200 you are aiming for no lower than 100 at nadir, these are safe drops. If kitty drops much more it will cause rebound (the cat is not used to lower numbers), this is a normal, natural process and a protective mechanism. We need to go slowly with this as big drops and high bouncing numbers are bad for kitty.
 
Marlena said:
Case, Sookie could have been throwing up for some reason and that itself could have caused her to go too low.
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I'm glad you said that because that's exactly what I thought at first too! Have to trust myself more with this. Its interesting how the numbers change so much, I didn't expect that. It's very easy to get a little number obsessed but I realize I'm going to have to be much more patient and look at the overall patterns. Also need to accept the lack of total control like you said, thats very true for me, I so just want to "fix it" for her.

Marlena said:
When kitty drops to nadir you want this number not lower than 50% of the preshot number so if preshot is 200 you are aiming for no lower than 100 at nadir, these are safe drops. If kitty drops much more it will cause rebound (the cat is not used to lower numbers), this is a normal, natural process and a protective mechanism. We need to go slowly with this as big drops and high bouncing numbers are bad for kitty.
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Good to know and makes sense, I've been reading a little about bouncing on here. Thank you for clarifying and especially thanks for the help and support! :)
 
Looking ok darling, if you can try to test during the day at +6 maybe. See what happens tonight.
Keeping my fingers crosse, Rocky sends purrs as well.:cat:
 
I will try for the +6, hopefully I can get out of work a little early today. Tomorrow I will probably try 1.75 when I can be around all day.

Many thanks to you and Rocky :smuggrin:
 
Ok, I think it is a good move as you tried 1.5 for few cycles and it looks like he needs a little more.
Good luck:cat:
 
Ok, you are having just pink numbers last 2 days, no reds so far. Let's keep this dose for few more cycles to see what occurs.
 
Will do, hopefully we don't see any more reds. Is it weird that with the higher dose her numbers aren't going down as much through the cycle?
 
Case said:
Will do, hopefully we don't see any more reds. Is it weird that with the higher dose her numbers aren't going down as much through the cycle?
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No, it is normal. It takes time to regulate and you will see strange numbers for some time until we can have a good picture how Sookie reacts to insulin.
I had the same with Rocky. It is better to do it slowly and just watch the numbers going down ever so slightly because if you have a big drop you will also see a rebound and it is not good for kitty. I think if you still have mostly pink numbers for next few cycles we can think about going to 2 units but I would be cautious with this as yet.
Just be patient and it will fall in place nicely if we are sensible.
 
Ok that sounds like a good plan to stick with. I can be patient, glad to hear it's a normal reaction. :)

Wow Rocky's spreadsheet looks awesome, happy he seems to be doing so well! :woot:
 
Case, what if we try 2u from tomorrow morning if he is still in pink numbers and is eating ok and you can keep an eye?
Could you please tell me how you feed Sookie? What food and how many times a day? We need to see the numbers without food influence so no food at least 2 hours before AM and PM tests and only snacks during the day.
 
I'm sorry darling, I saw feeding in your signature. And Sookie is a girl of course, I apologise, I'm tired most of the time and my brain is a bit redundant. I also realised you use FF lite test strips, this is what I do and when I did comparison to ATr they read rather similar if only slightly higher on higher numbers so your 360 with FF might be 396 on ATr so I feel more confident that your 2 unit would be a good dose.
Marlena:cat::)
 
Marlena said:
I'm sorry darling, I saw feeding in your signature. And Sookie is a girl of course, I apologise, I'm tired most of the time and my brain is a bit redundant. I also realised you use FF lite test strips, this is what I do and when I did comparison to ATr they read rather similar if only slightly higher on higher numbers so your 360 with FF might be 396 on ATr so I feel more confident that your 2 unit would be a good dose.
Marlena:cat::)
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I just started free feeding 1/2 cup Young Again during the day because I'm typically not home. Usually no food 2 hours pre shot test but the other night I forgot to pick it up :facepalm: I have 3 cats altogether so I'm still trying to figure the food situation and how much to leave out while I'm gone. The other day they all ate too much and wouldn't eat their wet food. We'll figure it out, everything is still so new for them. Yes Sookie is a girl and no need to apologize :joyful:

I don't like to change her dose when I'm not home but like I said I'm leaving food out for her and we've had pretty good luck with the 2u except once it brought her too low. I think that was a fluke anyways because of her not eating well that day. Otherwise she has a great appetite and probably eats too much (she used to be very fat). I agree I think it's safe to try it again. I appreciate the advice :)
 
It can be scary to go back to a dose that gave you a lime green before but sometimes we end up back to that dose or higher. The steps in the sugar dance don't always make sense :smuggrin:
 
Case, yesterday numbers look pretty normal to me.
You are doing great.
Sending hugs,
Marlena and Rocky:)
 
So Sookie's numbers are finally starting to come down during the day, which I'm so happy to see some blues! She was 380 at am pre shot and went all the way down to 94 at +6. I'm just wondering if that is too much of a drop. Should I decrease her dose slightly or is this ok and what we want?
 
Case said:
So Sookie's numbers are finally starting to come down during the day, which I'm so happy to see some blues! She was 380 at am pre shot and went all the way down to 94 at +6. I'm just wondering if that is too much of a drop. Should I decrease her dose slightly or is this ok and what we want?
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That's more than a 50% drop but it's a nice number. Be prepared for possible higher than usual bounce numbers after this. Try for a +2 this evening to see where she's headed. She had similar results on the same dose on 24 June.
 
Kris & Teasel said:
That's more than a 50% drop but it's a nice number. Be prepared for possible higher than usual bounce numbers after this. Try for a +2 this evening to see where she's headed. She had similar results on the same dose on 24 June.
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Ok thanks, I won't be discouraged by any high numbers tonight. I can get the +2, so I should keep the dose at 2.5 and see where it goes?
 
Well she certainly bounced back up, all the way to 411 pmps. Will stick with 2.5, thank you!!
 
Case, that green number would produce some higher numbers for about 3 days. After that bouncing should stop. If you continue with the same dose for few more days we would be able to see how Sookie is doing and take it from there.
Good luck.
 
Marlena said:
Case, that green number would produce some higher numbers for about 3 days. After that bouncing should stop. If you continue with the same dose for few more days we would be able to see how Sookie is doing and take it from there.
Good luck.
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I noticed this was starting to happen because yesterday she had all pink numbers and a red this morning. Kris & Teasel warned me about that happening as well. We will continue the dose for now, hopefully the bouncing will calm down and we can get some more blues and greens. :cool:;)
 
Case, I would like to give you some information so you can try to get your head around it as you have to make decisions what to do on daily basis.
I can see something happening on 2 occasions: 1st of July and again and 5th of August. It looks to me like a classic Somogyi phenomenon: you observe a steep drop in BG and straight after that BG goes up and up so you started with a pink number, sharp drop was a green number and then you have a red number pm. For many days after that you see that numbers are not moving much away from pink which looks a little like insulin resistance. This is all normal reaction to a steep drop in blood sugar level. This can last for 3 days (usually) or a bit longer. In a situation like that you don't increase the dose. If you increase the dose and the numbers go up you don't increase further, it is a classic mistake some vets make and poor kitties end up on ever increasing doses and are in danger of hypo. Usually it is a good idea to decrease the dose a little. If you decrease the dose and you get lower numbers - bingo! But if you decrease and the numbers go up it means that kitty needs more insulin.
But it is not as simple as that because what we observe might not be what we think is so we have to try things out and see how they work. Sometimes you just need more insulin to break that cycle of pink numbers.
I hope I did not confuse you too much, my brain is still a bit sleepy and writing in coherent manner seems a bit difficult for me at the moment.
Right now I would stick with a dose of 2.5 or reduce to 2.25 . Watch out those pinks when you give 2.5 as you might end up with hypo so maybe do not give 2.5 on a pink number.
I'm just curious now how Sookie is going to behave after getting that beautiful BG of 94.
It really is a good idea to read about Somogyi effect (phenomenon) and understand what it is (nobody really knows for sure it is happening as more research is being done) and I'm hoping that we get better information about it soon.
But for now it looks like your kitty is going to bounce on a little trampoline but we will get her well and even soon I hope.
Sending hugs,
Marlena and Rocky:bighug::bighug::bighug:
 
Marlena said:
I can see something happening on 2 occasions: 1st of July and again and 5th of August. It looks to me like a classic Somogyi phenomenon: you observe a steep drop in BG and straight after that BG goes up and up so you started with a pink number, sharp drop was a green number and then you have a red number pm. For many days after that you see that numbers are not moving much away from pink which looks a little like insulin resistance. This is all normal reaction to a steep drop in blood sugar level. This can last for 3 days (usually) or a bit longer. In a situation like that you don't increase the dose. If you increase the dose and the numbers go up you don't increase further, it is a classic mistake some vets make and poor kitties end up on ever increasing doses and are in danger of hypo.
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Thank you for the info Marlena, don't worry you're not confusing me too much. :) I did notice the pattern you're seeing as well. I read about Somogyi, but it's different being aware of it and actually seeing it's application in real life if that makes sense. I'm going to do some more research on it. I have been reading a few posts on here too and see that bouncing is pretty common, I was only hoping Sookie would avoid the trampoline because I can see how complicated it makes things.

Marlena said:
Usually it is a good idea to decrease the dose a little. If you decrease the dose and you get lower numbers - bingo!
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So when this happens you're saying to decrease the dose slightly? Just want to make sure I understand. I thought I was supposed to hold the dose until the bounce clears. This morning her amps was 357 so I gave her 2.25. I worry about her going hypo while I'm at work during the day.

Marlena said:
But if you decrease and the numbers go up it means that kitty needs more insulin.
But it is not as simple as that because what we observe might not be what we think is so we have to try things out and see how they work. Sometimes you just need more insulin to break that cycle of pink numbers.
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This is the part I don't totally get. If we decrease the dose and the numbers go up, how do we know she's not still bouncing? Is it just a matter of waiting a few days and seeing if the numbers go down? I'm trying to figure out when we need to back off on a dose or when she needs more. I'm guessing it's like you say, simply trying different things and seeing how they work. I just worry so much about making a mistake and hurting her, it's scary to me to have the responsibility of her life in my hands. I know its not an exact science and I appreciate you taking the time to explain this to me.
 
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