Dosing help pro-zinc every 8 hours

[Pabs&Ro]

Help please. Pabay has been an unstable diabetic for far too long and we decided to switch to a different dosing schedule from every 12 hours to every 8 hours. My aim was to try and stabalise him and if it worked switch insulin because it would demonstrate that Prozinc did not last long enough for him.


The results are promising (I think) but my vet is very concerned that I might be wrong about the insulin not lasting as long as it should do and therefore he will hit a nadir soon and far below acceptable limits. My vet has agreed to give 8 hours a go but if it doesn't work: use a libre sensor continuously and dose with prozinc twice a day and give a top up with human fast acting insulin (faster than caninsulin). The problem with that is Pabay hates the sensors and rips them off with his skin!


Today Pabay was reviewed at the vet and we decided to continue the 8 hour schedule but to fit a libre sensor (the second one in two weeks). Unfortunately something has gone wrong (again) and it is not reading yet again (£120 down the drain in two weeks) . So I am blood testing only.


Today I got a low BG after we got back from the vet 11.2 Mmol using centrist pet metre. This is the lowest reading I have had for ages but it is at the top of the range for a controlled cat.


Since I introduced the every 8 hour schedule there have been benefits:

1. Pabay’s thirst has backed off and he is not drinking excessively;
2. His poo is normal not loose or runny;
3. The BG readings are not bouncing;
4. There is no sign of having had a hypo since I started;
5. The BG readings are coming down slowly during the day and over the period since 17th March.

So if there is an experienced user of prozinc out there who has used 8 hour schedules and has time to take a look at the figures and let me know what they think I would be most grateful.


The only other thing I can think of is that Pabay is on too much insulin. Since Pabay was diagnosed in 2018 I have been constantly reducing his insulin.


I wonder if I should switch back to twice a day and perhaps try 1.2 units U40 twice a day (that would be 1.2 unit less than he is on now) or persevere with 8 hours a day for now and monitor him closely.

My vet advises us to undertake investigations costing £2500 before we go onto glargine!!!!!!


I have ordered more libre sensors!

Any advice?

 

[Deb & Wink]

So if there is an experienced user of prozinc out there who has used 8 hour schedules and has time to take a look at the figures and let me know what they think I would be most grateful.

No there isn't anyone here that I aware of that has used Prozinc on a TID basis.

 

[Pabs&Ro]

It is in the dosing advice for pro zinc on this board. Wonder who wrote it?

 

[Pabs&Ro]

It is in the dosing advice for por zinc. Wonder who wrote it then?

 

[Marje and Gracie]

It is in the dosing advice for pro zinc on this board. Wonder who wrote it?

I wrote it with input from past PZ users. Yes, we used to have several members here who did TID dosing. It used to not be so uncommon.

A few things that I will be very upfront with you about :

• I’m not convinced he needs TID dosing because of your lack of data. Whether you are dosing twice a day or three times, if you have no PM data, then you are missing half of it and making any kind of determination based on only 12 hours is...useless.
• Shooting without getting a PS test every single time is dangerous especially if you haven’t checked since PMPS and are shooting an unknown number at AMPS.
• I don’t believe Pabay is an unstable diabetic. I believe you aren’t managing his diabetes correctly (sorry, but beating around the bush won’t help you). When he’s really flat and high, it’s probably lack of enough insulin. When he was up and down on a higher dose, it’s very similar to what we often see. It’s called “bouncing” and he was doing it because he was dropping somewhere that you aren’t catching. That doesn’t mean he was dropping too low but he dropped lower than he’s used to and the liver responds. It also doesn’t necessarily mean the dose was too high.
• There are some cycles in 2020 where he wasn’t getting enough duration but even cats on Lantus sometimes don’t. There are a lot of reasons that can occur.

I’ve used bolus insulins with Levemir and we often help members learn to use it but Pabay is not a candidate for it and I would encourage you strongly to not use it. The reason he isn’t a candidate is because you aren’t testing enough. To use a bolus insulin, you have to know his onset, nadir, and duration of the basal insulin (PZI) as a basic starting point. Using a bolus insulin when you don’t have a grasp of how the basal insulin is working will cause him to go on a worse and more dangerous roller coaster.

I cannot imagine why he would need any “investigations” at all to switch him to Lantus (glargine).

My suggestions for you are:

• Do not lower or increase his dose until you know exactly where this dose is taking him. I believe he needs more insulin but without testing, I won’t suggest an increase.
• Always, always, always, get a PS test.
• Whether you do BID or TID dosing, you must have some data after the PMPS shot.

Once you’ve built some reliable data for a 4-5 days, then we can make a plan. Without that, no one here should make any dosing suggestions as we do not want to imperil him. Data is your friend and without it, nothing you do will get him regulated.

Again, apologies for being blunt but, for us, safety is first and advising on increase or decreases without data is unsafe. I will be happy to answer any questions you have but also want you to know that most days, my husband and I are volunteering at a COVID vaccination site and so there might be a delay in my responses. I’m usually around for a short bit in the mornings and later in the evenings on US MST time.

 

[Pabs&Ro]

Many thanks. I really appreciate your help. Every 2 hours for ps shot or 1. Ps I guess is through the night?

 

[Marje and Gracie]

Many thanks. I really appreciate your help. Every 2 hours for ps shot or 1. Ps I guess is through the night?

PS is preshot (before you give insulin). It would helpful to have at least two tests after PMPS like a +2 and before bed and then you can decide from there.

 

[Pabs&Ro]

Thanks for your message. I appreciate you being direct. I need to know what to do as I am at the end of my tether as is my husband. I think I need to understand what I should be aiming for that will give him a reasonable quality of life. I just don't know what that is anymore.

I am also confused. I have a few questions I hope you can help with please.

I understand the lack of data at night. I will fix this.

Generally however, Pabay can drop for a few minutes within and hour so I won't know how low he has gone. (I know this from the libre sensor data).

Pabay is shot at 6am; 2pm and 10pm. I gather data after 6am and after 2pm. So I guess you mean 2 hours after 10pm and 4 hours post? Or do you think I should go straight back to 2 shots. Pabay had a reading of 9.3 mmol at 16:57 ie +2.5 hours. He has not been in single figures since last autumn and that was because he had gastro problems. Before that he was in single figures on caninsulin (when PZI source dried up in the UK) and he was very poorly and then he ended up flat lining in the 30s.

So with the readings gradually getting lower, I wonder if the insulin is building up and he is heading for a major hypo. He is still not drinking anywhere near what he did before 17th March and is happy and active.

When Pabay flat lines in the 30s he is very poorly: clear signs of hypo. When he flat lines in the low to mid-twenties I agree he is not on enough insulin (he is nowhere near as poorly as when he is in the 30s).

I understand the concern regarding the morning shot but I do take into account his demeamour a great deal.

Pabay drinks to excess when his BG is above 24 mmol. He drinks until he is sick. This is why I have changed to x 3 because if I can't control his drinking in the morning it's a disaster for him and us: projectile vomit every morning. Pabay can drink a lot in the morning but not to the extent that he is sick. I have enough experience now to know that testing when he is drinking a lot but not to excess is when his BG is in the high teens low 20s. Drinking is a very good guide for me.

I do try to get am shots but he is out from 4am usually and comes in cold.

I will make sure I get them for the next few days though.

Finally can you help me with a cat like Pabay: what is good control then? I thought cats should be in the range of 5 to 11 mmol. Is it good control when you get into single figures but still have 30s pre-shot? What if you don't get into single figures is that good control? Or would the pre-shot have to be in the low 20s for good control. I am pretty sure 30's means Pabay has gone too low as his drinking is very excessive when we get into the 30s. What is good control for a diabetic whose diabetes has been caused by pancreatitis not from being overweight as I think there might be difference?

Thank you so much.

 

[Marje and Gracie]

Thanks for your message. I appreciate you being direct. I need to know what to do as I am at the end of my tether as is my husband. I think I need to understand what I should be aiming for that will give him a reasonable quality of life. I just don't know what that is anymore.

I am also confused. I have a few questions I hope you can help with please.

I understand the lack of data at night. I will fix this.

Generally however, Pabay can drop for a few minutes within and hour so I won't know how low he has gone. (I know this from the libre sensor data).

Pabay is shot at 6am; 2pm and 10pm. I gather data after 6am and after 2pm. So I guess you mean 2 hours after 10pm and 4 hours post? Or do you think I should go straight back to 2 shots. Pabay had a reading of 9.3 mmol at 16:57 ie +2.5 hours. He has not been in single figures since last autumn and that was because he had gastro problems. Before that he was in single figures on caninsulin (when PZI source dried up in the UK) and he was very poorly and then he ended up flat lining in the 30s.

So with the readings gradually getting lower, I wonder if the insulin is building up and he is heading for a major hypo. He is still not drinking anywhere near what he did before 17th March and is happy and active.

When Pabay flat lines in the 30s he is very poorly: clear signs of hypo. When he flat lines in the low to mid-twenties I agree he is not on enough insulin (he is a nowhere near as poorly as when he is in the 30s).

I understand the concern regarding the morning shot but I do take into account his demeamour a great deal.

Pabay drinks to excess when his BG is above 24 mmol. He drinks until he is sick. This is why I have changed to x 3 because if I can't control his drinking in the morning it's a disaster for him and us: projectile vomit every morning. Pabay can drink a lot in the morning but not to the extent that he is sick. I have enough experience now to know that testing when he is drinking a lot but not to excess is when his BG is in the high teens low 20s. Drinking is a very good guide for me.

I do try to get am shots but he is out from 4am usually and comes in cold.

I will make sure I get them for the next few days though.

Finally can you help me with a cat like Pabay: what is good control then? I thought cats should be in the range of 5 to 11 mmol. Is it good control when you get into single figures but still have 30s pre-shot? What if you don't get into single figures is that good control? Or would the pre-shot have to be in the low 20s for good control. I am pretty sure 30's means Pabay has gone too low as his drinking is very excessive when we get into the 30s. What is good control for a diabetic whose diabetes has been caused by pancreatitis not from being overweight as I think there might be difference?

Thank you so much.

Sorry I didn’t see this last night. To be sure and tag me so I see your posts, click “reply” at the end of my posts that you want to respond to and it will open a new text box for you and also tag me.

Because TID dosing is aggressive, I wonder if you might want to go back to BID dosing and do it correctly with the proper testing and adjusting of doses. If you read the stickys, which you’ve obviously read some of them, you would need to follow the SLGS method as you feed dry food. The members here can help you learn when to test but you will need to learn his onset, nadir, and duration which will help you catch the lows. Usually, when a kitty onsets, unless they are bouncing, the BG can drop quickly and if they are clearing a bounce, it drops very quickly.

I have to ask you to report numbers in mg/dL as that is what we use here. Most members here do not know how to convert mmoL to mg/dL and they will tend to overlook your posts if they have to figure out how to do it so please only post BGs in mg/dL.

For instance, when you say he flat lines in the 30s, he has clear signs of hypo, if you mean in the 30s mmoL, then he isn’t having signs of hypoglycemia. If you mean. 30 mg/dL, then he potentially is having signs of hypoglycemia. But then you refer to the 20s and how you think he’s not on enough insulin so I’m assuming there you mean 20s mmoL. You state in your signature block you are trying to stop hypos but on all his tabs, I only see one BG on 4/9/2020 that could have led to a symptomatic hypo.

While using signs such as drinking as an indication his BG is high, I wouldn’t rely on it solely. There are other health conditions that can cause cats to do that. You must get him and you into the habit of testing before every single shot. For me, that’s a nonnegotiable and I just won’t put a cat’s safety on the line to advise when the caregiver is not doing preshot tests. Many of our members whose cats go outside curtail that activity and keep them in as long as they are insulin dependent.

Thank you for getting the tests last night and this morning. He is very clearly bouncing today from that drop to blues.

Here is how we define regulation:

• Not treated [blood glucose typically above 300 mg/dl (16.7 mmol/L), poor clinical signs]
• Treated but not regulated [often above 300 (16.7) and rarely near 100 (5.6), poor clinical signs]
• Regulated [generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs, no hypoglycemia]
• Well regulated [generally below 200-250 (11.1-13.9) and often near 100 (5.6), no hypoglycemia]
• Tightly regulated [generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin]
• Normalized [60-120 (3.3-6.7) except perhaps directly after meals -- usually not receiving insulin]

As you can see, a cat can be generally below 300 with a nadir around 100 and be regulated. Our goal here in this board, is to get cats in the well regulated range, at least, if not into remission.

I would not assume that with the BG getting lower, he’s headed for a hypo. The goal is to try and flatten the curve over all and then decide if he needs more insulin to gradually bring the overall curve down.

I know you started shooting TID because you are worried about duration. Things that affect duration include:

• Lack of absorption which can vary up to 50% shot to shot
• Feeding too late in the cycle (after nadir)
• Incorrect dose

I also note you are feeding him dry food which is usually high carb and that can be contributing to his high BGs and could be the reason he is diabetic. I was helping another member who was feeding one of the new “LC” dry foods and the BGs were similarly high. When he went to a completely canned, LC food, his BG dropped into the normal range and he’s doing amazing. Of course, you can’t cold Turkey stop dry food as the BG will plummet but you have to do it gradually while monitoring the BG and making adjustments in dose.

You will have to decide if you want to go back to BID dosing but I’ve seen others do TID and it does wear on the CG and the cat. I would suggest you consider going back to BID dosing at perhaps an equivalent dose of what you are giving now which would be 1.5u every 12 hours. Collect data by always getting the preshots and then random tests during the cycles so we can build data and see what might be a good dose for him.

I’d also suggest you learn about feeding, try to switch slowly to a LC canned diet, and make sure he does not eat after nadir. If he gets hungry, a few very LC freeze dried treats or boiled chicken might work. I know you’ve been patient and tried everything but I hope you will give us a chance to help you all as I believe the efforts have been a bit helter skelter especially if you think he’s hypoing at 30 mmoL ...which is just not possible.

 

[Pabs&Ro]

Marje,

Many thanks. I am inclined to agree with the change back to x 2 a day but will just do one more night first.

I am sorry but I seem to have caused you some confusion. Pabay has overswings which make him very ill due to a previous episode of hypoglaecemia. Overswings make Pabay very ill.

1. When Pabay flat lines in the 30s ie up to 32.8 mmol/L (590 mg/dL) as on 11th August he is not hypoglycaemic!
2. What has happened is that he has had an oversewing (a bounce) due to a previous undetected episode of hypoglycaemia.
3. Yes he was hypoglaecemic on 9/4/20 but also possibly on 6/2/20 at 3.1 mmol/L ie 55.8 mg/dL because he could have dipped either side as he was low the hour before and the hour after. Also because on 8/11 he then flat lined in the 500 mg/dL. His demeanour when he is in the 500s mg/dL is also clear to me and he is very poorly. Unless there is constant testing you do not know when the dip was and he does not have to dip for long to cause hypoglycaemia.
4. On 1/21/21 he dipped to 5.5 mmol ie 104.4mg/dL but only at the point I tested him and he was low in the hour before and after. He then hit 547.2 mg/dL the evening. That tells me he had an overswing and must haver dropped lower than 104.
5. I am trying to stop hypoglyceamic overswings because they make him so ill. I am trying to flatten the curve.
6. I do not understand you when you refer to a bounce on 3/23/21. Dropping to 9.3 mmol 167.4 mg/dL and then rising to 25.8 mmol 464 mg/dL is not hypoglycaemia followed by an overswing (bounce) because he is not ill, he is not drinking excessively and it is simply not a low enough nadir not a high enough overswing based on my experience with Pabay.
7. Food - after the nadir Pabay gets boiled cod or pollock and he gets biscuits at the next jab time.
8. I am not new to this. Pabay is on dried food with 9.5% carbs. I have tried every type of raw, boiled, canned, sachet, roast food. Everyday I offer him wet food. Every few weeks I try yet another wet food from the great list prepared a member. Pabay has waxing and waning pancreatitis. Food that does not agree with him makes him vomit. Pabay would starve himself to death if he did not have biscuits. I have very little leeway because he is 4.7kg (today) and his sister is 5.4kg. Pabay is one score above the worst body condition score.

Hope this fills in some gaps. I will keep up with the data tonight and up date the spread sheet later and then see where we are tomorrow. I am also waiting to hear from my vet.

Thanks Julie

@Marje and Gracie

 

[Marje and Gracie]

Marje,

Many thanks. I am inclined to agree with the change back to x 2 a day but will just do one more night first.

I am sorry but I seem to have caused you some confusion. Pabay has overswings which make him very ill due to a previous episode of hypoglaecemia. Overswings make Pabay very ill.

1. When Pabay flat lines in the 30s ie up to 32.8 mmol/L (590 mg/dL) as on 11th August he is not hypoglycaemic!
2. What has happened is that he has had an oversewing (a bounce) due to a previous undetected episode of hypoglycaemia.
3. Yes he was hypoglaecemic on 9/4/20 but also possibly on 6/2/20 at 3.1 mmol/L ie 55.8 mg/dL because he could have dipped either side as he was low the hour before and the hour after. Also because on 8/11 he then flat lined in the 500 mg/dL. His demeanour when he is in the 500s mg/dL is also clear to me and he is very poorly. Unless there is constant testing you do not know when the dip was and he does not have to dip for long to cause hypoglycaemia.
4. On 1/21/21 he dipped to 5.5 mmol ie 104.4mg/dL but only at the point I tested him and he was low in the hour before and after. He then hit 547.2 mg/dL the evening. That tells me he had an overswing and must haver dropped lower than 104.
5. I am trying to stop hypoglyceamic overswings because they make him so ill. I am trying to flatten the curve.
6. I do not understand you when you refer to a bounce on 3/23/21. Dropping to 9.3 mmol 167.4 mg/dL and then rising to 25.8 mmol 464 mg/dL is not hypoglycaemia followed by an overswing (bounce) because he is not ill, he is not drinking excessively and it is simply not a low enough nadir not a high enough overswing based on my experience with Pabay.
7. Food - after the nadir Pabay gets boiled cod or pollock and he gets biscuits at the next jab time.
8. I am not new to this. Pabay is on dried food with 9.5% carbs. I have tried every type of raw, boiled, canned, sachet, roast food. Everyday I offer him wet food. Every few weeks I try yet another wet food from the great list prepared a member. Pabay has waxing and waning pancreatitis. Food that does not agree with him makes him vomit. Pabay would starve himself to death if he did not have biscuits. I have very little leeway because he is 4.7kg (today) and his sister is 5.4kg. Pabay is one score above the worst body condition score.

Hope this fills in some gaps. I will keep up with the data tonight and up date the spread sheet later and then see where we are tomorrow. I am also waiting to hear from my vet.

Thanks Julie

@Marje and Gracie

Thank you for the clarification

What you are describing as overswings are, yes, bounces. A cat does not have to go really low for that to occur. Any BG lower than what they are used to....such as the 167 he had yesterday, or even a sudden drop, can cause a bounce to happen. This is very common in cats and it is happening with Pabay. A cat does not need to show illness or drinking excessively to be in a bounce. You are seeing those symptoms when he bounces really hard and up into the 400+ BGs just like many cats do. But bounces can even occur to tightly regulated cats and can even just be from BGs below 100 to mid 100s.

The way to catch those low numbers is to test. Start with a +2 and if the BG is headed down, test sooner. Feed to stop the drop. When you got that 167, you should have continued to test to see how low he actually went which very probably occurred and triggered his bounce. Or, he might have started really high at PS and dove to the 167 which triggered it.

The term “hypo” is reserved here for symptomatic hypoglycemia. Many cats here dip down into the 30s (mg/dL) with no issues at all but any BG below 50 bears close watching and feeding to bring the BG up. Just because Pabay might have dropped below 68 on a pet meter does not mean he had a hypo. Has he ever exhibited true symptoms of hypoglycemia or are you going just by the BG?

A dry food with 9.5% calories from carbs (and that’s assuming that is what you are a tally looking at and not the guaranteed analysis) is way too much. There are many ways to slowly transition a cat to wet food. It’s not just a question of offering him food each day. Although this site is about raw feeding, it has a great deal of info for transitioning even just to canned food. It’s all about going very slow. I’m fact, when I transitioned my one cat at five years old, from the balanced raw he had been eating to Raw with EZ Complete from the linked site, it took me two weeks to slowly do it until he was eating the new raw. And he’d been eating raw since kittenhood.

 

[Pabs&Ro]

Thanks. The food is on the food list as an ok but not the best food as it is below 10%. We have tried the kibble on top etc. He has fortiflora to get him to eat. We have been going slow for almost 2 years!!!!!

Yes I think Pabay is at risk above 50 and I think 126 is the point to worry and yes it could be higher. So what range do you think I should be trying to keep him in as he does not fit the categories of control you list and is the one of the cats that bounces.

Pabay has exhibited signs of hypglycemia on less than five occasions. Most times it was back in 2018 when he was on very high doses. Floppy almost unconscious rapid shallow breathing and at times extreme lethargy and wobbly in his feet. He has never passed out. Treated with glucose or food and luckily on each occasion he has turned around. Also mild signs on 20th and 21st August 2020.
@Marje and Gracie

 

[Marje and Gracie]

Yes I think Pabay is at risk above 50 and I think 126 is the point to worry and yes it could be higher.

You’ll have to clarify because I don’t know what you think he’s at risk from above 50, why 126 is a point to worry about, and what you are basing that on.

The food is on the food list as an ok but not the best food as it is below 10%.

What food list as there are many? Most food lists don’t make the determination of whether the food is ok or not. They just provide the data.

Also mild signs on 20th and 21st August 2020.

Since you shot blind on the 20th, it’s possible he could have been too low to shoot and had symptoms. There is no reason at all that he should have had any symptoms from hypoglycemia on 8/21. It was probably due to high BGs.

Keep in mind that any issues you see from high numbers, even if you suspect there was a low one, are not considered hypoglycemic symptoms. For those, we are looking only at the low numbers; not the symptoms that come with him bouncing high and drinking a lot of water or feeling lethargic because his BG is too high.

he does not fit the categories of control you list

He is “ treated but not regulated” just based on what I can see.

Again, you want to strive for regulated, then well regulated, and hopefully tightly regulated....at least well regulated.

 

[Pabs&Ro]

@Marje and Gracie e and gracie
I don't know how to do what you did but here goes:

1. Food list is the uk food list on this site prepared by Elizabeth and Bertie. Having just checked the carb is below 9%.

 

[Pabs&Ro]

Why is 126 a worrying figure? Because on 24th January I had a great shaped curve and great readings until he was very ill: sick, withdrawn, lethargic, hunched, fur sticking up. The PM pre shot was high at 547 (30.4). The clinical signs and the uncharacteristically low figures and more than doubling and quickly in 3 hours or less all suggest to me that 95 is too low for Pabay and 126 (7) could be a safety barrier figure (or even higher). This is also borne out by events on 8th Jan 21 when my notes again show 142 nadir and that he was poorly in that he was withdrawn but not as bad as on 24th and he refused to eat anything in the evening and although the nadir was 142 we had PMPS of 583 (and that was a fasting figure).

Since you shot blind on the 20th, it’s possible he could have been too low to shoot and had symptoms. Yes possibly but being realistic as applied to Pabay and based on his historical figures since 2018 his pre-shots have never been too low to shoot.

He is “ treated but not regulated” just based on what I can see. The post you quote from Gill and Alex has another category missed of your list: "There may also be an extra category of "mostly above 300 (16.7) but with good clinical signs" which occurs with some cats who are getting insulin. We don't know why it happens, but such a cat probably should not be considered to be regulated". Since 17th March 2021 Pabay is mainly above 300 and the clinical signs are very very good. I even wonder if I should just aim for the glocosoria threshold to try and give him the best quality of life!

@Marje and Gracie

 

[Marje and Gracie]

@Marje and Gracie e and gracie
I don't know how to do what you did but here goes:

1. Food list is the uk food list on this site prepared by Elizabeth and Bertie. Having just checked the carb is below 9%. View attachment 60327View attachment 60328View attachment 60327 View attachment 60328View attachment 60327View attachment 60328View attachment 60327

My concern is that Eliz does state the values are “typical analysis” from the label. The calculators used to determine the % calories from carbs based on using typical or guaranteed analysis are often very inaccurate. The most accurate way to know the actual % calories from carbs is to obtain the dry matter basis or as fed values directly from the manufacturer. This post might be more informative for you.

Why is 126 a worrying figure? Because on 24th January I had a great shaped curve and great readings until he was very ill: sick, withdrawn, lethargic, hunched, fur sticking up. The PM pre shot was high at 547 (30.4). The clinical signs and the uncharacteristically low figures and more than doubling and quickly in 3 hours or less all suggest to me that 95 is too low for Pabay and 126 (7) could be a safety barrier figure (or even higher). This is also borne out by events on 8th Jan 21 when my notes again show 142 nadir and that he was poorly in that he was withdrawn but not as bad as on 24th and he refused to eat anything in the evening and although the nadir was 142 we had PMPS of 583 (and that was a fasting figure).

I always say that it’s really important for CGs to know their cats and I understand he was ill and not feeling well. But, honestly, I think you are hearing hooves and thinking zebras, not horses. I’ve worked with thousands of members here with their cats and looked at so many SSs, it would make your head spin and not one cat would have the symptoms you observed based on those BGs. It is common for cats, who have been in high numbers, to seem to feel lethargic and quiet when they first start getting into more normal numbers. A cat might also not feel well if they start in the 400-500s, drop to low blue or high green numbers, and bounce back up. The issue is not the lower numbers; it’s the v-shape curve from high to normal to high in 12 hours.

Since you shot blind on the 20th, it’s possible he could have been too low to shoot and had symptoms. Yes possibly but being realistic as applied to Pabay and based on his historical figures since 2018 his pre-shots have never been too low to shoot.

I really want to be respectful but if you had seen what I’ve seen, you’d understand how naive this statement is. You cannot possibly know that because you aren’t getting enough preshots. Every single time members have come here and said the same thing and they started testing at PS, they were stunned to find there were cycles with numbers too low to shoot. We’ve had members who shot blindly, their cat was exhibiting hypo symptoms by +1, they tested, and the cat was in the 20s. That means they shot too low. You have been very lucky, so far.

He is “ treated but not regulated” just based on what I can see. The post you quote from Gill and Alex has another category missed of your list: "There may also be an extra category of "mostly above 300 (16.7) but with good clinical signs" which occurs with some cats who are getting insulin. We don't know why it happens, but such a cat probably should not be considered to be regulated". Since 17th March 2021 Pabay is mainly above 300 and the clinical signs are very very good. I even wonder if I should just aim for the glocosoria threshold to try and give him the best quality of life!

This is not Pabay if he’s drinking large amounts of water when his BG is higher. If he’s drinking more, he’s peeing more. The above is rare....in fact, I don’t think I’ve seen a cat that falls in that category.

Aiming for renal threshold is not a good goal. Also aiming for any specific range goal, is not so simple.. I’ve seen many members say, and I said it myself, “I’d be happy with low blue”. Easier said than done and I know because I tried every technique I knew to do it. Also, renal threshold varies and is cat specific so you’d have to do a lot of urine testing at home to try and figure it out. A cat with a BG above renal threshold over the long run can have residual health issues including dehydration, loss of electrolytes, bladder infections, etc.

 

[Pabs&Ro]

Thanks Marje. Noted.

Pabay has stopped drinking excessively since 18th March 2021. This is a transformation.

I have been through your link about carb calculations, I wrote to the company in Feb 21 and Elizabeth's figures is accurate: 8.9% carbs by calorific value.

Any comments on latest spread sheet please if you have time later on?

Thanks

Ps I have tagged Elizabeth just for her information

@Marje and Gracie
@Elizabeth and Bertie

 

[Marje and Gracie]

Thanks Marje. Noted.

Pabay has stopped drinking excessively since 18th March 2021. This is a transformation.

I have been through your link about carb calculations, I wrote to the company in Feb 21 and Elizabeth's figures is accurate: 8.9% carbs by calorific value.

Any comments on latest spread sheet please if you have time later on?

Thanks

Ps I have tagged Elizabeth just for her information

@Marje and Gracie
@Elizabeth and Bertie

First, let me commend you on two things: getting more tests especially PSs and getting the as-feds from the food manufacturer. Well done, you, especially with the testing!!! It’s very helpful.

I want to address a couple things so easy one first.

I took the as-feds from the email and calculated the % calories from carbs, protein, and fats and I got, respectively, 8% (C), 48% (P), and 44% (F) for the Thrive dry Chicken. I hope you can get him on the canned as I feel he will do much better on a lower carb wet food.

Second.....dosing. Diabetic cats do better with consistency and that’s why we have dosing methods. We would not have ever recommended you decrease his dose today. You said it was because he had a lower than normal AMPS. Look at it this way: every meter can have a 20% variance from test to test.

365 x 20% = 73. 73 + 365 = 438. What that tells you is he is flat.

I appreciate you’ve realized you all need help and I want to give you info that helps you get him on track; therefore, I need to be straightforward with advice which is not criticism. The best way to work these insulins is to not dose hop. Sure, there are times when you might need to shoot a one-time reduced dose and PZ is more forgiving in allowing you to do that because there is no depot. But, by and large, we don’t dose hop; that is not helping him.

As long as he has any dry food, you would need to follow the SLGS method. That would have you holding the dose for an entire week unless he drops below 90. If he drops below 90, immediately reduce the dose at the next shot. While I believe he’s going to need more than 3u a day, if you are going to stick with TID dosing, I’d suggest you shoot 1u each cycle, always getting a PS, and getting at least 1-2 other tests during the cycles and vary the times so you can get an idea of what he’s doing say at +2 and +6 one cycle, +3 and +8 the second, and then at night, unless he’s running lower, save yourself and get sleep by doing a +2 and before bed. Of course, if you see him trending down below 200, you’ll need to test more. Don’t stop testing until he’s come back up but that doesn’t mean you have to test every hour unless he dips into BGs below 100. Post for help and someone can help you figure out how often to test. Be sure the subject line indicates you need help.

If you decide to go back to BID dosing, I’d suggest 1.5u every 12 hours. Again, one day in the a.m. cycle, grab a +2 and +6, the next day, try a +3 and +8. Also grab a +10 her and there so you can see what duration he’s getting. At night, again, +2 and before bed unless he’s dropping.

After one week, unless he drops below 90, we reassess and determine if he needs more insulin or less.

It would also be very helpful if you would track his food consumption in the Remarks on the SS: how much food and when in the cycle that it’s fed such as “cycle 1, +4, 0.5 oz 8% dry”. Food plays a big role in regulation for most cats so we can’t ignore how it might be affecting his cycles.

We have had decades of experience using SLGS and many cats have done well on it. If you gradually eliminate the dry, you can switch him to modified PZ dosing when he’s totally on wet food. That will allow you to change the dose a little more often.

Insofar as how his curve looks right now, it appears he’s bouncing from the 167 and however lower he might have gotten. It can take as much as three days (or 6-12 hour cycles) to clear a bounce so it will be interesting to see what he does between now and Saturday if you dose consistently. He might clear sooner but hard to say.

What do you think?

 

[Pabs&Ro]

Thanks, I don't understand some of the things you are saying can you clarify please:

1. By hop do you mean don't reduce the dose?
2. The pro zinc dosing advice says, "

• Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise."

I thought that is what I should do. So why was that wrong?
3. If the meter can be wrong by 20% one way then it can by 20% wrong the other way can't it? And every reading can be 20% out?
4. "365 x 20% = 73. 73 + 365 = 438. What that tells you is he is flat." I just don't understand this statement at all. Can you try and explain it again please?

Thanks

@Marje and Gracie

 

[Pabs&Ro]

Marje,

Can we just hold off until later today to make the conclusion that he is flat lining. I accept yes it is possible but at +3 he is 281. I have just got that reading at 17:00 hrs GMT. I might be wrong but he might go lower at +4.

thanks

@Marje and Gracie

 

[Marje and Gracie]

1. By hop do you mean don't reduce the dose?

Dose hopping means changing the dose too frequently. Consistency is the key unless there is a real reason to shoot a reduced dose like a low PS or you can’t be available to monitor.

2. The pro zinc dosing advice says, "

• Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise."

I thought that is what I should do. So why was that wrong?

Because his AMPS was not below his normal pre-shot value. It was basically the same. If his PS had been 225, you “might” have wanted to shoot a reduced dose. However, what you quoted is for people with very little data that are new to this. You have data...you’ve been doing this quite a while and even though there are a lot of gaps, you do have data over time. Plus, you’ve shot many times blind and I guarantee he was lower than 200 at some time when you did it You’ve dealt with BGs below 100. I’d like to see you shoot every PS 150 and above on time with the full dose for that cycle unless you cannot monitor. We start there and then slowly get it down to you shooting everything above 90.

3. If the meter can be wrong by 20% one way then it can by 20% wrong the other way can't it? And every reading can be 20% out?
4. "365 x 20% = 73. 73 + 365 = 438. What that tells you is he is flat." I just don't understand this statement at all. Can you try and explain it again please?

Yes, you are correct. It could have been less but see my comments above. Yes, every reading can be off and generally we don’t worry about it or give it a second thought especially when we are shooting BGs below 100 or making dose reductions. In other words, if you get a BG at any time below 90, don’t worry that it might actually be 20% higher, just reduce. Likewise, if you were to get a PS of 150, don’t worry that it might be 20% lower, just shoot.

I was just trying to show you that his AMPS today was pretty close to his others that you’ve gotten. It was just to illustrate to you that it didn’t warrant reducing the dose. Maybe the BG was a little higher, maybe a little lower but not significantly so.

There is a learning curve here and it’s great that you are asking good questions.

 

[Marje and Gracie]

Marje,

Can we just hold off until later today to make the conclusion that he is flat lining. I accept yes it is possible but at +3 he is 281. I have just got that reading at 17:00 hrs GMT. I might be wrong but he might go lower at +4.

thanks

@Marje and Gracie

Oh certainly....on the SS, you show 281 at +4 in the a.m. cycle. Are you now in a different cycle today and he’s at 281 again? It’s really important to keep the SS current or it’s really difficult to answer your questions correctly. Because of our time difference, I’m not sure what cycle you are in but I’m assuming it’s the last one. I don’t even know what your shot times are to be able to figure it.

 

[Pabs&Ro]

Just up loaded the new one. I am at + 3.5 in the the second dose of three. I am taking another reading at +4 in 30 minutes. @Marje and Gracie

 

[Marje and Gracie]

Just up loaded the new one. I am at + 3.5 in the the second dose of three. I am taking another reading at +4 in 30 minutes. @Marje and Gracie

Thank you. I don’t think you need to test at +4 but I’ll leave it up to your comfort level.

Unfortunately, I have to leave now. My husband and I volunteer at a large COVID vaccine site and we are working today. If I get a chance to pop in later, I will but it will likely be long after your evening shot time. Truly sorry but I hope I’ve given you enough info that you’ll feel comfortable shooting 1u tonight for any PS 150 and above.

Post if you need help but just be clear that you do.

 

[Pabs&Ro]

Thanks Marje. Pabay dropped later but PS well above 150 at 290. He was sick around + 3 which explains the drop, I think, as the food he ate at PMPS ended up on the carpet Not sick through drinking excess though.

We have learned a lot and we agree that 3 units is unlikely to be sufficient and that . We are going back to twice a day. What is important is that we do not have projectile vomit going back to two doses a day. Time will tell.

If you do make it to the UK in the fall let me know. We live within 1 miles of Wales at the old Roman city of Chester, my husband is Scottish and Pabay is named after a Scottish island east of the Isle of Skye. Many thanks for all of your valued assistance. Hope the vaccination went well today. Julie and Pabay (Ro is his sister named after the Scottish Island Rona located next to Pabay).

Ps looking forward to some sleep.

@Marje and Gracie

 

[Marje and Gracie]

Thanks Marje. Pabay dropped later but PS well above 150 at 290. He was sick around + 3 which explains the drop, I think, as the food he ate at PMPS ended up on the carpet Not sick through drinking excess though.

We have learned a lot and we agree that 3 units is unlikely to be sufficient and that . We are going back to twice a day. What is important is that we do not have projectile vomit going back to two doses a day. Time will tell.

If you do make it to the UK in the fall let me know. We live within 1 miles of Wales at the old Roman city of Chester, my husband is Scottish and Pabay is named after a Scottish island east of the Isle of Skye. Many thanks for all of your valued assistance. Hope the vaccination went well today. Julie and Pabay (Ro is his sister named after the Scottish Island Rona located next to Pabay).

Ps looking forward to some sleep.

@Marje and Gracie

Poor boy. Good luck with going back to twice a day and I hope his tummy settles.

We’ve been to Scotland many times as my husband’s ancestors originated in Dunblane; I also have Scottish ancestry but my ancestors migrated to Wales so I have more ancestors (Llewelyns and Morgans) from there. We’ve been by Pabay several times back and forth to Skye but never went to Pabay or to Rona. I truly hope we get there as we’ve been every year for several except last year. We were supposed to be there all of Oct...you know how that ended up. We are both fully vaccinated but we won’t come if we have to sit two weeks in quarantine. I hear the UK is doing a great job of vaccinating, though. You are lucky to live there...it is so beautiful!