Dosing suggestions? Back on the juice. :(

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JenM

JenM

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Haven't posted in here, only in the main forum. For those who may not know, Tink has been OTJ since shortly after he came home from his prolonged vet stay at initial diagnosis back in Oct/Nov 2013. He went into remission quickly at home and has been doing great. Until now. His numbers started slowly creeping up several weeks ago, but just within the last week or so started creeping into the yellow.

Ugh. So, not only are we back on the juice - now our numbers are going CRAZY.

Please let me know what you think. First... I'm not sure why we're suddenly seeing upper 300s and 400s when just a few days ago we were barely creeping into the 200s WITHOUT insulin. :/ But... I guess if it were predicatable, it wouldn't have the word "feline" in it. :lol:

ProZinc was what got him into remission (VERY quickly) and I still had some, so that's what we're using. Mind you, the bottle was purchased/first used in late October... but it seems like it's still working. I just dont know what dose to use. I started with .25 because his numbers weren't THAT high and because I was not able to be home to monitor him during the day (I'd intended to start the insulin on the weekend, but he had other ideas). Starting this afternoon, I'll be home more thru Sunday and will try to get a curve in (though this is graduation weekend for my daughter... so it's going to be a bit hectic).

I did have one goof up with his dosing... I wrote down that I gave him the dose, but then got sidetracked and didn't actually DO it! Tested him 3hrs later and realized what I'd done, so dosed him then. And yes, I was POSITIVE that I had not dosed him 3hrs prior when I wrote it down (plus his bg was significantly higher).

Anyway, we've now hit 400+ a couple times (mornings - he's always tested higher in the morning for some reason) so I've started playing with .5 doses when that happens. Do you think I need to move up to .5 as a rule? Or should I continue with .25 a bit longer and just give extra is he's super high? I know the depot needs to build up - but given that he had DKA before... I dont want to play in he 400s. I'll make sure I test his ketones this weekend as well.
 
Hi Jen. What great numbers you have been having for such a long time and awesome job of keeping track of his numbers. I am so glad that you have posted here. There are a lot of kitties who are on Prozinc however there seems to only be a few of us that post. I am new so I can't give you any dosing advice but there are a couple of folks here that can and I am sure that they will help you out very soon.

The only thing that comes to mind asking is; do you think Tink is having any other issues i.e. teeth problems, urinary track issues, etc.? Is he starting to drink more water and pee more? It might be worth checking his ketones with those test strips. How is his demeanor? Is he still hungry, purring, etc?
 
Hi Jen,

Glad you made your way here. Cindi had some great questions. Her Merlin is looking beautiful after a needed dental.

It does seem like the ProZinc is still working. It may not be as potent as it was at first, but hopefully it can make an impact. I am not sure about your two red amps numbers. Maybe get some midcycle numbers at night if you can this weekend.(before bed, when you wake up to use the facilities :mrgreen: early morning if possible) He may be dropping low at night and bouncing up. Those reds really look like a bounce.

Your doses look good to me so far; more data will really help to fill in the picture (i.e. spreadsheet), so to speak.
 
Tink was just at the vet last week for a checkup, though they didn't do any bloodwork. They did check for urinary issues and that came back clean. The vet was happy to not see ANY glucose in his urine and all other levels were normal as well. They said his teeth look excellent (especially given that he's 11!) and he didn't even really need a cleaning or anything. Of course, at the time he had only gone over 200 once, so the vet wasn't too concerned. However, now I'm thinking I should have them run some bloodwork to rule out pancreatitis and thyroid issues (assuming bloodwork would show both of those?). He's acting normal though his appetite continues to increase and he's more determined to steal food. Slightly increased thirst drive, but not excessive. Planning to test ketones next chance I get, probably tomorrow morning.

Just spent $2500 on the dog in this past week (who managed to end up with parvo, despite being fully vaccinated)... so my vet fund is hurting... but hey... that's what credit cards are for, right? :roll:

I've been trying to get at least one evening test before bed (usually +3 or 4) and it hasn't been low enough to suggest he's going too low overnight... but I can certainly set my alarm and do a +6 to make sure.

I haven't used insulin with him enough to know how it will work long term, since he went OTJ so quickly before. Once a dose is dialed in... should I still expect to see the up and down waves, or should his numbers stay more consistent like they were when he was not on insulin. It seems unhealthy to have the numbers riding the roller coaster up and down (being high at dosage, low at nadir). Is that just how it has to be when one is on insulin? Or will they eventually even out once his depot is built up?
 
We usually see a smile curve with ProZinc, higher at preshot, dropping to a nadir 5-7 hours after the shot and then back up at the next preshot. Generally we consider a cat regulated if they are in the lower 200s at preshot and double digits at nadir (but not below 50 which is approaching hypo territory.). It might be helpful for you to look at some of the spreadsheets in the remission thread above. It'll help you see where people started and how they dosed, going OTJ. Merlin's ss is interesting too. He was doing okay before his dental and now is in lower ranges. Cindi has tried holding a dose (as Merlin does seem to take awhile to settle into a dose) but sometimes also shoots a lower dose if she gets a lower than expected low number.
 
That's kind of how I was handling the ProZinc before - basing the dose on the preshot number... but then learning more about depot insulins, I was questioning if that's ok or not. But sounds like it is - within reason? I just can't see shooting a .25 when he's in the red, but certainly wouldn't shoot a .5 if he was in the 200s either. Darn cats - sure wish they didn't like keepin' us beans on our toes so much!
 
The insulins are different. Because the L insulins last longer in the body, tend to have a overlap and have a flatter curve, you base the dose on the nadir only. With Prozinc, you base the dose on the preshot with the nadir taken in consideration. So, say if the preshot is 300 but you know with a previous dose of 1.5 units, he got a nadir of 40 on a similar pre shot - you'd shoot a little less than 1.5 this time. It is in and out so seldom do you need to consider overlap.

You have seen the protocol? If not, it is at the top of the page.
 
Boy... looking back on his spreadsheet at Dec & January... I'm wondering if his weight isn't playing a big role. His numbers were SO gorgeous in Dec & early Jan! He was also under 12lb. This 13lb mark seems to almost exactly coincide with the higher numbers. May be a complete coincidence... but it's interesting.

Thanks for pointing me to the protocol, that was helpful. I think he's a "sliding scale" guy, based on our last bout with insulin... but time will tell I guess. I think I need to pick up some u100 needles too - definitely eyeballing my doses, which makes me nervous. On the bright side... knowing my critter clan... if I go buy a bunch of supplies, he just might go back into remission quickly (ya know, so it was a waste of money, lol). :lol:
 
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