ECID dosing gripes...

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SpotsMom

SpotsMom

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I really just wish I could find a dose that works and stick with it! Every time I think Spot is settling into a dose, his PS numbers start to inch back up to the 300s.. and what seems to solve it is REDUCING his dose. So counter-intuitive...

2 weeks ago 1u unit looked like a good dose, but when I tried to bump it up slightly, fat 1u caused higher PS... now I'm experimenting with lowering to 0.5u and these numbers look similar to what he was doing on 1u 2 weeks ago! I have no idea anymore... every day is a new hypothesis and I feel like I'm constantly on the search for some kind of trend in his numbers.

I'd like to get his nadir numbers lower, but every time I try to bump his dose up, his PS numbers start rising. I guess for now anyway we'll just be happy with mid-blues and yellows.. he seems happy there, so I guess I should be too o_O:arghh:
 
Kris & Teasel said:
Having a dose drift up and down over time is probably more common than being able to find a good dose that works day in and day out. Click on a variety of SSs (including mine) and you'll see you're not alone.
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Yeah I realize you're right.. and throw into the mix that how kitty is feeling on any given day also affects the numbers! Last week he was feeling off and wasn't really eating, so far this week he seems to be back to his old self. Who knows what tomorrow brings!
My vet thinks I'm neurotic for testing so much and wants me to lighten up... but I'm a data analyst by trade and a spreadsheet addict IRL so I don't think having too much data is ever a bad thing. Spot doesn't seem to mind.. he knows when I sit in a particular chair, its time for testing and comes right over to me. So on we go... constantly on the search for the "perfect for today" dose LOL
 
You're definitely not alone. I'm on diabetic foster cat #4. Each one has been on Prozinc and each one has been very different. My current guy's reaction to insulin has been driving me nuts. I was contemplating a switch to Lantus when my Prozinc runs. BUT lo and behold, he may be headed into remission despite his crazy cycles.

I'm glad you aren't afraid to try lowering a dose to see it that's the key to lower numbers. It is counter intuitive but in my experience that works more often than not. Ignore your vet, you're in good company here.
 
I love that "perfect for today" expression! I might steal that. :smuggrin:

Now as for dosing, I would suggest that you use the mid-cycle numbers to guide your dosing right now instead of the pre-shot numbers. You want to aim for mid-cycles in the 50-120 range (and under 100 if you can safely do it). As cats flirt with lower mid-cycles, the PS numbers will often rise a little as their body tries to adjust. Right now your mid-cycle numbers are above what is considered healthy and that's concerning.

I would suggest doing the 0.25u increases every few days and keep an eye on the lowest point to help guide if you should keep increasing or if you should pause at a dose for longer. And please never hesitate to post if you'd like someone to weigh in on next steps. Dosing can be tricky with Prozinc and a couple of extra brains on it can help sometimes!
 
Thanks for your input! I did go up to .75u for tonight, so we’ll see how that goes. I feel like I’ve been trying to find his new normal ever since I switched him to the lower carb FF. “Perfect for today” is really hard to pin down haha. I think we’re starting to get there but I agree... not quite there yet.

I have been going off the assumption that a slightly higher but less dramatic curve that keeps him below 300 is better than a larger drop and with more dramatic differences. It sounds like you are saying I don’t need to worry as much about the 300s as long as his nadir is looking good? His numbers seem to look like an S curve most of the time (highest around +9) rather than a smile, so I don’t always know what the right change is.....
 
If the drops are too too dramatic, they can cause the numbers to swing up and down too much, or get stuck up high. Then lowering the dose can sometimes help stabilize things a little. But in general if you aren't getting a smile curve, it means not enough insulin.

Below 300 is what a lot of vets say because they are assuming (a) that you're using a pet meter and (b) that you aren't really home monitoring. So they want the cat to run on the higher side of things to keep them safe. In reality, 50-120 is a healthy, non diabetic cat, so 300 is really much too high to be healthy.

First aim for the difference between PS and nadir to be about 50% so a 300 PS and a 150 nadir is pretty good. Then from there, start to gently nudge that nadir number lower and lower until you get some higher green numbers. As they get time in those healthy greens, often at that point the PS numbers will start to come down. It's definitely a bit of an art with Prozinc in order to get the nadirs lower without setting of wild bouncing. We are happy to help, so never hesitate to post and ask for a 2nd opinion.
 
98 @ +6! I love to see the green... but he's also not eating today.

He's so hit or miss with his appetite so that's another challenge thrown into the mix. I think I'll stick here for a few more cycles and try to get some more data :confused:
 
SpotsMom said:
98 @ +6! I love to see the green... but he's also not eating today.

He's so hit or miss with his appetite so that's another challenge thrown into the mix. I think I'll stick here for a few more cycles and try to get some more data :confused:
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Is there anything you can sprinkle on his food to tempt him - parmesan cheese, ground up low carb treats, tuns water, etc.?
 
Kris & Teasel said:
Is there anything you can sprinkle on his food to tempt him - parmesan cheese, ground up low carb treats, tuns water, etc.?
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He does like Fortiflora, so that usually gets him going a little bit.. but he just basically licks it off the top, then abandons the rest. Yes, to the low carb treats, he loves the Purely Fancy Feast Natural Treats, so I give him those liberally when he decides he doesn't like his food on any given day.

Today he was lapping at his food when I left, but then I got home 6 hours later and it was basically untouched since then. I really feel like sometimes he just likes company when he eats... even on his worst day, he'll usually eat while I'm in the kitchen looking at him haha!

Edit: for a few months after he was diagnosed before we stumbled on FF, he went through a catorexic phase where he just would not eat on his own. I had to force feed him in order to get anything into him. Thankfully he is no longer being that stubborn, just decides some days he doesn't want to eat a whole lot. Usually by the end of the day I can get 2 3oz cans into him, so I'm not super worried he's starving himself... just moderately concerned about how a dose increase would affect him...
 
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SpotsMom said:
He does like Fortiflora, so that usually gets him going a little bit.. but he just basically licks it off the top, then abandons the rest. Yes, to the low carb treats, he loves the Purely Fancy Feast Natural Treats, so I give him those liberally when he decides he doesn't like his food on any given day.

Today he was lapping at his food when I left, but then I got home 6 hours later and it was basically untouched since then. I really feel like sometimes he just likes company when he eats... even on his worst day, he'll usually eat while I'm in the kitchen looking at him haha!

Edit: for a few months after he was diagnosed before we stumbled on FF, he went through a catorexic phase where he just would not eat on his own. I had to force feed him in order to get anything into him. Thankfully he is no longer being that stubborn, just decides some days he doesn't want to eat a whole lot. Usually by the end of the day I can get 2 3oz cans into him, so I'm not super worried he's starving himself... just moderately concerned about how a dose increase would affect him...
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ProZinc is slow-ish in onset so we usually say if you can get a few teaspoons in before his shot it should be enough. A few more in the 2 or 3 hours after should see him through insulin onset and then he can graze the rest of the cycle.
 
Look at that pretty green yesterday! Looking at your spreadsheet, it looks to me like his onset of action happens fairly quickly. On many of your nighttime cycles he was going from the pinks to the blues by +2. His liver might have been dumping glucose when his body detected rapid drops in his blood sugar. It may be why he was staying high at the higher numbers. I hope lower doses are the key for him. On the lower dose the rapid drop isn't happening and his liver no longer dumps extra glucose. It's always a relief to see improvements!
 
We’ve been at 1u for a few cycles now and I feel like we’re on the right track but last night seemed particularly bouncy, and of course his PS numbers are higher than I’m used to seeing....

My concern is compounded by him not wanting to eat.. which is a problem we need to get sorted. I’m hoping to get him into the vet early in the week to get him on something to help with that. He's currently on an appetite stimulant but I think that’s solving the wrong problem... he’s very hungry just not eating. Maybe we need an anti-nausea or antacid? Not really sure but hoping we can figure that out....

Today has been a bit of a stressful day since he doesn’t even want to touch any of the yummy treats I can usually use to get him by. I had to resort to force feeding again. Which neither one of us likes. That being said, his curve today looks GREAT!! But I fully expect another bounce tonight... should we stay the course and hope the bouncing subsides??
 
Does he seem nauseated? A bit of pepcid can help...I think if you get the regular strength and then give 1/4 of it about 20 min before a meal it's supposed to help with nausea.

Wow! Those numbers are great today! I'd say to stay the course for now. The bouncing will eventually subside...give it time.
 
Rachel said:
Does he seem nauseated? A bit of pepcid can help...I think if you get the regular strength and then give 1/4 of it about 20 min before a meal it's supposed to help with nausea.
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Thanks! I will try that. He does seem nauseated... and it seems to compound on itself. The more he doesn’t eat the worse it gets until eventually he’ll start vomiting clear liquid. I try to watch him to make sure it doesn’t get that far but I wish I could just make him feel better :( Hopefully the Pepcid works!
 
Nice curve. I agree with Pepcid. Do you think he's dehydrated? That can make them go off food. Sometimes Subq fluids can work wonders.
 
AbyResq said:
Nice curve. I agree with Pepcid. Do you think he's dehydrated? That can make them go off food. Sometimes Subq fluids can work wonders.
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He definitely could be. I gave him some water via syringe a few times today but I will speak with the vet about subq fluids. I’m sure he doesn’t get as much from the syringe feeding as he normally would through his food.....

Thanks for the advice!
 
For dehydration, have you tried flavored waters like tuna water or bone broth or something? These can really help to get a cat to drink when he's dehydrated. Keep us posted. :bighug::bighug:
 
He seems to be doing better today. He ate ravenously after his PM shot last night and so far today seems to be back on his food with no help from me. I'll make sure to stock up on some Pepcid and canned tuna to try out the tuna water next time. I'm sure he'll go on food strike again soon. He just likes to make me worry......... :blackeye:
 
So glad to hear Spot is feeling better! It's always good to keep a little stash of bribery foods for when they get fussy. Hope he stays on his food for you!
 
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