Suzanne & Darcy
Very Active Member
Thank you, Shelley. I didn't even realize there was still a conversation going on on main. I think I just stay here to keep sane.
Help. About to do my first ever ProZinc Injection
- Thread starter Kili
- Start date
Suzanne & Darcy
Very Active Member
Right now, it's looking like Ottie will need to go back up to the .25 dose after 14 cycles -- as long as you are able to get a +2 test (and others, but first test at +2 to be safe) and are going to give him spoons of low carb food (or medium carb if the numbers warrant) -- since it appears that the steep drops and lime greens from before were because he wasn't getting food at the strategic points in the cycle. But I think you've gotten the hang of that much better now. Keep up the good work!
Kili
Member
Sadly, it seems like Ottie hasn't remained his old self. He seems to be back to mopy again.
The only change that I have done since yesterday was that we changed his food from Sheba Fine Flakes to Thrive. The main reason was that I am trying to find food that is low is phosphorous for his CKD. I had to change his food a few times since his diagnosis... because Ottie will eat the food for a day or so... then completely refuse. At the moment, I am not sure how long Thrive will succeed to keep him satisfied.
So far, its looking like his insulin dose needs to be increased... but I presume I remain on course at 0.1U until 7 days is complete?
I feel deflated today to watch him back to his mopy self.
I have been doing BG testing at +3 and +6 to reduce the amount of times his ears are pricked. BUT I will have to test him more (every 2hr) when I increase dosage to 0.25U.
Since yesterday, it seems like his water drinking has slightly increased too.
Is it worth trying a dose increase earlier? Or best to carry out the 7 days cycle.
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Elizabeth and Bertie
Very Active Member
If necessary, there are doses in between 0.1 and 0.25 of a unit... Your experience has shown you that he dropped into hypo range on the 0.25, so increasing the dose - if necessary - should be done with caution...
There are very few low phos 'ordinary' foods in the UK, unfortunately. But it is possible to add a phos binder to food if the cat needs that. Phos binders reduce the amount of phos that is absorbed.
See the low carb UK food list in my signature. Where phos data is available (and it's not easily available for many foods) this is in the blue/grey column to the right of the yellow carb column. The lowest phos foods - less than 1% dry matter phos - have the text written in bright blue.
Eliz
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Kili
Member
Is there any reason why you can't increase the dosage earlier? Maybe after 6 cycles or 10 cycles?
What I am wondering is that if I can see that his dosage is not lowering his BG enough... Is it still necessary to wait a full 14 cycles?
Ottie seems quite mopy and lethargic again... I wonder if it's the diabetes or CKD. I guess it could be either. Just disheartening because he was back to life yesterday, but today it's just the opposite.
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Shelley & Jess
Very Active Member
Looking pretty good!
As Suzanne said, holding for the 14 cycles is recommended - there's been so many changes the last couple weeks, let's give Ottie a chance to settle in and let his body get used to the insulin - it's a hormone and takes time for his body to adjust & get used to it, not like a medicine that gets to work right away.
As Eliz said, 0.25 units brought on a lime number - caution is definitely warranted.
Our protocols recommend holding the dose if you're seeing nadirs below 150 - our protocols were also written using human meter numbers.
Since pet meters read a little higher than human meters, in this instance, for Ottie, just starting out, I'm taking the pet meter into consideration too - he's so close to that 150 'hold the dose' using a human meter that I'm okay with the numbers you're seeing for just starting out while we learn how he responds and give him time to settle in.
As Suzanne said, holding for the 14 cycles is recommended - there's been so many changes the last couple weeks, let's give Ottie a chance to settle in and let his body get used to the insulin - it's a hormone and takes time for his body to adjust & get used to it, not like a medicine that gets to work right away.
As Eliz said, 0.25 units brought on a lime number - caution is definitely warranted.
Our protocols recommend holding the dose if you're seeing nadirs below 150 - our protocols were also written using human meter numbers.
Since pet meters read a little higher than human meters, in this instance, for Ottie, just starting out, I'm taking the pet meter into consideration too - he's so close to that 150 'hold the dose' using a human meter that I'm okay with the numbers you're seeing for just starting out while we learn how he responds and give him time to settle in.
Kili
Member
This is very confusing.
Recently, I have increased dosage for Ottie back up to 0.25U. This morning, he seems fine and his BG doesn't seem to fluctuate that much.
HOWEVER... his second time his PMPS is 13.4, and after +2hrs it drops drastically to 3.8. Is this dosage still too high?
Luckily Ottie is eating. Do I feed him as much as he wants to eat? He just seems to eat non-stop. He probably feels a low drop in BG, but I'm trying to not stuff him so that his BG doesn't spike again like my prior hypo situations.
Recently, I have increased dosage for Ottie back up to 0.25U. This morning, he seems fine and his BG doesn't seem to fluctuate that much.
HOWEVER... his second time his PMPS is 13.4, and after +2hrs it drops drastically to 3.8. Is this dosage still too high?
Luckily Ottie is eating. Do I feed him as much as he wants to eat? He just seems to eat non-stop. He probably feels a low drop in BG, but I'm trying to not stuff him so that his BG doesn't spike again like my prior hypo situations.
Suzanne & Darcy
Very Active Member
Question: Was he eating during this time between 13.4 and 3.8. Keep in mind that 3.8 is not a hypo, but it would be your "take action number" on an Alpha Trak meter, so I would bump up the carbs in his food and test every 20-30 minutes (20 minutes at first). Just keep monitoring. That number means that he needs a reduced dose of some sort.
Remember, with SLGS we want nadirs between 90 and 149. This protocol was written for those using a human meter, of course.
Suzanne & Darcy
Very Active Member
Have you gotten another test since you got the 68.
Suzanne & Darcy
Very Active Member
I can't stay around on the Board right now. You have options. You can drop back down to the .1 unit dose and see how he does. He is still very new to insulin. His nadirs are borderline within the SLGS range and we must also consider that you are using a pet meter. I would be perfectly okay with this. Otherwise, you can draw a tiny bit more insulin than the .1 dose. I am still not sure what syringes you have available, so I can't be really specific on how to do this right now. You could try drawing .2 units of ProZinc using a U-100 syringe (if available). To do this, you draw the insulin to the .5 mark on the U-100 syringe. Or you can test out trying to draw a "fat" .10 units using your U-40. I don't see how you will know if it's really more than the other dose that you've already been drawing though. You could use colored water and practice and see how many drops of water you get each time. What do you think? What will you be comfortable with?
Either way, please keep up the feeding each hour in the early portion of the cycle. I have worked with many people whose cats need to have higher carbs (either closer to 10 percent or in between 10-15 percent) in the first hour or two of their cycles. Right now, Ottie isn't consistently diving like he did tonight though.
You're doing a brilliant job of taking care of Ottie!
Either way, please keep up the feeding each hour in the early portion of the cycle. I have worked with many people whose cats need to have higher carbs (either closer to 10 percent or in between 10-15 percent) in the first hour or two of their cycles. Right now, Ottie isn't consistently diving like he did tonight though.
You're doing a brilliant job of taking care of Ottie!
Kili
Member
Ottie's latest reading was at +3 mark, and the reading came in at 4.3. I have been taking measurements every 30mins, but didn't put those readings into spreadsheet.
Suzanne & Darcy
Very Active Member
Beautiful. Please keep your spreadsheet updated
or we will worry!!! Keep up the good work!
Kili
Member
Yes. Ottie ate twice during the time between 13.4 and 3.8. He seems to want more food, so more food was given. He ate one full can of Thrive within 1hr period (which is a quick for Ottie).
Regardless, it seems like 0.25U is too high for Ottie.
Ottie's nadir seems to be between 8.4 - 8.6, which I thought was a bit too high. I was hoping his nadir will be 6-7. Isn't his diabetes still not controlled at 8.4?
Suzanne & Darcy
Very Active Member
What percentage of carbs is the Thrive?
Suzanne & Darcy
Very Active Member
8.4 would be 151, so that is at the upper end of the desirable range for people following the Start Low Go Slow dosing protocol, which new people do. It's a good place to start, but considering that you are using a pet meter, it's not bad. Normal BG for a cat not on insulin would be most of the time a little lower than that between 50-120 (human meter) and non diabetic cats frequently are in the 40s, too. So I guess I'm trying to answer the question about whether his diabetes is "controlled." If we get his nadirs into the desired range, he would be considered regulated. The good news is the 151 is below the kidney threshold, so easier on Ottie's kidneys. So factors to consider are -- Ottie is still very new to all of this. So it kind of depends upon your goals for Ottie -- if you want to try to get those nadirs down a bit soon or if you want to give him a little more time at the .1 unit dose or if you want to try to lower those nadirs a bit now (by trying a dose that's a little higher than the .1 unit starting tomorrow.) You are doing a great job of monitoring him, so I know you will keep him safe, so I'm not worried about you trying say a .2 dose drawn with the U-100 syringe. It depends on how and when you want to move forward.
Kili
Member
Thrive is actually low carb percentage (0.4%)... BUT for some reason, it spikes BG for Ottie as my spreadsheet indicates. So usually, I have stopped feeding him Thrive.
Do anyone have similar experience of giving their kitty low carb food, only to see the BG go higher?
Suzanne & Darcy
Very Active Member
@Shelley & Jess do you have any helpful ideas?
Suzanne & Darcy
Very Active Member
Maybe some ingredient in the Thrive? beef? what is the protein? Anyway, I would try something else. He needed more carbs early in this p.m. cycle.
Kili
Member
I gave Ottie the Tuna Fillet with Salmon.
He has also had lick-e-lix added to his Thrive to boost up BG. Do you think I'm still not out of the danger zone? I'm trying to avoid doing what I usually do, which is to spike his BG high.
I am trying to balance out over-testing as Ottie is getting rather mad right now.
Suzanne & Darcy
Very Active Member
Where are you in the cycle? How long until typical nadir? The last number I see is the +3. You can probably spread the testing out to hourly to give him a break since he had the 77 at +3. If he's still rising, then you can give him more of a break and test a bit later.
Kili
Member
From the spreadsheet, it appears that his nadir happens around the +4 or +5 mark. I'm going to be doing a +4 reading soon to see if it's rising. Ottie hasn't really eaten much between +3 and +4... so I'm not sure whether the BG will rise.
My concern now is being able to measure the microdose effectively... and what if at these microdoses, his nadir doesn't drop below 8. Wouldn't that still be no good for him that his nadir is at 8?
Suzanne & Darcy
Very Active Member
We
Well 8 would be 144 so not bad, but if your goal is green then you would need to make further dose adjustments, yes.
Suzanne & Darcy
Very Active Member
How did you measure the .13? Calipers?
Kili
Member
Although I put 0.13U (which is half of 0.25U)... I'm not entirely sure that's the measurement. I used a ruler to measure half the distance of 0.25U.
The only certainty I have is that the dose I'm currently giving is less than 0.25U.
With the U40 syringe... the measurements for these microdoses are less than 0.5mm in length. This makes it very difficult.
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Suzanne & Darcy
Very Active Member
Yep. It’s virtually impossible to make those tiny adjustments in dose (with any certainty) when just eyeballing it with a U-40. Can you obtain U-100s?
Elizabeth and Bertie
Very Active Member
Kili, seconding what Suzanne says...
Small doses of U40 insulin can be much easier to measure in U100 syringes.
I'm pretty sure that someone must have explained this to you already, but just in case it hasn't been explained, U40 insulins (Prozinc and Caninsulin) have 40 units of insulin per ml. U100 insulins have 100 units per ml. So there are 2.5 times the number of units in U100 insulin.
...People measuring small doses of U40 insulin can use U100 syringes to great advantage, because there are more 'usable lines' on the syringe barrel. So, for example, one unit of U40 insulin will measure to the 2.5 unit mark on a U100 syringe.
Quite a few folks using U40 insulin do use U100 syringes, along with the conversion chart that we have here.
Something to be aware of though is that the lines on some U100 syringes can be a bit inaccurate for the tiny doses that we use in cats. This is because they're made for use with human insulins, and humans generally need much larger doses.
The most commonly used U100 syringes among UK folks are the BD U100 0.3ml '+ demi' syringes ('+ demi' means they have half unit markings). These are the most widely available U100's in the UK. ...But many who use them recommend that they are used with digital callipers in order to accurately measure the doses.
...I don't use callipers. My own method is much more low tech. I keep a well marked syringe as a 'template' to compare other syringes to. ...So, I draw my template syringe plunger to the dose I want. Then I draw insulin into a fresh syringe, and compare the two syringes side by side, and adjust so that they are the same. ...My close vision isn't great. So I keep a craft magnifying glass on my kitchen worktop to use to measure the doses accurately. ...This works just fine 'for us'. But some others might say it would be easier to use callipers, haha!
There are some veterinary U100s available, made by Sol-Vet. These are less widely available. But folks who use them generally report that they have more accurate markings than the BD U100s.
Eliz
Kili
Member
I have just got a 7.8 reading for PMPS... Does that mean it's a no shot situation?
UPDATE
As per the guideline, I have decided on a NO SHOT.
Ottie's BG has remained flat since his +6 reading... all the way to preshot, despite the fact that he has eaten right up to -2hrs PMPS.
I should have just waited another 30mins without feeding to do another test... but I messed that up, and fed Ottie... so too late. I will do a +4 reading tonight... despite having given NO SHOT.... to monitor his BG. Hopefully, no spike...
UPDATE
As per the guideline, I have decided on a NO SHOT.
Ottie's BG has remained flat since his +6 reading... all the way to preshot, despite the fact that he has eaten right up to -2hrs PMPS.
I should have just waited another 30mins without feeding to do another test... but I messed that up, and fed Ottie... so too late. I will do a +4 reading tonight... despite having given NO SHOT.... to monitor his BG. Hopefully, no spike...
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Kili
Member
I had a catchup with my vet today... Mainly to discuss ongoing bloodworks to monitor CKD.
The topic started with Ottie's diabetes. Some of the things my vet said raised my eyebrows, and quite surprising.
My vet has access to the spreadsheet that you all have access to. First thing my vet said is that I am testing Ottie way too frequently, and commented that Ottie's ears would be completely mangled because of my incessant testing. She kind of told me off for testing Ottie too much.
I then asked her how often should one test... and I was surprised to hear from my vet that testing is only required when you are performing a BG curve after one week on the same dose of insulin. I asked my vet whether one should test preshot, and then once post shot to check whether the kitty is ok. She's indicated that that's overkill... and as long as they look happy and normal, there is no need to test. I proceeded to ask her how one can shoot without doing a preshot reading. My vet indicated it's not necessary... and as long as the kitty looks normal and is eating, there's no need to test. She also indicated that I'm the only one in her patient care that tests this much. The only thought I had at the time was WTF?? Can you guys confirm your thoughts on this?
My vet then insisted that I need to shoot at 0.25U... and I asked her whether I should drop the dosage if I see hypo numbers... and she proceeded to say that there is no need to drop the dosage, and should maintain course with the dosage. My vet thinks that a one off hypo number doesn't mean anything, and because Ottie got out of it unscathed, it's nothing of concern, and I should maintain dosage.
I then asked her if I get a preshot reading of less than 8, should I miss a shot? My vet said no. I should only consider it if my preshot number is below 5.
My vet insisted that because Ottie's nadir is not in the region of 3.8-5, that I need to increase my dosage to bring the numbers down. What do you guys think?
I then even asked her about what she thinks of Aluminium hydroxide as a phosphorous binder. Whether it's better than the Ipakitine that I'm using. To my surprise... my vet has never heard of it. She even questioned whether aluminum hydroxide is an alternative, and I pointed her to Tanya's website.
All in all, my vet just confused me even more.
The topic started with Ottie's diabetes. Some of the things my vet said raised my eyebrows, and quite surprising.
My vet has access to the spreadsheet that you all have access to. First thing my vet said is that I am testing Ottie way too frequently, and commented that Ottie's ears would be completely mangled because of my incessant testing. She kind of told me off for testing Ottie too much.
I then asked her how often should one test... and I was surprised to hear from my vet that testing is only required when you are performing a BG curve after one week on the same dose of insulin. I asked my vet whether one should test preshot, and then once post shot to check whether the kitty is ok. She's indicated that that's overkill... and as long as they look happy and normal, there is no need to test. I proceeded to ask her how one can shoot without doing a preshot reading. My vet indicated it's not necessary... and as long as the kitty looks normal and is eating, there's no need to test. She also indicated that I'm the only one in her patient care that tests this much. The only thought I had at the time was WTF?? Can you guys confirm your thoughts on this?
My vet then insisted that I need to shoot at 0.25U... and I asked her whether I should drop the dosage if I see hypo numbers... and she proceeded to say that there is no need to drop the dosage, and should maintain course with the dosage. My vet thinks that a one off hypo number doesn't mean anything, and because Ottie got out of it unscathed, it's nothing of concern, and I should maintain dosage.
I then asked her if I get a preshot reading of less than 8, should I miss a shot? My vet said no. I should only consider it if my preshot number is below 5.
My vet insisted that because Ottie's nadir is not in the region of 3.8-5, that I need to increase my dosage to bring the numbers down. What do you guys think?
I then even asked her about what she thinks of Aluminium hydroxide as a phosphorous binder. Whether it's better than the Ipakitine that I'm using. To my surprise... my vet has never heard of it. She even questioned whether aluminum hydroxide is an alternative, and I pointed her to Tanya's website.
All in all, my vet just confused me even more.
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