Help! Need advice for asymptomatic 36 BG at only +3.5

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lepick

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I apologize: THIS IS A REPOST from main health forum, but would love some specific advice from PZI users!!!
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I need some advice and obviously am going to need to switch up my insulin dosing, but I'm not sure exactly how. Xalli has been getting 1u compounded PZI and the past few days the nadir has been moving earlier and earlier and the nadir lower. Today I tested b/c something didn't quite seem right and at +3.5 she had bg of 36!! She's come out and headed up now so I feel some relief about that, but I am going to have to change something up.

I'm somewhat new here but with everything I've read it seems like maybe two options, either lowering the dose or going to 3/day administration of insulin. This is something I can do given my schedule, so if that is what I should do, I will. But what seems like the best thing to do at this point? LOWER? 3/DAY? If lowering, how much would you recommend going down?

And if 3/day, how does that even work? How do you figure dose? What are you looking for in terms of shootable numbers and appropriate high/lows? Is there a spreadsheet for 3/day, or anyone willing to share this if this is what I should be doing so I can get a sense of this?

So basically ANYTHING that anyone can offer is appreciated. Please take a look at my spreadsheet in my signature. Thanks so much for your help, and without these boards I wouldn't be hometesting and wouldn't have even known what to do. I'm so grateful and I can't tell you how much I appreciate all the time it takes to respond to these cries for help!

Lea
 
you are actually doing very well lea. it is time to reduce dose. if you can mark .75 or 3/4 unit that would be nice. of course that will depend on what pmps is. how did you get that number to rise..high carb? karo? or did it just go up itself
 
Thanks Lori--to bring up the bg level I fed her higher carb wet food than she normally eats. This was blue buffalo 10% carbs and I dropped in like 3 little pieces of kibble that are the prescription diabetic one at 13%.

I'm so glad this is indicating that I can just move down in insulin (depending on what happens with the number tonight). I have u100 syringes (and u40), so that would allow me to come down a little more precisely. Given that, would you say going to .8u (or 2 in my u100 syringe) would be good, or should I go down even further (.6u)...or shoot for being in between those to get closer to .75?

Also, what number would you say is reasonable for the pmps before i reduce? In the 200's? If over 300 would you think I should stick with 1u?

thanks!
Lea
 
Sorry, here is what I posted in the Health one. I did not realize it was here too. Basically we need to make sure what strength insulin you are using?? What does it say on the bottle/package?


How are you feeding? Free feeding or timed feeding? If timed feeding about what times? Also I trust you guys are doing law carb wet food only per J&B's?

What strength is your compounded insulin? U-100? Not all compounded insulin is u-40 like ProZinc. Your SS talks about using u-100 syringes. So are you converting?

Good work on home testing and getting that SS going. I might also suggest getting a profile put together [instructions in the Tech Support forum] that would help give us some background on your kitty.

You might need to lower the dose - maybe to .75u for a couple cycles & see how that goes? You are getting some pretty big swings. Tonight for instance you may see some higher numbers [but you may not]. I would suggest reading about rebound:
http://petdiabetes.wikia.com/wiki/Rebound
But achieving accurate increments smaller than 1u with u-100 insulin is challenging. There are some resources for that [measuring small doses in U-100 syringes] in the Lantus [forum] stickies. If you were compounded with a u-40 strength insulin [besides BCP, I've only personally seen compounded in U-100] then you could do the U-40 to U-100 conversion which is talked about in the PZI sticky.
 
It is u40 insulin and I am converting for u100 syringes bc I could find those in a much finer gauge that seemed to bother kitty less. But she does ok with the u40 ones now that she's been getting the shots more. Also, I guess I thought my doses were able to be *more* precise with the u100 for when I needed to go below 1 because on the u40 the lowest line is 1. Do you just eyeball 3/4 of that to measure at .75 dose?? Is the u40 more precise then??

Food is low carb wet exclusively--wellness 4%. During the day I do 4 feedings (after amps, then every 4 hours appx), and at night I leave out the wet for free feeding.

Thanks,
Lea
 
Yours is the first compounded PZI [other than BCP that I've 'seen']. So pardon my initial suspicion. :smile: OK. So as long as you are comfortable doing the conversion from u-40 insulin using the U-100 syringes than I'd just stick with the U-100 syringes. Make sure to use the conversion chart that's liked in the PZI Sticky. Good that you are doing u-40 insulin especially since it seems you kitty might need something in the 1u ballpark.

Then you could give .6 or .8 - heck you could even give .7 [between the marks].

Long term - if you are in the US, [doesn't have to be something done right now] you might think about changing to something like BCP or ProZinc which both have their advantages.

I'm hoping others might be along here to offer their input. I'm not exactly the best dosing guru for beginners :smile: But I do want to make sure you don't have any hypo events.
 
Looks like you are being well taken care of :) just wanted to comment on the 3x/day question. Generally IMO that works well when you have cats where you have enough data to know that they don't get more than about 8 hours duration from the insulin. Many cats get more than that, and even if it's not a full 12 hours (which is unusual), there's still enough duration to make 2x/day work well.

As someone who tried alternate strategies before really knowing if BID would work or not :oops: I can tell you it can be really confusing, and it is also exhausting, and expensive to go through all the test strips (minimum 6 tests/day if you are shooting 3x/day, can't get away with fewer tests when shooting that early).
 
yeah, just looked at the SS I wouldn't go TID, especially with some of the good #s you have around some of the +8s - no need IMO to be shooting more insulin on some of those #s. If you ever wanted to shoot a little early, like +10 or +11, you can head off some of the higher #s that way, but really her PSs are often pretty good, so I wouldn't worry about it personally. I think you are on a good track with BID and the dose reduction others talked about.
 
Great, thanks so much. Can y'all tell me if this is basically correct (knowing that ECID), if the numbers start to dip low and the nadir begins to get earlier and earlier, is that a good sign that it might be time to reduce the dose a bit? I'm sure this is elementary, but I'm still in my steep learning curve!

Lea
 
lea i think your .8u is a good idea...but at this point it is more important than ever to get those mid cycles. 2 MOST important times to watch your cat is when you first start out, and next is when they are doing better. If kitty is heading to remission you are likely to see more near hypo's. that's the road to remission. keep it in mind.
 
Lori-GREAT to know, thanks. It is definitely worth it thinking of it that way (especially as I'm sitting up at 2 am poking poor Xalli's ears!).
 
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