Hi - UK based Prozinc-er, curve variation

Schmill

Schmill

Member
Hi all, just thought I'd drop in to say from us and our Dusty cat.
Dusty's been recently diagnosed, and our Vet immediately recommended Prozinc (rather than Caninsulin), which as I understand it is a good thing, if somewhat unusual in the UK!
Anyway the vet themselves have only recently started prescribing Prozinc, and all their previous / existing diabetic cats have been left on caninsulin (since they are apparently stable on it). Anyway, the 'downshot' of this is that the vet doesn't appear to be very familiar with Prozinc, so this forum is going to be all the more valuable as a resource for us I think!

We've also recently purchased a glucometer for home use (as Dusty is so much more comfortable here) so that we can do our own curves; we opted for the AlphaTrak2 , so please bear that in mind if you look at our data, since obviously it is animal-meter data, not human-meter data.

A couple of queries I do have about Prozinc use, if anyone has any info?

  • How much variation do you expect to see on a curve?
    Everyone refers to them as a 'curve' but I don't know how 'curvy' is normal?
  • Effects of increasing the dose
    I presume that increasing the dose brings the levels down (kinda the point!), but does it effectively lower the curve down to a new level (whilst remaining the same shape), or does it start to flatten the curve?
We are seeing numbers from ~700 (34 mmol) dropping to ~460 (26 mmol) which seems like quite a "curvy curve" to me? (I am aware that those levels are also WAY too high, but we are still "finding the dose").

Also, how strict is the "life time" of the Prozinc? I know it has an expiry date, but it also states on the bottle that it should be discarded 60 days after breaching the seal. At 1 IU per injection, twice a day, our 10ml U40 bottle (400 units) has 200 days worth of insulin in it.
Do we really have to use it for 60 days then throw away 140 days worth of insulin that is still in the bottle?? (I realise that this will change if/when her dose changes, but still, how strict is that "60 day" limit?

Thanks all, and "hi" from us all!
 
Hi and welcome! You've asked some great questions! I'll try to address them all, but if I miss something (or misread something), please don't hesitate to ask again!

1. Variation in a curve: You're going to hear this a lot about here, so much so that we have an acronym for it, but Every Cat is Different (ECID). A typical Prozinc curve looks like a smile - higher at the beginning and end, lower in the middle. Occasionally there is a cat that will get an S shaped curve, but that's quite rare. Usually you're looking for a smile. A good curve at the beginning you're looking for about a 50% drop from beginning to nadir (the lowest point in the smile - usually sometime around +6, but again, ECID. My guy hits nadir often around +3).
2. Increasing the dose: over time, it should shift the entire curve down. However, you'll often see just the nadir go down for a long time, making the smile steeper, and then you'll often see it get a bit lopsided with one Pre-Shot (PS) number coming down, and then you'll see the whole thing has moved down a bit. For some cats it all happens quite quickly. For others it's a very long, slow, two-steps-forward-one-step-back kind of process. It is rarely a linear, logical process. We often call it a dance, and only the cat can hear the music.

In some cats a Prozinc curve will begin to flatten, but that's most often in longer-term diabetics (over six months since beginning treatment).

3. Prozinc Lifetime: Up to six months after opening if you treat it well. Keep it in the center of the fridge, not in the door to avoid vibration. Make sure you always keep it in the fridge and don't leave it out on the counter. Don't let it freeze or warm. Don't shake it - just gently roll it to make the clear and cloudy parts. Keep it clean. As long as you don't see any white floaty things, and as long as the data shows that it's still working, you can keep using it. The longest vial I've kept made it to six months, but then the impact started to wane a bit.

4. Hooray for your vet prescribing Prozinc! Even vets that prescribe it all the time don't often have a strong understanding of it, so we are happy to help!

5. You didn't ask about this, but given the numbers on your spreadsheet, what is Dusty eating? You want to make sure he's on low-carb, wet food for him to have the best chance of healing. There is a food list in my signature, but I don't know if there is much overlap to foods you can get in the UK. I believe there is a UK list somewhere around here though if you maybe do a search for it on the Main forum.

Please ask as many questions as you have. It's a big learning curve, especially at first and we are here for you!
 
Hi! Welcome to you and Dusty! We don't have too many UK members here so please forgive us if we're not able to answer right away...at times you may be posting in the middle of our night. :) Djamila has given you wonderful information and asked the question I had about your food, so I just wanted to stop in and say hi and let you know we're glad you're here! Please do ask tons of questions...we know how hard this is especially at the beginning!
 
Djamila said:
5. You didn't ask about this, but given the numbers on your spreadsheet, what is Dusty eating? You want to make sure he's on low-carb, wet food for him to have the best chance of healing. There is a food list in my signature, but I don't know if there is much overlap to foods you can get in the UK. I believe there is a UK list somewhere around here though if you maybe do a search for it on the Main forum.
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Hi, and thanks for the welcome :)
We currently have the Prozinc in the door of the fridge as it was convenient to make sure it stayed upright as it fits well in one of the little pockets, but we'll look to move it towards the back of one of the shelves instead to avoid vibrations. To be honest its probably the most expensive fluid we will be buying, so taking great care of it is definitely high on our agenda!

In terms of food, unfortunately we know she is not on the best food tbh :(, but for now for 'good' reasons.
If you take a look at her SS we've added "Food Data" sheets to it in addition to the normal BG tracking, and her current food "calories from carbs" figures come in at 16.1% for the meat, and 33.1% for the biscuits! :eek:

A bit of history:
About a year ago (~ Sept 2017) she was placed onto Royal Canin Digest Sensitive (meat) and Digestive Care (Biscuits) since she had severe issues with diarrhoea and blood in her stools. It helped a huge amount, and for almost a year she had been great, albeit gradually losing weight very slowly. Now a year on she was diagnosed with Diabetes, dehydration, and constipation. She was put on fluids, had an enema, and is now on her "initial insulin dose" of 1 IU twice a day. Was due to go back to the vets for a curve on Tuesday, but we have since decided to take the curve readings ourselves and then take the data to the vet.​

We've removed the biscuits for now, but needing to keep something stable (and the fact that we had just stocked up on the meat!) we're keeping her on the meat for now. Once we get better at things then we do intend to try swapping the meat out for something more suitable, (allowing for the fact that we might then have to reduce the insulin), but we'll need to keep an eye on her general gut health at the same time then.
 
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Yes, that Prozinc is expensive! I eventually wrapped mine up in a bit of cotton because I...uhh...dropped it and smashed the bottle once. I almost cried at the time! Many people keep it in the little box it comes in with a bit of cotton around it just in case something happens...but that's up to you of course! Keeping it on the shelf is good for the vibrations and also because it keeps it a bit colder than in the door where it opens and closes a lot.

As for food, you have to do what's right for Dusty! I'm glad you took the biscuits away, as I think that will help a lot. For food, even when you decide to change, we would recommend doing it slowly for a kitty who is NOT sensitive, so we definitely would for Dusty. You might start looking around now for foods that you could change to so that when you decide to do it, you're ready to jump in. Was the vet able to give any reason for the blood/diarrhea? I don't know much about RC...is the meat food wet? That will help with dehydration as will adding some water to the food (I make my cats sort of an applesauce consistency and they love it). I do agree that for right now, you want to keep things as stable as possible and removing the biscuits but keeping the old food is a good first step. Slow changes will help you to see what is working for Dusty and what isn't.

Beyond that, does Dusty have any other health issues?

I'm glad you're going to do the curve yourself! Kitties usually have much lower numbers at home due to less stress, and of course both they and we are happier when they're home!

Have you read our Protocol? It's a good place to start and though it can be a bit confusing and often takes more than one read, it might help give you some good info. We, of course, are happy to provide any info we can and to help with dosing or anything else you need. :)
 
It sounds like she might have IBD? Has the vet ever suggested that? Far better than that food would be adding a probiotic and getting her on a species appropriate diet. The two main ones used around here are s.boulardii which is pretty easy to find anywhere, or my personal favorite: https://www.chewy.com/animal-essentials-plant-enzyme/dp/49372

@Kris & Teasel has one she gets in Canada that hopefully she can post for you too and might be easier for you to get.

My cat has IBD also, and the probiotic has been life changing. It takes a couple of weeks to reach full effect, although I noticed an improvement within a few days. Unfortunately IBD and diabetes are often found together in our cats.

The thing with the food isn't just that she'll need more insulin to counteract it, it's also that carbs cause the BG to be inconsistent and harder to predict. It also prevents a kitty from going into remission. I agree with making changes incrementally, but I would encourage you to find a food that is much lower in carbs and continue the journey of transitioning sooner rather than later. Perhaps the vet will take back some of the unused food?
 
Sorry, couldn't see how to multi-quote, so replying to both, and indenting your comments :)

Beyond that, does Dusty have any other health issues?​

Knowing her, probably, but we'll tackle this biggy first ;)

Was the vet able to give any reason for the blood/diarrhea? I don't know much about RC...is the meat food wet?

...

It sounds like she might have IBD? Has the vet ever suggested that?
​
Nope, never been suggested and tbh the vet didn't seem too bothered about the diarrhoea, it was more us that got fed up with it and obviously Dusty wasn't happy either, but the RC food sorted all that.
The RC meat is described as "thin slices in gravy" on the equivalent US site, and looks like this page: https://www.royalcanin.co.uk/products/cat/feline-care-nutrition-wet/digest-sensitive/

The probiotics sound good, but we are UK based, so I'll have to find out what is available here.

We are currently compiling a list of the foods we can actually get on the "Food Data" tabs of our SS (which is continuously changing at the moment as we find out new things!)

​
 
Hello from another UKer.
How's dusty getting on. How are you finding the prozinc.
Our car has only been on it a week so far so just getting into things?
 
Hi Becki (and sox!)
How is Sox generally? I only ask as when we started Dusty really was in quite a bad way.
I see from your SS that you've been adjusting the insulin dose already? Unless you feel like you REALLY need to, it is generally a good idea to let it "settle" and see how things are going before you make an adjustment.
Dusty started on 1U of Prozinc twice a day on the 7th Sept, then after a few weeks (2nd Oct) the vet reviewed our BG data and advised an increase to 2U twice a day, and most recently (after sending the next set of data) she was upped to 2.5U on the 30th Oct.
At the same time we have been adjusting Dusty's food to a lower carb diet (which is recommended) - what do you feed Sox, happy to pass on any advice if you would like?
We have now bought our second bottle of Prozinc (since the 1st bottle has passed its "60 days of being 'broached'", so we wanted one in reserve), and things seem to be going well touch wood. Dusty has taken to her new food, and is starting to put on weight again (she was quite underweight at diagnosis) - her spine no longer feels like an Xylophone when stroking her(!) , and her general health (coat & skin state, walking etc.) is all a LOT better now.
She had (prior to diagnosis) been moving around very little, and when she did it seemed awkward, we had put it down to 'old age' and assumed arthritis. Now she is back to jumping up onto the sofa, running up and down the stairs :)

Overall we've been very happy with the Prozinc and she doesn't seem to care about the injections either (she's usually got her face buried in either her breakfast or evening meal when we do it!), and she's even pretty calm about the ear pricking when we have to take her BG measurements these days.

Not sure where you get your supplies from, but we spent a fair bit of time looking and found sources for the various bits-n-bobs ( including the Prozinc ), and I'm more than happy to pass on the details for those if you are interested?
How is Sox walking? Looking at your numbers you may have got the Diabetes diagnosed before things got too bad (so the BG numbers weren't excessively high for too long) so hopefully no damage caused. Dusty suffered badly with hind leg weakness due to the diabetes, but we've been giving her B12 since 11th Oct and it seems to have helped a lot. Again, if required, I am happy to let you know what we got and where from.

Hope that Sox does OK, will keep an eye on the spreadsheet, but yeah, my advise (not vet or medically trained) would be to keep the dose stable for a while and see where the BG figures settle after a week or so. Variations happen, stress, exercise, amount of food eaten and when, and just the cat being a pain in the backside, but I'm sure we'll all get there.
We are due to do another curve soon, so we'll see what our numbers are like then being on the 2.5U now, but just looking at her she is a much healthier, happier cat now than she has been for a long time.
 
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Hi. Sox is ok thank you. We took him to the vets due to him loosing quiet abit of weight and also his fur was starting to look a bit in kept. We also put alot of it with Sox down to older age glad we got him checked though.

The main reason we swapped the units of insulin was due to how he reacted on the first day and how his numbers were too low at night time shot to issue another shot at that time. Mainly because I work Monday to Friday and in honesty I was abit scared to leave him all day on his own with that dose. Just incase he did drop to low at any point. I have a few good people on here who recommended dropping the dose lower and gradually build it up.

Food wise we've swapped over to butcher's and took all crunchies away. If you can recommend any other good tins with no sugars and vegetables that would be good.

Sox is generally good with shots and tests like dusty he isn't fussed when his heads in a bowl of food lol.

So far we've only brought first lot of supplies from vets but have been told you can get them cheaper online so we will definitely look into doing that.

I'm glad that dusty is doing so well and just goes from strength to strength.
 
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Schmill said:
Hi Becki (and sox!)
How is Sox generally? I only ask as when we started Dusty really was in quite a bad way.
I see from your SS that you've been adjusting the insulin dose already? Unless you feel like you REALLY need to, it is generally a good idea to let it "settle" and see how things are going before you make an adjustment.
Dusty started on 1U of Prozinc twice a day on the 7th Sept, then after a few weeks (2nd Oct) the vet reviewed our BG data and advised an increase to 2U twice a day, and most recently (after sending the next set of data) she was upped to 2.5U on the 30th Oct.
At the same time we have been adjusting Dusty's food to a lower carb diet (which is recommended) - what do you feed Sox, happy to pass on any advice if you would like?
We have now bought our second bottle of Prozinc (since the 1st bottle has passed its "60 days of being 'broached'", so we wanted one in reserve), and things seem to be going well touch wood. Dusty has taken to her new food, and is starting to put on weight again (she was quite underweight at diagnosis) - her spine no longer feels like an Xylophone when stroking her(!) , and her general health (coat & skin state, walking etc.) is all a LOT better now.
She had (prior to diagnosis) been moving around very little, and when she did it seemed awkward, we had put it down to 'old age' and assumed arthritis. Now she is back to jumping up onto the sofa, running up and down the stairs :)

Overall we've been very happy with the Prozinc and she doesn't seem to care about the injections either (she's usually got her face buried in either her breakfast or evening meal when we do it!), and she's even pretty calm about the ear pricking when we have to take her BG measurements these days.

Not sure where you get your supplies from, but we spent a fair bit of time looking and found sources for the various bits-n-bobs ( including the Prozinc ), and I'm more than happy to pass on the details for those if you are interested?
How is Sox walking? Looking at your numbers you may have got the Diabetes diagnosed before things got too bad (so the BG numbers weren't excessively high for too long) so hopefully no damage caused. Dusty suffered badly with hind leg weakness due to the diabetes, but we've been giving her B12 since 11th Oct and it seems to have helped a lot. Again, if required, I am happy to let you know what we got and where from.

Hope that Sox does OK, will keep an eye on the spreadsheet, but yeah, my advise (not vet or medically trained) would be to keep the dose stable for a while and see where the BG figures settle after a week or so. Variations happen, stress, exercise, amount of food eaten and when, and just the cat being a pain in the backside, but I'm sure we'll all get there.
We are due to do another curve soon, so we'll see what our numbers are like then being on the 2.5U now, but just looking at her she is a much healthier, happier cat now than she has been for a long time.
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Hi Schmill-

I'm quite concerned about what I'm seeing on your spreadsheet and the approach your vet is taking to dosing. If you haven't had a chance yet, you might read the "stickies" at the top of the forum that explain a bit about how Prozinc works and how to approach testing and dosing. And if you start a thread of your own, we'd be happy to help as well. I don't want to take over Becki's thread by starting a whole discussion here. :)
 
Schmill said:
she was upped to 2.5U on the 30th Oct.
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Schmill, I see you gave 2.5 units at a (totally normal blood glucose) pre-shot number of 5.9.... That 2.1 that followed a few hours later is a seriously hypo number on Alphatrak! The dose is TOO HIGH, please reduce....

Eliz
 
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Djamila said:
Hi Schmill-

I'm quite concerned about what I'm seeing on your spreadsheet and the approach your vet is taking to dosing. If you haven't had a chance yet, you might read the "stickies" at the top of the forum that explain a bit about how Prozinc works and how to approach testing and dosing. And if you start a thread of your own, we'd be happy to help as well. I don't want to take over Becki's thread by starting a whole discussion here.
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I think this is Schmill's thread. Isn't it? o_O
 
Hi all, apologies, for some reason I didn't get any thread post notifications after Becki's initial reply.

First things first, Dusty is fine, thanks for all your concern. Due to other commitments this is also the first time I have been able to update the SS with the remaining data points for the day, (I really didn't expect anyone to really be paying any attention to it unless I posted - sorry!).

Based on previous data we fully expected her BG level to increase to a spike after breakfast (after the AMPS), and she is given her insulin at the same time as her food. Sure enough the BG number did increase in the very next reading, then dropped again through the day, before climbing back up to the PMPS point.
We ourselves were also concerned about the levels potentially being a bit too low, so reduced the evening dose (and every dose since then) back to 2U. What I did find interesting was that there are obviously a lot of warnings about hypo and what to look out for, but Dusty has been at this dose for a couple of weeks and (thankfully) hasn't show any symptoms at all, in fact is the healthiest, happiest, and most active she has been in a long time.
It may be the increased activity that has also played a part in the lower levels, but she does seem to have quite a 'steep' curve, so getting the majority of it in the good range is tricky.
As above, we have now adjusted her dosage to 2U twice daily, and will test her again when we can.

Now to reply to the various posts that I missed....

Becki and sox said:
Sox is ok thank you. We took him to the vets due to him loosing quiet abit of weight and also his fur was starting to look a bit in kept. We also put alot of it with Sox down to older age glad we got him checked though.

So far we've only brought first lot of supplies from vets but have been told you can get them cheaper online so we will definitely look into doing that.
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Sounds very similar to how Dusty was, fairly high weight loss (you can see it in her SS on the "Weight Chart" tab), and generally bad coat condition and pretty bad "dandruff".
As for the supplies I'll send you a message with the information of where we've been getting our stuff from.

Djamila said:
I'm quite concerned about what I'm seeing on your spreadsheet and the approach your vet is taking to dosing. If you haven't had a chance yet, you might read the "stickies" at the top of the forum that explain a bit about how Prozinc works and how to approach testing and dosing. And if you start a thread of your own, we'd be happy to help as well. I don't want to take over Becki's thread by starting a whole discussion here
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Hi and thanks, I have read the stickies (albeit several weeks ago now, so a refresher read would likely be worthwhile :) ), and as soon as we saw the shift in the numbers we adjusted the dose; we didn't do it in the morning as we are aware of the sharp upward spike Dusty tends to get after breakfast and AM shot, so (as we were going to be with her all day, and had been giving this dose already for ~2 weeks) decided to carry on "as was" and see what the figures did for the day. By the evening, we decided to decrease the dose.
This is my thread, but I'm happy to share :)

Elizabeth and Bertie said:
Schmill, I see you gave 2.5 units at a (totally normal blood glucose) pre-shot number of 5.9.... That 2.1 that followed a few hours later is a seriously hypo number on Alphatrak! The dose is TOO HIGH, please reduce....
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Thanks, dose has been adjusted after collecting the data for the day. Will see what the revised dose of 2U does in due course.

FurBabiesMama said:
I think this is Schmill's thread. Isn't it?
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Yup ;) - happy to share though!

Diana&Tom said:
Yikes... can you update us Schmill to let us know how the rest of Dusty's curve went on Sunday? We worry!
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Update done now, sorry for any worry caused :(
 
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I'm so glad to hear Dusty is OK. I have to admit I too was panicked today when I saw that 2.1 mmol on the SS and nothing after that.

You've suggested there is a lot of "warning" of hypo however it's important to note that some cats, like some humans, do not show any warning of an impending hypoglycemic episode and will suddenly have a seizure at low BG levels. Any reading lower than 3.8 mmol is your warning to get some food into Dusty to prevent BG from dropping any lower. Hypos can be fatal.

I noticed the AMPS on the 18th was only 5.9 mmol and that is a little too low to be giving insulin at all and particularly if you are not home to monitor closely.

It appears you are doing a curve whenever able but not taking readings before each shot of insulin every day. We strongly suggest testing before EVERY shot to ensure BG is high enough that it is safe to give insulin. We also recommend getting random tests during the peak action time for your insulin which in many cases would be between 4 and 7 hours post shot. This can be difficult when working but getting a test before bed at night and randomly whenever it is possible to do so, will help you keep Dusty safe and help you determine when and if dose adjustments are needed. :)
 
MrWorfMen's Mom said:
I'm so glad to hear Dusty is OK. I have to admit I too was panicked today when I saw that 2.1 mmol on the SS and nothing after that.
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Sorry :(

MrWorfMen's Mom said:
You've suggested there is a lot of "warning" of hypo however it's important to note that some cats, like some humans, do not show any warning of an impending hypoglycemic episode and will suddenly have a seizure at low BG levels. Any reading lower than 3.8 mmol is your warning to get some food into Dusty to prevent BG from dropping any lower. Hypos can be fatal.
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Thanks, I had assumed from the reading that there would always be some sign that the levels were getting too low before they actually got low enough to cause a seizure. I hadn't realized that they might 'just happen'.

MrWorfMen's Mom said:
I noticed the AMPS on the 18th was only 5.9 mmol and that is a little too low to be giving insulin at all and particularly if you are not home to monitor closely.
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That day we were with Dusty all day, as we were doing the curve, but yes, generally I see that could be too low.
Dusty does seem to have a very peaky-troughy curve, so it is difficult to keep the entire thing at decent levels, but that certainly was one of the lowest readings we had seen.

MrWorfMen's Mom said:
It appears you are doing a curve whenever able but not taking readings before each shot of insulin every day. We strongly suggest testing before EVERY shot to ensure BG is high enough that it is safe to give insulin. We also recommend getting random tests during the peak action time for your insulin which in many cases would be between 4 and 7 hours post shot. This can be difficult when working but getting a test before bed at night and randomly whenever it is possible to do so, will help you keep Dusty safe and help you determine when and if dose adjustments are needed. :)
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To be honest, to start with Dusty was massively against the testing. The shots she couldn't care less, but the tests had her running away, hiding under the furniture, and actually trying to escape so vigorously we were afraid she was going to do herself more harm, both physically (by crashing into / through things) and also with her already erratic BG levels, hence we only tested when we needed to or were trying to do a curve. She has got a lot better now, but still isn't a massive fan of being a pin-cushion. that said we will be trying to do another curve this weekend now that we've reduced her dose back to 2U and see what happens.
 
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Sooo...

We've run another couple of curves with Dusty reduced to 2U of Prozinc twice a day, and boy is she keeping us on our toes!
On the 24th we had a curve that seemed to be a fairly reasonable levels (allowing for the fact that she managed to scoff some of her brother's breakfast mid morning, hence the little hump!), perhaps dropping a tad low during the nadir, but then she threw us a real curve ball at PMPS with a higher than expected, reading, and at PMPS+1 it had continued to climb!
Thankfully by the morning of the 25th her levels had dropped again, and her levels stayed much flatter that day, with a slight increase towards the PMPS again.
For now we are sticking at 2U, with the thought that we might need to increase to 2.25 (as 2.5 seemed to be too much), but she seems quite unpredictable at the moment. I'd almost be tempted to say that the insulin was not having an effect (since we are near the end of the bottle) except on the 18th and 24th it seemed to have a very pronounced effect!
As far as 'she' goes, she's looking very healthy thankfully, coat and skin much improved, and putting on weight gradually, it would just be nice to have slightly more predictable BG levels - lol
 
Glad to hear Dusty is looking better and putting on some weight. She really is a cutie pie! :D

Those higher numbers today are what we refer to as a bounce. Dusty got down to 3.4 yesterday which again is too low. 3.8 is your warning of a possible low BG problem and your cue to intervene with some food to bring her BG up a little. The rest of the day cycle yesterday was very nice but we have no idea what she did during the night and it appears the 2 units may still be too high a dose. Today the higher numbers are because her system is not used to those low numbers yesterday and possibly last night and so her body panics and spills stored glucose into her bloodstream to bring the BG back up to levels her body perceives are safe.

I would suggest you reduce the dose to 1.75u if BG is over 11 mmol and see how that works for her. Skip the shot if Dusty's BG is less than 11 mmol at pre-shot . As well as testing before each shot, it would be very helpful to get a test in before you turn in for the night. That test will tell you if Dusty's BG is dropping quickly so you can intervene and slow her down with food if need be.
 
Ok, so on the 12th, 19th and 30th Jan 2019, 7th and 15th Feb 2019 (today) we have taken curves to see what Dusty's reaction is to the different doses.
The reason for this was we thought originally we had missed the "sweet spot" and perhaps entered "bounce" territory (due to her unpredictability), so dropped the dosage right back to 1.00U, and then have increased by 0.25U (usually after completing that day's curve, leaving it for ~ 1 week, then taking a new curve at the new dose.
So the dose has been 1.00, 1.25, 1.50, 1.75, and now we are back to 2.00U again (I've updated the "BG Curve Data" chart on Dusty's SS to cover just this period)

I must confess I'm really not sure how to interpret these curves now...

The 12th Jan (1.00U) curve looks a bit high
The 19th Jan (1.25U) curve looks very high
The 30th Jan (1.50U) curve looks to keep the same shape as the 1.25, but the levels overall are lower
The 7th Feb (1.75U) curve looks to drop the overall levels further, and the first part of the day looks good, but it kicked up in the evening.
The 15th Feb (2.00U) curve (today - as yet incomplete) looks to have started really high, crash at nadir, and now (AMPS+8) looks to be climbing again.

We are thinking that we'll keep the 2.00U for tonight so as to complete the curve, but then drop back to 1.75U and do another curve in a week, and then perhaps again a week later (keeping the dose at 1.75U) and see how similar they come out.

Just wanted to check in here to see what others thought of those curves, and what others with experience might suggest in terms of the dosing.
One thing of note is that Dusty did have her annual boosters last Friday (8th Feb), and seems to have developed a bit of a lump in the 'tissue' around where the injection was done. Other than that she is fine, but we did wonder whether her boosters are likely to have thrown the readings at all?
 
I see you were on the ProZinc forum many months ago. I'm gad you came back. :)

Dusty is very sensitive to insulin and dose changes - ie, she's bouncy. I have a bouncer too and what I've learned is that consistency in dose and making only tiny changes when needed are essential in kitties like this. Even 0.25 u changes made frequently can magnify the erratic BG numbers. What works best is to choose a reasonable dose for the recent overall BG levels you see on your SS and keep that same dose both AM and PM regardless of what the PS is unless it's much lower than usual. In that case a small dose decrease *might* be in order. What doesn't work well in these kitties is dosing according to the PS number.

I suggest you try 2.0 u for now both AM and PM. The dose is assessed according to how low it drops the BG. The PSs are more important in seeing whether the planned dose is safe. Keep that 2.0 u dose for a few days unless you see lime green at nadir or PS begins to be much lower. You're able to test a lot so you can very likely give a full dose on lower PSs than you have been. Here's a general guide on how to approach lower PSs:
Once you begin to get more PSs below 13 you can try a variety of things:
  • if close to 13 (maybe 11 and above), stall without feeding for 30 minutes and retest. If BG has risen try the full dose.
  • if in the 9 to 11 range, try stalling up to an hour and if rising do the above. If BG isn't rising much give a reduced dose. How much to reduce is always a conundrum. Maybe try a 2/3 dose.
  • if BG is much lower (say, 7 to 9) give token dose - size depends on what the normal dose is. Only do it if you can monitor. You can be braver with this once you have a lot of data. It's best to avoid skipping if you can but sometimes that's the safest thing to do.
Again, the above is a guide. As you see how Dusty responds to these experiments you can be a little braver. The big takeaway, though, is to be consistent. :)
 
Thanks for your reply - what had us / me concerned was that the levels seem to have gone UP despite us increasing the dose. Was wary of ending up with high PS and too low nadir, which I thought was a sign of a potential bounce.
 
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Schmill said:
Thanks for your reply - what had us / me concerned was that the levels seem to have gone UP despite us increasing the dose. Was wary of ending up with high PS and too low nadir, which I _thought_ was a sign of a potential bounce.
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You can't control bouncing with frequent dose changes. Those often exacerbate the problem. Stability and consistency is key. You could try feeding a small snack of low carb wet food around +2 or +3 to cushion the onset of the insulin. That can sometimes help. Bouncing can also be reduced (somewhat in a volatile cat) by reaching a good dose range where you see more low blue and high dark green numbers on your SS.

Have a look at my bouncy guy's SS. I use a human meter so the BG ranges are lower and I've been at this three years but it's still a colourful array of cells. Notice how he can go from pink to dark green in 12 hours (eg. 01 and 08 Feb) - and he's on Lantus, a depot insulin that is supposed top give flatter curves.
 
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Hi there! Welcome back! Just to clarify -- it looks like you're only testing on curve days maybe once/week or so, is that right? Or do you have data in between? So each line is a different week, not day by day? If that's correct, then it looks like you are holding the doses for a fair amount of time.

However, the broad range makes me think that your kitty might be having some lime green numbers in between curve days that are setting up a lot of this bouncing. I would really encourage you to be testing every day. You certainly don't need to do a curve every day, but test before each shot (am and pm), and then get whatever extra tests you can - whether that's before you leave for work, or right when you come home or right before bed -- anything will help to start to sort out what's going on.
 
Just wanted to drop in and say "Hi" again to all you folks :)

Dusty is still be a peaky-and-troughy as ever, but it seems that 2U is about the sweet spot for her, anything less and the whole curve rises and gives really high AMPS and PMPS, anything more and her nadir goes too low for comfort.

We do put down a small amount of Porta21 at around AMPS+6 - assuming this is a "slower" release feed than the wet meat she has for breakfast and dinner do you think that putting it out sooner might help to keep the nadir a bit higher, and therefore allow a slightly higher dose? I mean "she" doesn't seem to need it, shes quite happy and full of energy, but I'm just wondering if we should be looking at ways to try and "flatten" the curve?

In other news we've had some excitement recently; following her last batch of flea treatment she reacted very badly to it.
We used (and have used for years) Bob Martin Clear Flea & Tick Spot on for Cats & Kittens, and the back of her neck reacted really badly to it :(
The first we were aware of it was when we came down in the morning and she had ripped big chunks of fur and skin away where she had been scratching so vigorously, leaving red raw bleeding open wounds!
Its only since it happened and I've done some internet searching that I've become aware that this doesn't seem to be an isolated incident, and that there is a LOT of warnings around of similar issues.

Needless to say, having a huge sore patch on her neck & back has made giving the insulin injections interesting, but we've made it through it :)
She's actually been really good for the most part, and put up with us washing the wound quite well. I was surprised to find that it didn't appear to have affected her BG curves at all, so that at least was a pleasant surprise!
Unfortunately every time it all started to heal she would scratch at the scabs and cause a bigger, rawer injury, so we ended up resorting to using a saline wash, low adherent dressing, and stretch bandage to hold it in place to provide some padding against the onslaught of her claws against her own skin.
All in all it does seem to be recovering now albeit she looks like she's wearing a little waistcoat with the bandage wrapped around her, but its all for the best and she seems to get used to it after a few minutes (we change the dressing every 2 days once she starts to rip it apart!), however we'll certainly be looking for a different flea treatment moving forward!

These cats - they certainly like to keep us all busy don't they!
 
That flea reaction sounds terrible! Poor Dusty! I hope she has a speedy recovery from here out. And well done figuring out a way to keep her bandaged so her skin can heal.

As far as your numbers. I see a curve from 5/3, and then the data before that is March. Do you have other data you could share? We base our dosing here on regular, consistent testing from day to day since a single day's curve can be quite deceiving. I'd be hesitant to suggest anything with only one day from the past month to look at as I could end up leading you in the wrong direction.
 
Hi all, just thought I'd post a quick update.
Happy to report that Dusty is doing much better now, and has healed up nicely. It's taken a long time (4 months!) but she has finally recovered from the "Bob Martin Clear Flea & Tick Spot on for Cats & Kittens" treatment.

I've included some images below for those that are interested, but hidden them behind spoiler tags for the sake of those that don't wish to see:

11th April 2019 - Initial Reaction
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21st April 2019 - When she won't leave it alone!
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11th May 2019 - Scarred
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11th May 2019 - One of many days of bandaging
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22nd June 2019 - Healing nicely
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6th Sept 2019 - Looking a lot better :)
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Hi, just wanted to say hi, we are in the UK (south coast), we use Prozinc and we also use alpha Trak 2! Fairly new to this journey, but I've done lots of research on food available and the list on here is awesome. Welcome to you and Dusty
 
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