Higher dose = higher readings

zenworm

zenworm

Member
Hi all, back in April we had a death in the family and our kitty Sid got off track just as he was hitting some great green numbers.

I haven't been able to get him back on track since, and for some reason the current trend seems to be the more Prozinc I give him, the higher his numbers are.

Has anyone ever seen something like this? I've been doing 2u recently and he's reading HI pretty consistently, vs. a few weeks ago on 0.5 he wasn't reaching that high.

Official dose from vet is 2.5 currently.

https://docs.google.com/spreadsheets/d/1rITra1Rw72B38mbDW-dWIRNtgkmHB_z2LefnGkVWFaw/edit?usp=sharing
 
I am so sorry for the delay in my reply to you. We also had a tragedy in our family and I haven’t been around much at all.
Looking at your spreadsheet data, I would increase to 2.75 units per the SLGS protocol. Your nadirs are high. I would hold that dose for 7 days unless Sid drops below 90. Please keep testing as much as possible (you are doing a really good job, by the way!)
 
Please let me know if you have any questions or concerns. By the way, are you testing for ketones in Sid? I want to make sure he will be okay!!

We may only need to increase him for a short time, but we will know by holding that new 2.75 dose - whether we need to increase or decrease.
 
Thank you for getting back with us. Totally understand about family stuff, that’s what got us totally off track with our baby.

I’ll bump to 2.75 either tomorrow or Saturday to make sure I can do a full curve.

I have the ketone test strips but haven’t used them yet. Months ago his breath did have that smell, but in recent months his breath has been fine. I’ll do more reading on how to do the ketone test and will try to do one this weekend.

Thank you @Suzanne & Darcy !
 
Just checking in. I see a little improvement. Did you get a ketone reading? I think we will have to go to three units in a couple more days. Get as many tests as you can. It looks like you are at work today? At what point in the cycle will you be home?
 
Yes was working today. I have the strips ready but haven’t been able to catch him to try to collect. Will keep trying!

We are still all over the place and high again this evening although his energy levels have definitely improved.

Any idea why he was staying in the 400s with a dose of 0.5 but now tracking consistently higher with a higher dose? I’ve heard mixed things on Symogyi effect and not sure if he’s fighting this dosing or not.
 
zenworm said:
Any idea why he was staying in the 400s with a dose of 0.5 but now tracking consistently higher with a higher dose?
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I am not seeing those numbers on a .5 dose. Can you tell me which date to look at? I may be missing it. Right now, I do not see evidence of any bouncing or overdose on the current dose. The more testing you can do, the better. Then we can analyze what is happening better.
 
Okay. I see the dates in June when he was on .5 units. There are no mid-cycle tests at all that I see so we have no idea what he was really doing on that dose. It’s very important to know how low a dose is taking Sid (nadir) or we can’t make good dosing decisions to keep him safe. We need to know more than just the AMPS and PMPS numbers. Yes, those are important so you can make sure it’s safe to shoot, but there’s so much more we need to know.
 
One thing that can really hamper your progress is holding doses for too long. It can really make it much harder to break through some of the high numbers. If you can get some mid cycle tests then we will probably want to adjust his dose after 7 days. If you are not able to during the week, then you can run a curve on the weekend and we can make sure it’s safe to raise his dose. We need to get him out of the pinks (mid-cycle.)
 
I am sorry about the high, but remember it’s just a color. There’s no real difference between 498 (yesterday’s AMPS) and today’s (which could be 500). It’s all high.
 
I was encouraged by the pinks you caught this past weekend. If we know from test data that he’s getting down into pinks mid-cycle after 7 days, we should increase to 3 units. Some cats need to increase in doses before they start earning reductions.
 
Well this is weird. I tested him at +9 and he was 418. I tested him at PMPS and he's lower at 383. First time I've seen that happen in a long time. That's coming from HI from his AMPS. We will watch him closely this evening.
 
Fantastic! A yellow last night! Many cats do tend to drop lower during the evening, but later this week when you can test more (Friday?) we will see if he’s been dropping into yellow during the day. It’s progress!
 
Hi! I’m just checking up on you and Sid. A pink preshot this morning! Sid hasn’t had one of those for a while. I think he’s making some progress and I think we will need to move to 3 units for the time being, but I would like to see a few tests around +4 and +6 tomorrow at least. I am optimistic.
 
Thank you for checking in! I should be home most of tomorrow so can get some more readings. How do you feel about the Freestyle Libre? I've done it once before and it was nice not having to draw blood manually, but it left a bad spot that took awhile to heal. Vet is wanting to do it again but I may just give them manual curves.
 
zenworm said:
Thank you for checking in! I should be home most of tomorrow so can get some more readings. How do you feel about the Freestyle Libre? I've done it once before and it was nice not having to draw blood manually, but it left a bad spot that took awhile to heal. Vet is wanting to do it again but I may just give them manual curves.
Click to expand...
Well, the Libre is a convenience, of course, but we have found that they really tend to read too low in the lower numbers (causing panic among some people). They don’t really track well with the human meters, but as long as you have a human meter as a backup to check low numbers, it’s probably okay. Oh, wait, I just checked again and I see that you are using a pet meter so that may muddy the waters a bit more since the Libre is a human meter— but still we would know that we don’t want your kitty going below 68 on the pet meter.
 
I see you got that 80 nadir. I would hold the dose for now. He swings back and forth a lot, but we need to ride out the highs and lows and let him become accustomed to lower numbers. If he drops below 68 then of course we will reduce his dose. If you want to follow the start low go slow protocol then you would reduce if he drops below 90. He’s been on insulin for a while now and I think as long as you are able to monitor his cycles that I would opt for the Modified ProZinc Method. Most of “my” ProZinc kitties do a lot better on the modified ProZinc method, but it depends on the person’s schedule and ability to monitor.
 
Do you think I should have dropped his dose back on July 26 after he got down to 80?

He seems to be bouncing hard now. Today he hit 107 at +3 but now at +8 he’s already off the chart again.
 
Hi there. I have been traveling and just now getting caught up. One major thing I notice on his spreadsheet is that he is dropping was too fast and that can set up some really big bounces. The way to try to control that is to give more carbs early in the cycle. More carbs at breakfast (closer to ten percent) and more carbs at a +1 and definitely at a +2 snack (again, closer to ten percent). If the 9/10 percent carb food doesn’t do the trick then even going with medium carb food of 11-14 percent may be necessary. Preventing steep drops needs to be a priority if at all possible.
 
As for the skipped shots when he had a blue preshot number, we can’t completely know if it was a good decision or not because there are no subsequent tests done on the evening of the skips. Judging by how high the AMPS were, I would say that a reduced dose would have been a better way to go, but when you give a reduced dose, you need to be able to test afterwards to get an idea if the reduced dose was too little or too much.

With regard to the dose, he has earned a .25 unit reduction back down to 2.5 units on several occasions (three times at night recently) when he dropped below 90. I do not think he’s been in any danger at any point, but I am just talking about reductions earned according to the SLGS protocol.
 
Ok thank you, this is all super helpful. I’ll do more reading an out how to handle the drops and will load up on some higher carb food. We have a local store that carries Open Farm which is around 8 and very clean.

thank you again! Our vet is really no help at all when it comes to this level of detail.
 
Ask anything that crosses your mind and I will do my best to answer. Veterinarians don’t actually receive very much training on feline diabetes— what little they get is dog related — and even that isn’t a lot of training. They certainly don’t manage the daily cycles of a diabetic cat (unless maybe they have one of their own!)
 
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