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Mandy and Bradley

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Okay guys,

Just looking for some insight. In the early mornings when I give insulin, it is too early so I can never reach anyone on the forum. I was just wondering how my early-morning decisions have been. For example, today he was at 266, and I gave .5. He was at 197 7+ today. Now, this evening, can anyone give me suggestions. I'm thinking he may be between 200 and 300. Now, this is my thought process but I want to hear yours. If he is between 200 and 270 maybe, I was thinking .5, and then from 270 to 300, than 1 unit. Is this a good plan? Now, if he is over 300 to 400, would that be 1 unit as well? TIA!
 
Welcome Mandy and Bradley,

Have you just started on insulin? If so, you are getting a nice, if uneven response. PZI is a great insulin in that you can change the dose as needed. But it also pays, in some cats, to hold the same dose for several days so their body can adjust.

If I were you, I would start giving one unit and hold that dose for a couple days, testing to see mid cycle numbers. If you get a pre shot number under 200, test again in 20 minutes to see that he is sure headed up. At that point, you would probably want to lower the dose.

If you recently changed to wet lo carb, that also may take a while to kick in and help lower the numbers.

Other things that can have an impact are feeding times (usually we suggest smaller, more frequent meals day and night) and other health issues. Any infections etc.?

Have you read the sticky at the top of the forum? It has some great info on how PZI works.
 
Hi Sue!

It's me...my previous name was SilverMoon. I changed it. You and I have been "working" together for about a week now. :smile: Bradley's been on wet for a couple of days now.
 
Oh, you can't go changing your name on me. I can only remember one thing at a time.....

So disregard my previous post. Except the part about keeping the dose. I think we have to give it time to work. I think switching the dose may not be helpful. I would stick with the one unit unless you see a low ps number.
 
I'm still kind of a newbie (in other words not an expert), but I took a look at Bradley's spreadsheet. Looks like you changed him over to the wet low carb diet on April 6, so he's had a few days but not a full week on the new diet. And it looks like the diet change has already helped lower Bradley's numbers (yay!). This first part is a lot about data gathering with the testing and learning how the insulin works on Bradley. As Sue said, with ProZinc, you can vary the dose based on the numbers, but it's also nice to hold a dose a few cycles. Looking at the tests you have so far, you haven't had a super low nadir (lowest BG # in the cycle, usually between +5-+7 hours after insulin dose), so I think you could stay with the 1u even with a pre shot # in the mid 200's. Not that what you did today is wrong (it's good to be cautious at first when you're learning) because you got see how Bradley did on the lower dose. With the 197 @ +7, you now know that .5u wasn't quite enough since you would like Bradley to be lower for the nadir. Depending on your pre shot # tonight, I would go back to the 1u and try to get some tests in tonight and tomorrow, especially around when the nadir might be. That will help you know if you need to go up or down. You're doing great and already have Bradley in a lot better numbers.
 
If you get a number in the 200s, you can still shoot one unit. His nadir numbers are not that low. If you get a number near 200, wait 20 minutes and test again. As long as it is headed up, you can shoot. If you get a number nearer 150, then you want to consider adjusting the dose - when you are sure it is headed up. If you are shooting before any one is on the forum, we might be able to give you a sliding scale for dosing. But we probably would want to wait at least a week until we have more data.

Hey Holly, posted before I saw your reply. Good job!
 
Thanks guys! If his numbers come out higher than expected tonight, I may be back for more help, but so far, sounds like 1 unit may be the ticket.
 
Saw you got a 226 for your pre shot and shot the 1u. It's interesting that Bradley had a lower PMPS on less insulin than the morning pre shot. I think the diet change may still be kicking in. That's good. If you can, try to get one or two tests in tonight before you go to bed.
 
hollyall said:
Saw you got a 226 for your pre shot and shot the 1u. It's interesting that Bradley had a lower PMPS on less insulin than the morning pre shot. I think the diet change may still be kicking in. That's good. If you can, try to get one or two tests in tonight before you go to bed.
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Yes, I am so very confused because he was at 266 yesterday morning pre-shot. I gave him .5. Then before his PM shot yesterday, he was at 226. I gave him 1 unit last night and then he ate some wet food before I went to bed, and then this morning, he was up at 336. It doesn't make sense to me. Maybe I should leave wet food out for him all night to munch on? He does eat much more during the day, which may be why his PM numbers aren't too bad. It seems the mornings are when he tends to get a higher number. His PM numbers have seemed to stabilize a bit more in the 200s. I just tested him 4+ and he was at 164. I intend to get another test in another hour or so for the nadir.
 
HI Mandy!
Welcome to the frustrating world of variable dosing! When I was doing variable dosing with Squamee, I considered a 50 point drop from PS to PS great---and would not have changed the insulin amount. (You upped to 1U). I can't say that is the right thing to do, but I wonder what would have happened. (Gator, who I worked with then, told me that the idea was to not look at absolute numbers, but to aim for a downward trend) Leaving food out at night is not a bad idea. If the pancreas is working at all, eating low carb food may bring the numbers down.
Good job testing!
 
It is possible that he went lower than his body is used to overnight and is bouncing back up. The food is also a possibility. It is always a good idea to try feeding overnight - with an automatic feeder or with frozen food. It can just support the pancreas, but if he feels he is going low, he can get to bring himself back up. Sometimes arranging for some food about 3 hours before your amps can also lower that number.

It's all about trying things and seeing what works for Bradley. Be sure to note on your ss when you try something so you can go back and remember what might or might not have made a difference.
 
When you say automatic feeder, wouldn't that consist of dry food though? Also, what do you mean by frozen food?

Just tested him around nadir and it's at 105. Before I continue, I want to make sure you think it's still best to stick with the 1 unit, at least for a little while until we have more numbers?

Just think, if I wasn't doing this, poor Brad would still be on 2.5 units per the advice of the vet! What a difference!
 
Many of us leave wet food out all day and then all night. It doesn't seem to spoil---there have been posts about how it is manufactured and why it doesn't spoil---you'd have to search this site. I remember reading that dry food spoils faster than wet! Also, many of us freeze food in icecube trays and then save the pucks in ziploc bags--and leave them out when we want our cats to have fresh food several hours later (when it defrosts).

I don't like giving dosing advice, I think it is really your call. But as long as you are at 1U (which is the number we typically recommend people to start at) why not stay there for now and see what happens? This is all about trial and error--you pick a number, shoot, and then test to see what happens. Then you make more informed decisions as you get more and more data.
 
Just peeked at your SS, perfect curve today, YAY! Looks like you have got the perfect dose, you are going to make everyone jealous. :mrgreen: I would probably lower to 0.75 if tonight's PS is considerably lower than this mornings.

As others have said, if you get a PS under 150, definitely no insulin on that. Wait 30 min & retest and only shoot once the PSs is above 150 (and consider lowering the dose a little further). You may want to start with a no-shoot of 200 or 180 until you have a little more data. It's not to skip the shot altogether, just to make sure their PS is high enough that there is room for the insulin to work without putting their nadir too low. Sorry if you already know all that. :)
 
I agree. That is a safe nadir and as long as you are testing regularly and leaving food out, I would continue with the one unit - unless you get a number under 200 for the pmps. Then you need to do the testing/waiting thing. And maybe consider a skinny one unit - somewhere between .5 and one.

I use the PetSafe5 - the only one that a determined Oliver couldn't break into. And he tried! It is easy to program and has 5 places for food. PetSmart sells them. I freeze my food in a cupcake pan - a silcone one so it slides right out and a can of FF fits perfectly - and then refreeze in a plastic bag. Either or both way works.
 
Joanna & Bix (GA) said:
Just peeked at your SS, perfect curve today, YAY! Looks like you have got the perfect dose, you are going to make everyone jealous. :mrgreen: I would probably lower to 0.75 if tonight's PS is considerably lower than this mornings.

As others have said, if you get a PS under 150, definitely no insulin on that. Wait 30 min & retest and only shoot once the PSs is above 150 (and consider lowering the dose a little further). You may want to start with a no-shoot of 200 or 180 until you have a little more data. It's not to skip the shot altogether, just to make sure their PS is high enough that there is room for the insulin to work without putting their nadir too low. Sorry if you already know all that. :)
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No, I don't know anything about the no-shoot. Could you explain that further? Does that mean, if the sugar is between 180 and 200, than I am to try not to give insulin at all, and then test again in 30 minutes?
 
The no-shoot is the level where you don't want to give insulin - but not to skip the shot entirely, you just keep retesting say every 30 minutes until their BG is above the no shoot. Typically we suggest that newbies set 200 as their no-shoot level. Once you have given a shot around that level, you get some data on it if you can, to be sure your dose is safe. Then if that goes well, you lower your no-shoot to 180 and do the same - shoot when you get a PS around that, collect data, and determine if the dose is safe. Then you can lower to 150, and in most cases that is the stopping point for PZI. No PZI below 150 ever (there are some exceptions, but it's a hard & fast rule IMO unless you have a ton of data on your cat and a lot of experience under your belt).

So basically it's about collecting data to be sure you have enough safety room not to get a low nadir. Alternately if you got a PS like 180 and your no-shoot level is 200, you could try a reduced dose (maybe shave off 0.2u) on the 180 and collect data on that. You wouldn't really play around with the 150 no-shoot like that, but the 180 & 200 levels are to give you some room to experiment & collect data, so you can kind of choose whether to wait & retest on a 180, or go ahead a shoot a slightly reduced dose.
 
Joanna & Bix (GA) said:
The no-shoot is the level where you don't want to give insulin - but not to skip the shot entirely, you just keep retesting say every 30 minutes until their BG is above the no shoot. Typically we suggest that newbies set 200 as their no-shoot level. Once you have given a shot around that level, you get some data on it if you can, to be sure your dose is safe. Then if that goes well, you lower your no-shoot to 180 and do the same - shoot when you get a PS around that, collect data, and determine if the dose is safe. Then you can lower to 150, and in most cases that is the stopping point for PZI. No PZI below 150 ever (there are some exceptions, but it's a hard & fast rule IMO unless you have a ton of data on your cat and a lot of experience under your belt).

So basically it's about collecting data to be sure you have enough safety room not to get a low nadir. Alternately if you got a PS like 180 and your no-shoot level is 200, you could try a reduced dose (maybe shave off 0.2u) on the 180 and collect data on that. You wouldn't really play around with the 150 no-shoot like that, but the 180 & 200 levels are to give you some room to experiment & collect data, so you can kind of choose whether to wait & retest on a 180, or go ahead a shoot a slightly reduced dose.
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Oh my..my head is spinning :smile: Please forgive me, this is all new to me :smile:

So, say I test him today and he is at 200 (not gonna happen but just using it as an example)...I should skip the insulin and continue to test every 30 minutes until he rises above 200, even if it is a little over 200, and then give insulin? How much would I give at that level? Then, i would get data on it, meaning test every couple of hours or so to make sure he doesn't go too low. Am I understanding correctly?
 
You got it. We tell newbies not to shoot under 200 - the kitty is just too new to insulin to predict what might happen. So you do the waiting/testing thing. If he shoots up over 200 quickly, you can give your usual dose. If he is just barely over 200, you might want to give a reduced dose.
 
Keep asking questions! you are doing a good job getting us to be clear. Sometimes it is hard to remember who you have told what to, and how much a person knows. Because we don't want to risk a hypo (technically any BG below 35 can mean you are putting your cat at risk) we don't shoot below 150-200. We like the nadir (the lowest the BG goes between the PS numbers--also called the peak) to be around 80. If you get a no shoot PS number we keep testing for 2 reasons, to be sure that you are not so low that the insulin will bring you to hypo-land, and (for the same reason) to be clear that the BG is rising.
 
Okay, so I just tested him for his PM shot and he's at 141. I am in total disbelief!! So now my question is...how quickly does sugar normally rise? I understand to test him until he reaches 200 and then give insulin, but it's 6 pm here and I am not feeling well as it is and will most likely be turning in early. Any ideas? If he is to rise, it would happen within an hour or two, right? Is it possible he may not rise at all?
 
Wow! Nice number. Yes, wait 20 minutes and retest. You will want to reduce the dose since you got a pmps that you couldn't shoot. We just don't know how much yet.

This is excellent news. :-D
 
Great PMPS--you're doing Great!

There are a lot of Great people here to help you.

Good Luck!
 
Ditto...nice #. Means Bradley had a long nice surf in good #'s. Yay! Keep us posted on the re-test. Also, in case you're wondering, you don't feed in between the retest. As a newbie, I didn't realize that. You want to see if Bradley is going up on his own without food.
 
Sorry I get a little (LOT!) wordy sometimes. :mrgreen: Often PZI has a "poop-out" time and they will start shooting up at that point, anywhere from maybe +10 after a shot to around +14. So from here you can test every 20 minutes if you want, or if that is too much to handle, I would just test 1 hr from normal shot time, and then another 30 minutes or 1 hr after that. If he's not up to 200 and you need to go to bed, I would say if you have a clear rising #, like he's at 180 by then, go ahead and shoot a reduced dose. If he is staying flatish, like is only 145 or something, I'd skip the shot and pick up in the morning.
 
You'll want to reduce your dose tonite, and stick with the reduced dose in the morning. Looks like 1u is a little more than he needs. I'm guessing 0.8 or so, but see what you get on your retest tonight.
 
Okay, so I retested and now at 209. Should I do a skinny one like you mentioned, between .5 and 1, maybe .75 if I can find it on the tiny syringe? Also, how do I note this on my spreadsheet since I tested twice, one for his PM shot and then one hour later? If you can, please check out how I have my sheet now and I would love any suggestions on how I should enter it. Thanks!
 
On the SS, I would put the actual test from before you shoot in the PMPS column, and then put a note in the cell before that (or after it) that it is at +13 (or whenever it actually is). Then I'd put "+12 141" in the Notes.

On the dose I think you could go with anything from 0.5 to 0.75. How are you feeling about it?
 
I would think .5 - even a skinny .5. If you figure in the 20% variance in meters, he is hovering right around 200. Up to you. You could wait few more minutes and test again to see whether he starts to climb enough that .5 feels really safe. You can shoot now but I would test again tonight if possible. Or if you are feeling ill and nervous, just give a drop or 2. (start with .5 in the syringe, and shoot out some in the air until it looks like a drop.

Regardless, don't be alarmed if he is higher tomorrow. I would still shoot less than one unit then.

I see Joanna's post. I tend to be conservative (wimpy?).
 
So maybe 0.5 then after reading Sue's post? I'd go ahead and shoot - you have a clear rising #, and are above 200, so I don't see a need to wait. If the 0.5 makes you nervous you could pull back from there, but since it's a late shot and 0.5 looked to be too low a dose yesterday, I think it's a safe bet.
 
To elaborate, I don't think 1u put you in danger territory today or anywhere close, it's more a practical matter of wanting to keep your PSs shootable at every 12 hours. So that's why I don't think you need a huge dose reduction - you got a 2/3rd drop today, which is perfect really. But I still would shave off so you can keep to a 12/12 schedule.

Speaking of which, after you decide on tonight's shot, come back and let us know how many hours it will be til tomorrow's shot? That will affect your dosing decision in the AM. Another reason actually to shoot lite tonight (0.5 rather than 0.75, or less if the 0.5 scares you), if tomorrow's shot will be less than 12 hours away.
 
I did .5 tonight. I did the shot at 7 pm and will be shooting again at 7 am tomorrow. Will you guys be around at that time? I have no idea what to expect for tomorrow a.m. and most likely will be unsure of what to do, too, since it has been decreasing. If not, could you give me a sliding scale as to what some good dosing numbers would be? For example, what dose would I give for sugar between below 200, between 200 and 300, 300 and 400, etc?
 
Sounds good. Here's what I would do in the morning:

PS below 150 - skip the shot if you don't have time to retest
150 - 200 - assuming you don't have time to retest until he gets to 200, go ahead and give 0.25u
200 - 300 - stick with 0.5u
above 300 - bump up to 0.75

I don't think you necessarily need a real sliding scale, at this point I see it more as adjusting to your dose to give you a PS in the 180-200 range with each shot. If the PS is creeping up the dose is probably too low. If the PS is below 150, then the dose is probably too high.

Hope that makes sense!!! I will check back in again tonight, but will not be around in the morning, and probably not by your PM shot if you are East Coast.
 
Also, just curious...I just tested him 2+ and noticed his sugar was a tad higher at 213, when it was 209 two hours ago. Does that mean the insulin hasn't kicked in yet? If not, how long does it take for it to kick in?
 
You got it - onset with PZI is often around +2. It's an ECID thing, so the only way to know is to do some tests - like say +1.5 & +2 and see which is higher. Then another day +2 & +2.5, or +1.75 and +2.25 and see which is higher. Personally I wouldn't bother too much, as I have seen other factors that can complicate it, plus if the nadir moves around on ProZinc it seems to me onset could move around a little too.

But if you got 141 at +12, 209 at +13 (PS) and 213 at +2, I would guess it went up some after the 209 and has started coming back down already. Could have been something like +1 280 if you go with the zoom rate from the +12 to +13, but it's just guesswork without the actual data.

But yeah, it's normal for their BGs to keep rising for an hour or two after the shot.
 
Before I go ahead and give .25 unit, I was hoping you guys could take a look at the sheet.

I didn't get a chance to do much testing today, but I did his PM pre shot (12+) and it was 160, then again at 13+ and it was 159, and then one more at 13.25+ and at 161.

Is it safe to give him .25 since he is not moving much from that number? I am now almost 14+.
 
Test again in 30 minutes.

Someone more qualified than me will be around to answer.

I would be in no hurry to shoot on that number.
 
Mandy, with the 20% variance, those numbers are virtually the same. So you still can't be sure that he is headed up. I would play it safe and not shoot tonight.

I know that this is nerve wracking but this is good news, Mandy. He doesn't seem to want much insulin!
 
I'm with you on the late--I am in North Carolina.

I see Holly is on line, she probably will see your thread and respond. She is good at dosing small amounts.

If someone doesn't respond, create a new thread and ask for dosing advise. it might get more attention.
 
It's up to you, but you might hold on the shot tonight and see how Bradley does without insulin...one more test tonight and then test in the morning. Sounds like he's holding steady and not going up. This part can be tricky when your kitty is in low-ish #'s for shooting insulin but still above normal. You'll eventually want Bradley in lower #'s on his own (normal is 40-120), so you might need to micro dose (.1u to .2u) depending on how Bradley tests. Anyway, I'm conservative and didn't shoot Max when I got a similar #, just tested and saw how he did without.
 
Thanks guys. I will give it one more test in 30 minutes and I may meet ya back here. If it's at the same number around 160, I won't shoot and I'll see what I get tomorrow.

This certainly does seem like good news though, Sue! I am very happy about all of this! Great downward trend going :smile:
 
This is good news, although maybe a little stressful for you. It seems like Bradley is needing less and less insulin (yay!). Are you using the u40 syringes? For micro dosing, it's a little easier to do with the u100 syringes and then use the conversion chart to convert the dose to u40. See how Bradley does overnight and you can think about the syringes tomorrow. I got mine at Walmart. You can also just eyeball the smaller doses. Paws crossed Bradley stays steady.

Conversion Chart
http://www.felinediabetes.com/insulin-c ... rinter.htm
 
Okay guys, I just restested my final test tonight....Got 177, so it is on its way up. He hasn't eaten in a while either. I'm planning on feeding him now.

Any ideas on dosing?
 
I think your .25 would be okay - you might even make it skinny. Draw it up and let a little out before shooting. Will this mess you up for dosing in the am? You will have to be around 200 at shot time and be sure you are headed up.
 
Sue and Oliver (GA) said:
I think your .25 would be okay - you might even make it skinny. Draw it up and let a little out before shooting. Will this mess you up for dosing in the am? You will have to be around 200 at shot time and be sure you are headed up.
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What do you mean by mess me up for tomorrow? I can still give it in 12 hours if that's what you mean. I'm a stay-at-home-mom, so I'm always here. :smile:
 
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