How can I lower morning numbers

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For many cats, the AMPS is the last number to fall into line. This is likely do to what is termed the "dawn phenomenon." Hormones work on a normal daily cycle. Stress hormones begin to rise in the early AM as a means of preparing the body for the stresses of the day. As a result, there's a normal rise in BG levels.

More specifically to Lenny, I don't think he's getting enough insulin. Just from eyeballing your spreadsheet, it looks like his numbers are averaging in the high 200s/low 300s (or higher). You're seeing only some scattered numbers in the 100s. You want to evaluate your dose based on how low that dose is taking the numbers. There was a drop to 87 toward the end of May but you didn't reduce the dose. To be honest, I'm not sure what guidelines you're using to inform your dosing decisions. Have you seen the information on Prozinc dosing in the sticky notes on the Prozinc forum?
 
NancyJH said:
Lenny for the most part has good numbers but the morning numbers are usually high. What dose change should I do to fix this? Thanks!
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Similar to what Sienna and Gabby said, I think you will start seeing better numbers if you follow one of the Prozinc dosing methods (either Start Low Go Slow (SLGS) or the Modified Prozinc Method (MPM)).

This is a link to the dosing methods: https://www.felinediabetes.com/FDMB/threads/prozinc-dosing-methods.225629/

It seems that you’ve been holding doses for longer than would normally be recommended on Prozinc. With these dosing methods you also wouldn’t decrease doses unless Lenny fell below 90 on a human meter for SLGS or 50 if using MPM. So he wouldn’t have earned any reductions recently, and you would want to hold and increase the doses systematically depending on which dosing method you choose.

My cat, George didn’t start seeing decent pre-shot numbers (yellows, blues and greens) until I switched to MPM. He was consistently in the pinks, reds and blacks before that.
 
It seems like when I increase the dose, instead of making a smile during the day, it’s lower at the evening test. What I was doing to try to increase by the evening shot, was to test around 4:00 pm and since it was usually much lower than in the morning, I’d give him a snack to raise his number by the time he would get his evening shot. Is this wrong?
 
NancyJH said:
It seems like when I increase the dose, instead of making a smile during the day, it’s lower at the evening test. What I was doing to try to increase by the evening shot, was to test around 4:00 pm and since it was usually much lower than in the morning, I’d give him a snack to raise his number by the time he would get his evening shot. Is this wrong?
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It’s ok if his pmps is lower than his amps. Eventually this is what will help level out his numbers overall. Since pm numbers are usually the first ones to go down, that’s what you want to see. And it seems like he’s still in the pinks and yellows at pmps most days, so even though it’s lower than amps it’s still not low.

As far as feeding goes, it’s also ok to feed any time except for the two hours before shot time, but he hasn’t ever specifically dropped low enough that you would need to try to intentionally raise his numbers. At +8 when you normally test there’s still quite a bit of time to go for his numbers to go up on their own.
 
Should I increase both doses of insulin? I get nervous giving a larger dose in the evening if the number is high 200’s. Will that go too low overnight and will that eliminate the morning 400’s?
 
Why did you lower from 1.5 down to 1? I didn't see where it went too low. The lowest I see is 125. When you got that low preshot of 164 you gave a half dose. Another option when you get a low number is to stall withought feeding for an hour and see if the number is going up. If it is rising and is over 200 you could shoot the full dose. I would go back to 1.5 u
 
NancyJH said:
Should I increase both doses of insulin? I get nervous giving a larger dose in the evening if the number is high 200’s. Will that go too low overnight and will that eliminate the morning 400’s?
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You should be giving the same amount of insulin at each dose, yes.
 
NancyJH said:
Should I increase both doses of insulin? I get nervous giving a larger dose in the evening if the number is high 200’s. Will that go too low overnight and will that eliminate the morning 400’s?
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I used to be scared to shoot full doses in the yellows too, but if you look at my spreadsheet I started getting much better pre-shot (and overall) numbers once I did. I had to learn for myself too that the decrease isn’t linear…so if your dose brings him down 200 points when he’s in the 300s, that does not mean that it will also bring him down 200 points when he’s in the 200s. I wish I had followed the dosing protocols sooner and started off shooting the regular dose when he was over 200 rather than trying to adjust based on pre-shot numbers.
 
Hshray said:
I used to be scared to shoot full doses in the yellows too, but if you look at my spreadsheet I started getting much better pre-shot (and overall) numbers once I did. I had to learn for myself too that the decrease isn’t linear…so if your dose brings him down 200 points when he’s in the 300s, that does not mean that it will also bring him down 200 points when he’s in the 200s. I wish I had followed the dosing protocols sooner and started off shooting the regular dose when he was over 200 rather than trying to adjust based on pre-shot numbers.
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Yes — I see what you mean about your spreadsheet — even though you had evening preshots in the blues and yellow, you gave the same dose. That’s what I’m scared to do and usually reduce it. I’ll keep it the same.
 
JanetNJ said:
Why did you lower from 1.5 down to 1? I didn't see where it went too low. The lowest I see is 125. When you got that low preshot of 164 you gave a half dose. Another option when you get a low number is to stall withought feeding for an hour and see if the number is going up. If it is rising and is over 200 you could shoot the full dose. I would go back to 1.5 u
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I get nervous when it’s lower at night thinking it will drop too low overnight. I’m going to increase it. Thanks%!
 
Everyone gets nervous shooting lower numbers. What I'd point out is that you've shot as low as in the 220s and had a good cycle. While it's counterintuitive, shooting low generally doesn't cause the numbers to plummet. It may flatten out the cycle.

If you never start to shoot progressively lower numbers, Lenny is going to stay in higher numbers. I would encourage you to think about where you are comfortable shooting. Progressively lower that number until you are familiar with how Lenny responds and confident in your ability to manage those numbers. (FWIW, I was a Lantus user. I would shoot anything over 50.)

I'd also encourage you to increase/decrease by 0.25u. The only time we encourage using fat or skinny doses is if you are zeroing in on a lower dose (i.e., your cat is closer to regulation/remission).
 
NancyJH said:
I get nervous when it’s lower at night thinking it will drop too low overnight. I’m going to increase it. Thanks%!
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Good. If after a few days you aren't seeing number around 100 we may say go up to 1.75. But I think try a few more days at 1.5.
 
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