Looking for advice again

[Barb & Mr. Frog]

Hi again, I have been trying to handle Froggii's insulin by myself, but we are getting consistently lower numbers and I'm a little scared/confused on when exactly I should shoot, and how much..... I've been giving him tiny bits for awhile now, and often none at all if I know I wont be able to be awake/home with him in case of emergency. Other than when he got into some gravy food he wasn't supposed to, his numbers look pretty darn good ( I think ) I haven't been doing a lot of mid-cycle testing because he isn't being very tolerant of the testing lately, treats or no treats, so I do what I absolutely have to.

Hoping someone who knows more than me (not a high bar to jump over, lol) can advise as to whether I should be shooting these low numbers, and if so, how much. I plan to go up to harbor freight tomorrow to see if they have some of the digital calipers in stock locally, if they don't I will order them online. I am fairly certain the markings on these syringes, while they are close, are not exactly right, and I fear that I'm not giving him what I *think* I'm giving him.

I am curious too about the 'sliding scale method' with prozinc? I found some info on the web, but I'd much rather hear about it from people who actually do it, or have seen it done at least. How does one know when this method would be a good choice?

 

[Rob & Harley (GA)]

BEAUTIFUL spreadsheet!!

I urge every Prozinc user in the group to look at Mr. Frog's ss to see how fast things can turn around and what you are shooting for (pun intended).

To be honest I was only the second person on this board to shoot a sliding scale with Prozinc and it worked for us, feel free to check out Harley's ss, there were many using a sliding scale with PZI but we wern't sure how similar the insulins were but that was 4 years ago.

I have been typically the one here to put together a sliding scale but to be honest I never shot below 120 to 130, so you and Mr. Frog may be pioneers in shooting even lower numbers. I would like some time to analyze your ss completely.

There are pictures and directions for shooting mear drops of insulin somewhere here on the board, I'll go looking for them tomorrow.

Welcome back, I hope you'll stay with us for a while.

 

[Carl & Polly & Bob (GA)]

Dang, I had this terrific long-winded response all typed in and lost it! I'll try again!

Hi Barb,

To me, it looks like everything you're doing is "right". It looks like Froggi is bound and determined to quit getting insulin in the near future. He's just "not quite there" yet.

I took a look at the SS and here's what I see...

Other than the 294, which you figured out was due to him getting into some gravy (bad kitty!), the rest of the numbers recently are wonderful numbers.

He's been hanging out in the upper end of "normal" at the worst. And recent numbers in the 130-140 ranges have been "after eating" numbers, which means they include a little bit of "food" in them.

I shot a sliding scale pretty much the whole time Bob was on insulin. It works great for some kitties, and Prozinc is a good insulin for that type of dose routine.

That said, I think you are down to only two options on dose (unless you see a number over 200 that you can't explain simply like gravy or some other "junk food".

I think your choices are .1u, or skip the shot. Now the trick is "where do you draw the line" for shooting or skipping. That's totally up to you. But I'm not seeing any numbers that need .2u rather than .1u.

The last time you shot .2u, on a 131, he dropped down to the 50s, and that was after vomitting up his breakfast. I don't think the low number was due to losing breakfast. I would think that would be pretty stressful, and the stress would probably cause the numbers to rise some. The boost from eating should have already hit by the time he vomitted. Anyway, when you saw the 54, the SS says that you fed him 3/4 can of HC food. Which should have caused his numbers to go pretty high, right? Well, they didn't. He went to 130, just above "normal" for a cat. And 5 hours later (I would have expected a high PMPS too), you get a 78 on the meter. His system processed the "sugar" and pushed the number back down, not up. So something "in there" is working pretty well.

I think you can proceed one of two ways, and either way can work.

1 - keep doing what you're doing. The only decision you need to make is "what's the lowest number I will give .1u on?" I'm thinking 140, 150? But you need to make that call. Continue to test AMPS and PMPS, and decide to shoot or skip based on your "line in the sand". An occasional nadir test will help so you can see how green he gets mid-cycle.

2 - On a cycle where you give a shot, get a nadir test, and then test again at +12. If the number is high enough, give another shot. If not, then what you do is feed, and then test him 2 or 3 hours later. See if the number is high enough for that .1u dose. If so, give him a shot. It might be 15, 18, 20 hours after you gave the last shot. You will be "chasing the numbers".... testing until you get a high enough number to give a shot, but not waiting 24 hours between shots.
That method requires more tests, and it sounds like Froggi is pretty much fed up with tests, so it might not be your best way to go.

Either way, I think his plan is to get off the insulin, and like I said, I think either method can work.

One other thing you might consider is altering his feeding schedule. With multiple cats, that might not be an option. If he eats multiple small meals over the course of 12 hours, it can spread the "carb boost" from eating more evenly, and it might enable his pancreas to keep up on its own.

I also wanted to say that I was sad to read your post in Health yesterday, and wanted you to know my thoughts and prayers are with you. As lots of people have already told you, you did the RIGHT thing for little Bo. That doens't make it any easier, but too often the right choices are the hardest choices.

Hugs,
Carl

 

[Barb & Mr. Frog]

I think your choices are .1u, or skip the shot. Now the trick is "where do you draw the line" for shooting or skipping. That's totally up to you. But I'm not seeing any numbers that need .2u rather than .1u.

Hence why I'm here bugging you guys.. its a little scary shooting that low... I find myself literally staying with him the whole time, maybe overkill but whatever it takes, you know?

The last time you shot .2u, on a 131, he dropped down to the 50s, and that was after vomitting up his breakfast. I don't think the low number was due to losing breakfast. I would think that would be pretty stressful, and the stress would probably cause the numbers to rise some. The boost from eating should have already hit by the time he vomitted. Anyway, when you saw the 54, the SS says that you fed him 3/4 can of HC food. Which should have caused his numbers to go pretty high, right? Well, they didn't. He went to 130, just above "normal" for a cat. And 5 hours later (I would have expected a high PMPS too), you get a 78 on the meter. His system processed the "sugar" and pushed the number back down, not up. So something "in there" is working pretty well.

It was so very strange, that vomit episode, the food looked almost unprocessed at all, pieces of the freeze dried chicken, plus the canned food mixed up together, but otherwise looking very unchanged, that unsettled me, because I can't think of a good reason food could be in his stomach for that long without being altered significantly, which is why I gave the petromalt, it was the ONLY thing I could think of, but even that doesn't quite ring true as a cause for that, unless I misunderstand how that works.

I think you can proceed one of two ways, and either way can work.

1 - keep doing what you're doing. The only decision you need to make is "what's the lowest number I will give .1u on?" I'm thinking 140, 150? But you need to make that call. Continue to test AMPS and PMPS, and decide to shoot or skip based on your "line in the sand". An occasional nadir test will help so you can see how green he gets mid-cycle.

2 - On a cycle where you give a shot, get a nadir test, and then test again at +12. If the number is high enough, give another shot. If not, then what you do is feed, and then test him 2 or 3 hours later. See if the number is high enough for that .1u dose. If so, give him a shot. It might be 15, 18, 20 hours after you gave the last shot. You will be "chasing the numbers".... testing until you get a high enough number to give a shot, but not waiting 24 hours between shots.
That method requires more tests, and it sounds like Froggi is pretty much fed up with tests, so it might not be your best way to go.

/sad I wish his ears weren't so sensitive... I'm kind of wondering if it isn't the lancets themselves, he seems to get small raised patches wherever I poke, its not big, almost not visible at all, just like, the skin is annoyed for a day or two on that spot..... I've been using vetericyn after each test to soothe it, it looks better and clears up quicker when I do. I may go buy a different brand and see if that makes any difference. And maybe if the new lancets don't bother him I will try going back to the ointment, since maybe it wasn't the problem.

One other thing you might consider is altering his feeding schedule. With multiple cats, that might not be an option. If he eats multiple small meals over the course of 12 hours, it can spread the "carb boost" from eating more evenly, and it might enable his pancreas to keep up on its own.

I am feeding them all roughly every 4-6 hours, plus, and I haven't added this to my sig yet because I'm out of characters, and I don't want to just remove bobo yet ... but I have been keeping Young Again Zero Carb dry out for them for those times when I'm out or just taking a bit too long for one or the other hungry kitty ... They don't eat much of it (usually less than 1 cup per day split among all/most of them I see them nibble a bite here or there, but not really going crazy with it), and I've purchased two new water fountains to help make sure they drink (two still not using them, but they have a bowl too)

I also wanted to say that I was sad to read your post in Health yesterday, and wanted you to know my thoughts and prayers are with you. As lots of people have already told you, you did the RIGHT thing for little Bo. That doens't make it any easier, but too often the right choices are the hardest choices.

Hugs,
Carl

Thank you... I still feel stunned... this morning I was groggy and started getting his meds out before it hit me again


Rob, thank you, and I have seen the photos of drops, but my eyes aren't so wonderful these days, which is why I'm going to get calipers (hopefully tomorrow, but if not, whenever the mail brings it)

I should probably mention, since maybe you guys won't think I'm insane, a couple of times I intended to shoot low-ish numbers, and Frog told me not to... so I listened to him. Is it completely insane to trust him? lol

 

[BJM]

Go with your gut or Mr Frog as the case may be.

A syringe magnifier may be helpful. I found one at a local pharmacy.

 

[Barb & Mr. Frog]

Thanks BJ, I have some magnifying glasses I use, but sometimes my eyes are still a bit unclear even with those. I couldn't find a syringe magnifier for the 3/10 syringes, so I bought the glasses. It works well usually, I just sometimes have to take the insulin/syringe and draw it right next to a light where it is sharper (I try to keep my hand around the insulin bottle when I do that to protect it from the light) Unfortunately I don't have the ability to move his ear right up by the light, lol... maybe Ill grab one of those little flashlights from harbor freight today too.

 

[Sue and Oliver (GA)]

Hi Barb, good to see you and Frog again. It looks like he is doing beautifully.

I wonder about his ears. Are you using the larger lancets? If so, you might go down to a 30 gauge and see if that helps, as long as he is bleeding well. Sometimes a tiny smear of vaseline or neosporin helps, before the poke.

I was sorry to read about your Boo. He sounds like he was well loved and very well cared for. What more can a kitty want from life? Oliver had heart disease and I know it is difficult to treat and treatment is often not successful. Know you did your best and that he knew that.

 

[Barb & Mr. Frog]

Hi Sue, thank you.

I have switched to the 31g lancets (relion brand) (the 28s were relion brand also) I had previously discontinued use of the Neosporin +pain relief because of the bumps arising each place I had poked, it looked much worse previously with the Neosporin than it has recently without, but still seems irritated. I thought he must be allergic to the Neosporin ( I am, so I thought perhaps he was also ) But... since he is still reacting to just the poke without the ointment, I plan to try a (or maybe several) different brand, thinking perhaps the coating on the blade is affecting him somehow?
(to be clear.. the marks I got with the 28g were definitely more defined and irritated than the 31g has been, but his response is still unfriendly at best these days..... (he doesn't mind the shots at all, I just show him the syringe, tell him what I'm doing and he looks the other way and waits while I do it... except those couple times when he told me not to shoot)

It was my plan to pick up a new brand of lancet today, but I got sidetracked, and did not... I did manage to stop and buy a digital caliper, however, now I have to take it back because the readout is so faint I can barely see it, plus it kind of flashes in and out.... possible battery issue, or possibly just a bad one... either way, I have my grandson tomorrow so I can't take it back til sunday at soonest, probably Monday.

 

[BJM]

In a pinch, a small, adjustable, crescent wrench may work to set a reference level, or a ruler with millimeter markings you can see, even if it isn't a multiple of 0.25 units.

Or use colored water in a reference syringe

 

[Barb & Mr. Frog]

Hubby got me a battery for the caliper, it is working now, will try using it tonight.