Low number at shot time! What do I do???

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Meowluv

Member Since 2013
Just took Ferdi's bg and it is 129. Don't know whether or not to shoot. Please someone advise! I know I can't shoot 3 units which is what he is on currently. Sorry my ss isn't working right. I just can't get it to update!

Melody
 
No shot

Without feeding, wait 20 minutes and retest to see if rising and how much.

That low of a pre-shot suggests the dose may be too high, too.
 
You're using ProZinc, right? Wait 20 minutes without feeding and retest, to see if the number is rising and over 200.

It is a sign that the dose needs to be reduced. The goal is to have 2 shootable numbers 12 hours apart.
 
A soon as it has been at least 20 minutes, please re-test to see what is happening, and let us know. Some cats do swing quickly when the insulin is wearing off.
 
Then you'll either need to "chase" the number or skip. Chasing the number would be testing in the next few hours until he is over 200 and then shooting a reduced dose. The complication is that your shot after that would have to be 12 hours later so it will throw your schedule all off.

Skipping is easiest. Just be prepared for a high number in the am (24 hours since last shot). Regardless of that number, I'd reduce the dose.
 
Could either skip for tonight, or maybe give a token dose.

30 points in 20 minutes.
How late can you go before 10 hours later for the next shot won't work?
 
Ok I think I will just skip the shot. That would be easiest as our 9 am & pm shot times work best for me. What should I reduce his dose to?
 
I'd vote for 2 units. Get some midcycle numbers when you can to see how low the insulin is taking him. If he is too high after 3 cycles, increase by .25
 
ProZinc is more flexible with time; you could shoot as much as 2 hours late, if necessary, though I'd maybe just go with half of what you were giving, once its over 200 tonight.

If you completely skip, he will probably be high in the morning.
 
If he's sky high in the am, I wouldn't reduce yet.
You might have to consider adjusting the dose based on your preshot numbers. It's better, in my opinion, than having to skip shots or reduce regardless of preshot numbers.
Maybe something like 3u if you see a number around 400, and 2.5u if he's around 300? Or something along those lines. Personally, I think PZI works better on a sliding scale than a "set dose" does, But that's just my opinion.
 
Carl,
Rob & Harley who has been advising over in the ISG for PZI would agree with you on the sliding scale for PZI and for Prozinc. She has been creating individualized dosing scales for some people over there lately.
 
Robin is really good at creating scales, I agree.
I think an important part of scales is that they need to be flexible, and adjusted as needed based on preshot and nadir numbers.
I also try to remove "bounces" from the equation. They are going to happen, no matter what you do. To me, it's not a bounce unless you have the data that shows the "low" that caused a bounce. Without that, it's just a high number. And you shoot accordingly. If you do see a definite bounce, tweak the dose down a little. But don't adjust the whole scale up or down at the same time based on the results of one or two cycles. It's an intuitive method of treatment and you have to trust your gut. And you have to test around nadir to evaluate the effectiveness of a dose.
It's not the easiest way to manage FD, but with a "done and gone" insulin, it can be effective. IMHO.
 
Ok I just took Ferdi's bg levels for his am shot and he is at 193. Since he is below 200 I'm not comfortable giving him a shot, at least not at 3 units. What should I do?

Melody
 
Interesting. You skipped last night, right? If so, that means he is maintaining good numbers without any insulin. Same choice as last night - wait 20 minutes and retest, without feeding. I would guess he will be over 200 soon. And reduce the dose. (i still like 2 units)
 
Ok. That is what I will do.:) Thanks for your help. I am hoping maybe he can be on a much lower dose.

Melody
 
Ok tested again and it is only 1 point higher at 194. Should I keep testing it or should I go ahead and give some kind of low dose? I don't want to wait until 9 pm tonight to shoot.

Melody
 
He doesn't seem to be rising much; I think I'd be very conservative and give a small dose of 0.5 units. I'm not sure he'll go up enough to handle 2 units and I'm concerned it might send him into a hypo.
 
Just tested again and he is at 208. I gave him the .05 units and then I'll test him again in a couple of hours and see how he is doing. Thanks so much everyone! :)

Melody
 
.5 is fine. One/two cycles will tell you whether he responds to that dose - it's a bid drop from 3/4 units he was on. But better to add .25 as needed than to have to deal with low numbers.
 
I agree it is better to give the .5 and see where he goes from there. I am going to test him again in about 30-45 min and I will post the reading. Interested to see where he will be at.

Melody
 
Good going!

How are you doing with all this? Sometimes, we forget to check on the 'bean' (being).
 
Oh I'm doing ok lol. Thanks for asking though. I'm rather stressed because I am leaving on Sunday for 2 weeks. I am a grad student and I have to go to VA to take classes during this time. I'm just nervous about how dh is going to handle Ferdi's insulin and bg checks plus 2 kids and a dog with heart disease.
 
Ferdi's levels are now at 212. So looks like they are steadily rising. Since I gave.05 units this am what amount should I give in the pm? I'm going to continue to test him throughout the day today. I have a feeling that he may do better and I might be able to get his numbers consistently lower on a smaller dose of insulin.

Melody
 
Well, you now know that 0.5 isn't going to keep him below 200 mg/dL, nor take him down to 50 mg/dL, so going up makes sense.
There's no depot to worry about carry over and you were using 3 units until he got really low. We just don't know why he got low like that.

How would you feel about 1.0 unit?
 
Ferdi's bg level this morning is 301 so up a little from last night. I think I need to increase the dose to maybe 1.5 units? I'm going to try that and see how it goes. Any advice? Should I increase or is that to much of an increase?

Thanks!
Melody
 
I"d give each increase 3 cycles to settle in before I increased and then I would increase by .25 This process will take a while but it is safe and eliminates sudden low numbers.

Would you start posting in the PZI forum? That is the best place to get dosing advice on PZI.
 
I think you would have been ok with the increase. The .5u dose didn't do anything other than hold the numbers flat. That's not a bad thing, but shows the dose had no effect in lowering the numbers in the middle of a cycle.

If you can get a test around the middle of a cycle, you can get an idea how effective it was.

I'm not a big believer in the "settling in" theory with non-depot insulins like PZI/Prozinc. I think the effectiveness of a dose is revealed fairly quickly, within a cycle or two. I adjusted Bob's dose more or less on a shot by shot basis, and if he ever goes back on the juice, I'd do things the same way. But that's me, treating my cat. And most people probably don't agree with that method, and that's fine. And the primary reason I no longer advise much on dosage. 'My way" is aggressive and probably less safe, or at least more stressful. And safety should be our top priority when giving advice to other people's cats.

You have to do things your way, with your cat.
 
I made a post on the PZI forum just a bit ago. +2 today he was at 277. At +11 139 and at shot time was still there! Not sure if I need to stay at 1.50 units or go down to 1.25 units. I definitely want to go the safe route and want to do what is best for Ferdinand. :)
 
What did you end up doing last night?

I tried to check your SS but it hasn't been updated in a couple of days. You might want to try for some updates there.
 
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