LOW PMPS reading, shoot or no shoot?

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Liang & Nathan

Liang & Nathan

Member Since 2020
Update 05/28/2020

Hello ladies,

I just did a BG curve today, and caught a nadir as 83.

I plan to talk to the vet about reducing the dose tomorrow. So what should be the new dose? 1.75u or 1.5u?

I do plan to decrease the dry food on 05/30/2020 from 20g to 10g daily. And totally off the dry food on 06/03/2020.

My feeding schedule now is as following:

AM shot time
AM +5 hour (If I test, I test before feeding)
AM +9 hour (If I test, I test before feeding)
PM shot time
PM +4 hour (If I test, I test before feeding)

Thank you all for giving me advice. I appreciate any suggestion.
===================================================================
Hello all,

Just got another low PMPS reading, 161.
Stall 45 minutes without feeding, 162.

Do I shoot or not shoot? If shoot, what dose?

Any suggestion is welcome.

THANKS A LOT.
 
Last edited:
Hi there!

Great job stalling. I don't think this number is high enough to shoot at this stage, certainly not your regular dose. If he were moving up, it might be a good chance to start moving the "no-shoot" number down, but he isn't that high and he's not (so far) moving up.

A couple of questions for you: is there any history of ketones or diabetic ketoacidosis (DKA)? and, if you were to shoot (which, again, I am not recommending), would you be able to monitor late tonight?

Perhaps a ProZinc user will stop by soon to offer some more detailed advice... In the meantime, it's nice to see those green numbers in Nathan lately!
 
Nan & Amber (GA) said:
Hi there!

Great job stalling. I don't think this number is high enough to shoot at this stage, certainly not your regular dose. If he were moving up, it might be a good chance to start moving the "no-shoot" number down, but he isn't that high and he's not (so far) moving up.

A couple of questions for you: is there any history of ketones or diabetic ketoacidosis (DKA)? and, if you were to shoot (which, again, I am not recommending), would you be able to monitor late tonight?

Perhaps a ProZinc user will stop by soon to offer some more detailed advice... In the meantime, it's nice to see those green numbers in Nathan lately!
Click to expand...

Thank you very much. I just gave a token dose 25% of 2U which is 0.5u. Based on this post.

http://www.felinediabetes.com/FDMB/threads/prozinc-dosing-methods.225629/

I will test at +4 or +5 hour.

His blood work on 05/15/2020 showed negative ketone and no prior history of ketone.

I do wonder if the 2U dose is too high for him now (as I reduce the dry food and increase the canned food).

I have got a few 90+ numbers (2 of them are at +9 hour, weird?) , and I am not sure if I missed some <90 numbers since I cannot test every hour.

I plan to do a BG curve tomorrow to see how BG changes every 2 hour.
 
Nan & Amber (GA) said:
Well, again, I'm not a prozinc person, but looking at your spreadsheet and reading your other thread, I think a dose reduction with the food change sounds like a good idea. You can always go back up, after all!
Click to expand...
I agree with Nan. I think a dose reduction is in order for Nathan, since you have decreased the amount of dry food twice in the last 10 days.

I do think the 2U dose is a bit much for him right now. Not sure if 1U or 1.5U would be better. Partially that depends on when you will be reducing the dry food amount again.

So when will the dry food amount be decreased again?
Any stomach upset or diarrhea with the food change so far?
 
Deb & Wink said:
I agree with Nan. I think a dose reduction is in order for Nathan, since you have decreased the amount of dry food twice in the last 10 days.

I do think the 2U dose is a bit much for him right now. Not sure if 1U or 1.5U would be better. Partially that depends on when you will be reducing the dry food amount again.

So when will the dry food amount be decreased again?
Any stomach upset or diarrhea with the food change so far?
Click to expand...

Thank you very much for your reply.

I do plan to decrease the dry food again on 05/30/2020 from 20g to 10g daily. Then totally off the dry food on 06/03/2020. I am not sure if it is too quick.

So far there is no stomach update or diarrhea.

But I just found that he has lower (if not lowest) BG at +9 hour. Is it normal?

Thanks again. I really appreciate your advice.
 
Technically, Nathan has not reached a reduction point in the dose, as his BG levels have not fallen below 90 mg/dL. But with the food change happening at the same time, it's safer to reduce the dose for now. Plus, he has been awfully close to that 90 BG that is an automatic reduction per the Prozinc SLGS protocol.

But ECID (Every Cat is Different) and they don't follow the rules in our protocols. They keep us guessing.

That+9 is late for a nadir with Prozinc. A bit unusual. But try testing at +6 or +7 some cycles if you are able to, and you may find that Nathan is dropping even lower at those times. Don't know if that is a possibility for you, to test at those times. Work and family responsibilities take up a lot of our time these days.
 
Deb & Wink said:
Technically, Nathan has not reached a reduction point in the dose, as his BG levels have not fallen below 90 mg/dL. But with the food change happening at the same time, it's safer to reduce the dose for now. Plus, he has been awfully close to that 90 BG that is an automatic reduction per the Prozinc SLGS protocol.

But ECID (Every Cat is Different) and they don't follow the rules in our protocols. They keep us guessing.

That+9 is late for a nadir with Prozinc. A bit unusual. But try testing at +6 or +7 some cycles if you are able to, and you may find that Nathan is dropping even lower at those times. Don't know if that is a possibility for you, to test at those times. Work and family responsibilities take up a lot of our time these days.
Click to expand...

Thank you very much.

We will do the BG curve tomorrow on Thursday and test every 2 hour. Hope We can find that Nadir.
 
Update 05/28/2020
Hello ladies,

I just did a BG curve today, and caught a nadir as 83.

I plan to talk to the vet about reducing the dose tomorrow. So what should be the new dose? 1.75u or 1.5u?

I do plan to decrease the dry food on 05/30/2020 from 20g to 10g daily. And totally off the dry food on 06/03/2020.

My feeding schedule now is as following:

AM shot time
AM +5 hour (If I test, I test before feeding)
AM +9 hour (If I test, I test before feeding)
PM shot time
PM +4 hour (If I test, I test before feeding)

Thank you all for giving me advice. I appreciate any suggestion.
 
Did you shoot 2.0U, as per the spreadsheet? I'm sorry no one has gotten back to you. I believe that the 83 you got today earned Nathan a reduction of 0.25U, all on its own. With the continued removal of dry food, I'd definitely be as conservative as possible.

Going forward, I don't think I'd shoot more than 1.5U if it were me, but definitely wait for Prozinc people to weigh in on this!
 
That BG reading of 83 at +4 today 5/28/20 is an automatic dose reduction of 0.25U, per our SLGS Prozinc protocol. Any reading <90 mg/dL should be treated the same way. Reductions should be taken at the next dosing cycle.

I see you still gave Nathan 2U of insulin. At least according to your SS you did.

The insulin dose should be no more than 1.75U, 1.5u would be preferable, since you are still decreasing the dry food.

Let's keep Nathan safe and reduce that dose ASAP. Please don't wait to hear from your vet, don't wait until you have completed the food change. Don't wait until Nathan has a hypo and you need to rush him to an emergency vet. Please make that dose reduction now. Please. Let's keep Nathan safe.

If you gave Nathan the 2U, you'll want to monitor a bit more this evening. He dropped almost 200 points after this mornings insulin dose. That is A LOT to drop so fast. Please get at least a +2 to see where Nathan's BG levels are headed. If lower than the pre-shot, then you'll want to test at +4 also.

p.s. Nan replied as I was still typing an answer.
 
Nan & Amber (GA) said:
Did you shoot 2.0U, as per the spreadsheet? I'm sorry no one has gotten back to you. I believe that the 83 you got today earned Nathan a reduction of 0.25U, all on its own. With the continued removal of dry food, I'd definitely be as conservative as possible.

Going forward, I don't think I'd shoot more than 1.5U if it were me, but definitely wait for Prozinc people to weigh in on this!
Click to expand...

Thank you very much. Yes I gave him 2u as PM shot.

I will test at +2.5 hour and +5 hour tonight.
 
Deb & Wink said:
That BG reading of 83 at +4 today 5/28/20 is an automatic dose reduction of 0.25U, per our SLGS Prozinc protocol. Any reading <90 mg/dL should be treated the same way. Reductions should be taken at the next dosing cycle.

I see you still gave Nathan 2U of insulin. At least according to your SS you did.

The insulin dose should be no more than 1.75U, 1.5u would be preferable, since you are still decreasing the dry food.

Let's keep Nathan safe and reduce that dose ASAP. Please don't wait to hear from your vet, don't wait until you have completed the food change. Don't wait until Nathan has a hypo and you need to rush him to an emergency vet. Please make that dose reduction now. Please. Let's keep Nathan safe.

If you gave Nathan the 2U, you'll want to monitor a bit more this evening. He dropped almost 200 points after this mornings insulin dose. That is A LOT to drop so fast. Please get at least a +2 to see where Nathan's BG levels are headed. If lower than the pre-shot, then you'll want to test at +4 also.

p.s. Nan replied as I was still typing an answer.
Click to expand...


Thank you very much. I will start 1.5U from tomorrow.

I will also test at +2.5 hour and +5 hour tonight.
 
Deb & Wink said:
That BG reading of 83 at +4 today 5/28/20 is an automatic dose reduction of 0.25U, per our SLGS Prozinc protocol. Any reading <90 mg/dL should be treated the same way. Reductions should be taken at the next dosing cycle.

I see you still gave Nathan 2U of insulin. At least according to your SS you did.

The insulin dose should be no more than 1.75U, 1.5u would be preferable, since you are still decreasing the dry food.

Let's keep Nathan safe and reduce that dose ASAP. Please don't wait to hear from your vet, don't wait until you have completed the food change. Don't wait until Nathan has a hypo and you need to rush him to an emergency vet. Please make that dose reduction now. Please. Let's keep Nathan safe.

If you gave Nathan the 2U, you'll want to monitor a bit more this evening. He dropped almost 200 points after this mornings insulin dose. That is A LOT to drop so fast. Please get at least a +2 to see where Nathan's BG levels are headed. If lower than the pre-shot, then you'll want to test at +4 also.

p.s. Nan replied as I was still typing an answer.
Click to expand...

Just tested at +2.5 hour. First We got 333! We then tested again, and got 287.

Is it unusual?

I am very sure I gave him 2u and it wasn't a fur shot.
 
Meters are allowed to vary from test to test. This is known as "meter variance" and can be different by as much as 15 to 20% from one test to the next, and still be considered to be accurate.

So that 333 and 287 are within 15% of each other. Still about the same "range". We don't focus strictly on the exact BG number in most cases, but look for numbers within a range if you do a retest.

Do you understand?
 
Deb & Wink said:
Meters are allowed to vary from test to test. This is known as "meter variance" and can be different by as much as 15 to 20% from one test to the next, and still be considered to be accurate.

So that 333 and 287 are within 15% of each other. Still about the same "range". We don't focus strictly on the exact BG number in most cases, but look for numbers within a range if you do a retest.

Do you understand?
Click to expand...

Thank you so much. Got it. So is it normal that +2(or+2.5) reading is higher than the pre-shot reading?

I will test at +5 or +5.5 hour to see how BG changes.
 
Cats have a built in protective mechanism, that causes their BG levels to rise due to hormones and extra sugars dumped into the bloodstream. We call that reaction "bouncing". A bounce can take 3-6 cycles to clear. That "lower than your cat is used to" BG level is the trigger for the bounce. The low does not need to be low enough to be concerned with hypoglycemia, to cause a cat to bounce.

Here's a quote for you that gives a good explanation of bouncing.

"Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles)."

Chris has said this many times about the +2 BG reading, with some additional notes by me specific to Prozinc or another in-and-out type insulin.

The +2 is like an "early warning" for most cats!
If the +2 is about the same as the PS, it's usually a pretty normal cycle...dropping down to nadir and then rising back up again.
If the +2 is higher than the PS, that usually signals a bounce, and those are the cycles when you can usually take a break from testing.
If the +2 is lower than the PS, that's your "Early warning" that kitty might be going much lower later in the cycle so it's important to plan on getting another test or two (or 6) in.

It doesn’t work every time or with every cat. But it does hold true most of the time, so keep this in mind for next time.

With Prozinc by Deb & Wink

More than a number range, think of the percentage of the drop at +2, that may tell you if your cat is going to drop much lower. Think of that +2 as being an indicator of what direction the BG levels may be headed.
With Prozinc, if you see a 40%, 50% or greater drop, between the pre-shot and that +2, that's a serious heads up warning.
If you see a 20-25%, 30% drop, not quite so worrisome. But still be cautious.

Your cat drops 2 color ranges between pre-shot and the +2, pull out your hypo kit and plan on staying up to test.
Your cat drops 2 color ranges between pre-shot and the nadir, that is to be expected. But you don't want the drop to be much more than 50% between pre-shot and nadir with Prozinc.
Cats tend to bounce high if the drop is 50% or more from pre-shot to nadir.
So you steer those mid-cycles with food, to slow down the steep drop and stop the bounces from being too high.

It's a balancing act.
 
Deb & Wink said:
Cats have a built in protective mechanism, that causes their BG levels to rise due to hormones and extra sugars dumped into the bloodstream. We call that reaction "bouncing". A bounce can take 3-6 cycles to clear. That "lower than your cat is used to" BG level is the trigger for the bounce. The low does not need to be low enough to be concerned with hypoglycemia, to cause a cat to bounce.

Here's a quote for you that gives a good explanation of bouncing.

"Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles)."

Chris has said this many times about the +2 BG reading, with some additional notes by me specific to Prozinc or another in-and-out type insulin.

The +2 is like an "early warning" for most cats!
If the +2 is about the same as the PS, it's usually a pretty normal cycle...dropping down to nadir and then rising back up again.
If the +2 is higher than the PS, that usually signals a bounce, and those are the cycles when you can usually take a break from testing.
If the +2 is lower than the PS, that's your "Early warning" that kitty might be going much lower later in the cycle so it's important to plan on getting another test or two (or 6) in.

It doesn’t work every time or with every cat. But it does hold true most of the time, so keep this in mind for next time.

With Prozinc by Deb & Wink

More than a number range, think of the percentage of the drop at +2, that may tell you if your cat is going to drop much lower. Think of that +2 as being an indicator of what direction the BG levels may be headed.
With Prozinc, if you see a 40%, 50% or greater drop, between the pre-shot and that +2, that's a serious heads up warning.
If you see a 20-25%, 30% drop, not quite so worrisome. But still be cautious.

Your cat drops 2 color ranges between pre-shot and the +2, pull out your hypo kit and plan on staying up to test.
Your cat drops 2 color ranges between pre-shot and the nadir, that is to be expected. But you don't want the drop to be much more than 50% between pre-shot and nadir with Prozinc.
Cats tend to bounce high if the drop is 50% or more from pre-shot to nadir.
So you steer those mid-cycles with food, to slow down the steep drop and stop the bounces from being too high.

It's a balancing act.
Click to expand...

Thank you so much for the information.
Many thanks to you.
 
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