Modified ProZinc Method - Feeding times?

Sam&Penny

Sam&Penny

Member
Hi All,

I am looking to get Penny started on the Modified ProZinc Method.

(We spent the last 3 weeks attempting a sliding scale, +8 dosing - this led to a lot of unpredictable BG values)

I had questions about feeding times. The sticky states "multiple small meals a day", she currently gets 4 - 1.5oz meals (6am, 11am, 5pm, 10pm). Will this feeding schedule work with a 6am/6pm dosing pattern or is the 5pm feed too close and I will looking at a food spike?

Thanks for your help!
 
Hello and welcome to the ProZinc forum. You have found out what usually is the case, that a sliding scale usually produces bouncing and wild unpredictable variations in blood glucose. Which of your spreadsheets is current and which meter are you currently using? It’s very important for is to know the nadir or how low a particular dose is taking your cat, so we will need to have some mid-cycle tests. I would be very happy to help you with your Penny’s dosing and progress.
 
Do you have spreadsheet data of what’s been going on recently— there’s a big gap on your spreadsheet for the weeks prior to today.
 
I have added to my signature "Sliding Scale SS" this is what I was using for the past 3 weeks while on the sliding scale. I'm not sure if there is a way to convert it into the FDMB version, but I'd be happy to give it a try. I will be using the "Penny New SS" going forward. She got her last sliding scale dose this evening. She was previously on 0.6u in 12hr dosing, so that is where I plan on starting her out.

I am using the Contour Next One meter. Switched over from the AlphaTrak based on the advice found on FDMB.

My goal in starting the modified ProZinc method was to get +3, +6 and +9 as much as possible in these early days and when those are not possible at least a test between +4 and +7. So far Penny has found nadir some time around then, depending on the dose.

Thank you so much for your help! Please let me know what other information you need from me. I will hanging out with Penny all weekend as we get this new routine sorted.
 
I do think I am probably getting way ahead of myself to be asking on the second day of Penny's transition back to 12hr dosing but, I wanted to ask your advice on dosing for a situation like I just had,

187/10.4 @ +12, so I decided to stall and see if she would come over 200/11.1 to be able to give her a full dose.

I tested at +12.5 and she ended up at 266/14.8 and therefore she got a full dose (0.6u).

Was this correct or should I have not stalled and given a reduced dose considering she was above 150/8.3?
 
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Sam&Penny said:
I do think I am probably getting way ahead of myself to be asking on the second day of Penny's transition back to 12hr dosing but, I wanted to ask your advice on dosing for a situation like I just had,

187/10.4 @ +12, so I decided to stall and see if she would come over 200/11.1 to be able to give her a full dose.

I tested at +12.5 and she ended up at 266/14.8 and therefore she got a full dose (0.6u).

Was this correct or should I have not stalled and given a reduced dose considering she was above 150/8.3?
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There’s nothing wrong with stalling (without feeding) to see if kitty is coming up in numbers— as long as your schedule will allow for it. Another approach is to give a reduced dose— as long as you can monitor and gather data to see if the reduced dose is the right amount or too little or too much.
 
Are you giving small meals/snacks at +2, +4 and possibly later? It’s helpful to have the small low carb mini meals early in the cycle — to stabilize BG in the cycle.
 
At the moment we feed at
6am with a dose
11am (+5)
5pm (dose at 6pm)
10pm (+4)

All equal amounts of food. The cats are both pretty flexible with it all. Could easily move feeding to coincide with +3.

Would you recommend that the +3 feedings be smaller meals or is keeping it all equal amounts still okay?
 
Well we can hopefully adjust feeding times as the numbers dictate. For many cats, ProZinc tends to onset (begins to lower BG) at about +2 so that is why I recommend feeding at +2. We can look at the numbers and when things begin to dip and adjust snack times accordingly? If you are willing/able. It can be individualized to the cat.
 
You had a very nice cycle last night. Good job getting those tests. I don’t understand the .8 dose in the a.m. cycle though. If her regular dose is .6 then we should stick with that— or else you are back to the sliding scale again.

I definitely would like to see the meals moved up a little earlier. We can see from the SS that the ProZinc is definitely starting to onset by +2 (or a little earlier) so some food at that time would help. Some of the drops in BG are a little too steep.
 
Sorry about the 0.8u. Old habits die hard. I was worried because she was so high through the previous cycle. She’s post DKA. So I am very fearful of getting back into high sugars.

I will adjust her feeding to get a meal around +2.

My husband typically works from home, but has to be in the office most of the time until the end of May. I can get home Monday's and Tuesday’s to get a +6 test in. But expect a few gaps in Penny’s data until May. That’s when he’ll be home much of the week and we can really get after our closest monitoring.
 
I am sorry about the DKA. I know what that is like. It’s good that you’re doing MPM now then. We should be able to adjust her doses every 6 cycles if it looks necessary and if we have enough data to make sure it’s safe. I am actually very encouraged by how much green she’s had on the .6 dose — so for right now we would not increase her dose anyway because of those green nadirs.
 
You should be testing for ketones. I purchased a blood ketone meter after my boy had his DKA and spent a week in 24 hour emergency care. If you already are testing for them, you could make an additional column on Penny’s spreadsheet to record the ketone readings.
 
Suzanne & Darcy said:
You should be testing for ketones. I purchased a blood ketone meter after my boy had his DKA and spent a week in 24 hour emergency care. If you already are testing for them, you could make an additional column on Penny’s spreadsheet to record the ketone readings.
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I have the urine test strips for keystones. I don’t test with any regularity, only if she has spent a longer time than expected over 13mmol/L. Do you have a suggested interval?
 
I’ve adjusted Penny’s feeding times. We now feed at
6am +dose
8am +2
11am +5
6pm +dose
8pm +2
11pm +5

so far seeming like the initial drop is blunting a bit and maybe not getting quite as low as previous.

My read is that she is due for a dose increase in the near future. Let me know what you think or if we need to watch at this dose for a little longer.
 
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Thanks. She needs a little longer on the .6 dose because she hasn’t had the full six cycles on the .6 dose. Also, she has had some green nadirs so we generally hold the dose a little longer. Let’s at least give her tonight and tomorrow to see how it goes. Okay?
 
No tests during the day today, unfortunately we both worked away from home today.
Let me know what you think about increasing her dose. We are going away (with Penny) for the long weekend and would like to get any changes started before we leave on Saturday morning.
Thanks for your help!
 
I always used to take Darcy with me on trips. He actually loved the trips once we got there.

So you will be able to test Penny while y’all are on your trip?
 
You just increased to .8 units last night. We need to hold the .8 dose for a minimum of 6 cycles before considering what her nadir is on .8 and whether she needs additional time on that dose or if she is ready for an increase to 1 unit.
 
I would be cautious about increasing too quickly. You already had some green nadirs on the .6 dose, and with a green nadir we normally hold the dose a little longer than 6 cycles before increasing (even when following MPM.) I know she was in yellow last night, but that doesn’t mean she’s going to stay in yellow on this dose. We don’t know how low she dropped yesterday, but it definitely would have had an influence on the p.m. cycle. I am optimistic for how she will do on this dose — I just want to make sure we don’t rush the process and end up with a lime green or just wacky swinging numbers. You are both doing great (and I know it’s not always easy when you’re both working on the same day. You did great to get those tests last night!
 
And last minute cancellation of plans, my Dad got a cold so we will be home for the holidays. But yes, the plan was to test while we were away. My parents have other animals so we always find that our cats get stressed moving from our quiet house with just the two of them, to my parents place with 2 more cats and 2 dogs. Do you find that the stress caused by something like that alters the test results much? This is our first trip with Penny since her diagnosis.

I will start the 6 cycle timer on the 0.8u and see where this takes her.
 
Sam&Penny said:
And last minute cancellation of plans, my Dad got a cold so we will be home for the holidays. But yes, the plan was to test while we were away. My parents have other animals so we always find that our cats get stressed moving from our quiet house with just the two of them, to my parents place with 2 more cats and 2 dogs. Do you find that the stress caused by something like that alters the test results much?

I will start the 6 cycle timer on the 0.8u and see where this takes her.
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In some cats we really do see an increase in numbers with stress like that.
I am sorry your father is ill. I hope he will be better soon.
 
Any thoughts on how the 0.8u is going? I’m a little disappointed that I haven’t seen any green with this increase.
 
It is disappointing, isn’t it. I think this dose needs to be held another cycle or two so we can better what is going on. Last night was a fur shot, so that kind of interrupted things. I am wondering if Penny is going to have a late nadir again today and be in the blue at PMPS.
 
Is there a reason for the late nadir? or all just part of the wonkiness of working towards regulation?

Is there anything more we could be doing to move closer to normal curves?
 
Penny hasn’t been on insulin for that long. She was probably diabetic for quite a while before she was diagnosed and it can take time to reach regulation. Late nadirs can occur when a bounce is breaking. Some cats are very regular about their nadir and others have nadirs that move around.
 
I'm getting worried about polyphagia in Penny. She is has always been happy to get her food but the last 2 days have been extreme. She keeps trying to get into the sink to lick any dishes in there. Also seen a fewer higher volume pee clumps today. Anything I can do about this?
 
At what point does she seem most hungry? In the morning and evening? When is she eating? At what hours in the cycle? Is she getting enough calories? Unregulated diabetic cats are frequently very hungry. Is she underweight?
 
She’s usually eager to eat but this is up a level and I am sensitive given that she hasn’t been getting very low lately and I’m still carrying the DKA trauma.

She seems most hungry before her big meals. But she was just in the sink licking dishes right after her 6pm meal today.

She is fed at
6am +12 - 1.5oz
8am +2 - 0.7oz
11am +5 - 0.8oz
6pm +12 - 1.5oz
8pm +2 - 0.7oz
11pm +5 - 0.8oz

Another 0.25 oz of treats when she gets her doses.

In total she gets 6oz of Tiki cat wet food + treats.
I think that gets her to about 170-190 cals/day.

Her weight is good. She was maybe a little overweight leading up to her diagnosis. In her 4 day hospital stay she came down a bit and I’d like to be able to maintain this weight. She is looking really good.
 
I think you should increase the size of her meals a bit. If a cat is spending time in higher numbers, their body cannot make use of the food for energy very well and they need more calories. When they start getting into better numbers, their appetites usually decrease.
 
I will increase the size of her meals an extra 0.2oz on the big meals and 0.1 on the smalls. That should take the days total from 6oz to 6.8oz.

Unfortunately no tests during the day, both of us working away. However, as long as nothing comes up, my husband will be home for the rest of the week to get in more mid cycle tests.
 
If the +3 is lower than it usually is (lower than yellow) I would test earlier rather than later. If it’s similar to last night then you can test a little later. Sometimes it’s helpful to get different hours— to fill in the spreadsheet like a checkerboard. If you always test at +3 for example then on a different day you might try getting a +4 instead. Or it you usually get a +6 test then on a different day you might try to get a +5 or a +7. Of course, sometimes the numbers will tell you when you need to test.
 
I’m not sure if I’m overreacting, but I am getting very stressed about how high Penny has been through her last few cycles. I’m concerned that her spending this much time in the yellows and pinks could be harming her. Any thoughts on this?
 
I see you increased to 1.2 today. You should have waited the full six cycles to give time to clear any bounce. I know how hard it is to see them in high numbers. Penny was diabetic for a long time probably before her diagnosis, and it can take a few months to get them regulated. I am hoping this 1.2 dose will be better for her. We can increase again after 6 cycles unless she starts to have blue nadirs and then we will hold a little longer.
 
Sam&Penny said:
I’m not sure if I’m overreacting, but I am getting very stressed about how high Penny has been through her last few cycles. I’m concerned that her spending this much time in the yellows and pinks could be harming her. Any thoughts on this?
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And I just want to say that certainly am not dismissing your worries… I really do understand your concern about yellow and pink. Those are not healthy numbers (particularly the pinks and higher yellows) and we want to get her out of them. It’s just that it’s not always safe to increase too rapidly. We will do it as fast as we can while still keeping her safe from hypo.
 
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