need advice about dosing

PatJ

PatJ

Member
Hello everyone and a Happy New Year to you all,

My cat is due for another 3.50 units in 2 hours and at the moment his BG levels are at 10.2. Normally at pre-shot time they are much higher at around at least 16.0 mmol/l and usually 18.0 t o 20.0. but he's only got less than two hours to go before he needs his injection and I'm worried that they won't rise high enough to give him 3.50 units, but I'm no expert, obviously, so I'd be grateful for your advice as to whether it will be safe or not. Thanks in advance.
 
Happy New Year, Pat! :)

You have a few options:
  1. If he's below 11 at PS you can stall for 30 minutes without feeding, retest and if he's rising, give the usual dose. You can repeat the stall once more if needed. You have about an hour's flexibility with ProZinc. Test at +2 to see where he's heading.
  2. If you aren't able to stall and he's not above 11, try a slightly reduced dose like 3.25 u or 3.0 u.
  3. Skip his shot. This is the least desirable option.
You can post again in 2 hours if you're still unsure.
 
Happy New Year to you and Teasel!

Sorry to sound a bit thick, but when you say give the usual dose if it rises above 11 does that mean it's OK to give the full dose at 12.0? Just want to make sure I've understood properly. Does the hour's flexibility with ProZinc include an hour before as well as after? Sorry to bend your ear like this but there's so much to learn and thanks very much for replying.
 
PatJ said:
Happy New Year to you and Teasel!

Sorry to sound a bit thick, but when you say give the usual dose if it rises above 11 does that mean it's OK to give the full dose at 12.0? Just want to make sure I've understood properly. Does the hour's flexibility with ProZinc include an hour before as well as after? Sorry to bend your ear like this but there's so much to learn and thanks very much for replying.
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No, not thick at all! It takes a long time to learn all this stuff! Yes, you can try the full dose at a BG of 12 mmol/L (I'm Canadian so I use those units). You'll have to eventually and you need to learn his responses in a variety of dosing situations. We usually suggest testing at +2 if you do anything a bit different or new. That +2 test can be a good predictor of what the cycle might look like - more below.

The hour's flexibility is a total, not an hour before and an hour after. It's a handy characteristic of this insulin because sometimes your schedule dictates a change. The reason is that ProZinc *usually* lasts about 12 hours in most cats so there isn't *usually* a lot of dose overlap.

How a +2 test can help:
  • if that BG is higher than the PS the cycle will probably be uneventful, ie., no dramatic drop - good to know if you want to sleep that night!
  • if it's about the same as the PS test again at +3. If there's a big drop then feed a small snack of regular low carb food to try to steer the BG away from a big drop. If there's no big drop at +3 kitty might want to "surf" - ie., stay close to same BG level for several hours
  • if there's a significant drop (5 mmol/L or more) feed a small snack of LC food because the kitty might be planning a dive. Test again at +3 to see what's going on. You *might* have a sleepless night ahead if this happens in the evening.
 
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Thanks so much for the information. I'm just going to test his BG now so fingers crossed that it's gone up. Have taken all on board that you've told me. Going to test in 2 hours and I really appreciate your help. Thanks!
 
I see that he bounced right back up there for PMPS. You might want to bump him up to 3.75 u tomorrow. I'm focusing on the lows in suggesting that. Some bouncy kitties will often have very high PSs even if the middle cycle numbers are better. Teasel was like that on ProZinc. He's still bouncy but flatter on Lantus.
 
Thanks, Kris for suggesting an increase. I gave it to him this morning and see what happens. He does seem to bounce a lot. Do you think that Lantus is better for bouncy cats, because my vet was going to change from ProZinc to Lantus just before Christmas, but the vet who owns the practice said that there was no need to change as there was nothing to choose between them! I must admit, I was a bit disappointed because he doesn't seem to be much lower than when he was first diagnosed at the end of August, but maybe he's just one of those cats that take their time to regulate. I don't know. Anyway, Kris, thanks once again for all your help. It's much appreciated and it's such a relief to know that you and your friends with all your knowledge are there to help us navigate through this horrible diabetic minefield!
 
Yes, Lantus is better for a bouncy cat. Many will continue to bounce but less so and some calm right down. If you've had discussions about it with your vet and are interested in trying it I say go for it. The other vet is wrong about there being no difference - if that's what was meant.

Here's a bit of a comparison:

PROZINC
  • fairly slow and gentle in action
  • usually gone by 12 hours
  • ability to push down BG in the first 2-3 hours can promote bouncing in bounce prone kitties
  • typical curve is a smile shape with the depth determined by bounciness of kitty
  • expensive to use if dose is higher because it's a less concentrated U40 insulin
LANTUS
  • slow and gentle in onset so there's less likelihood of promoting a bounce up at the end of the cycle
  • duration of the dose can exceed 12 hours so you can have dose overlap that helps to keep BG more level
  • typical curve is much flatter (but bouncers are rarely typical!)
  • pricey up front but can be cheaper in the long run because it's a more concentrated U100 insulin (can be bought for half the price from a reputable Canadian online pharmacy if your vet provides a prescription). If you're in Canada you can buy Lantus OTC.
  • FDMB has two different VERY clearly laid out dosing methods for Lantus which a big help to new users.
As I said there's no guarantee that William will stop bouncing but he should improve. One downside to Lantus is that it's in an acid base and can sting some kitties as a dose gets bigger. Levemir is a similar insulin in its action but doesn't sting. Levemir will keep many kitties even flatter than Lantus but that wasn't the case for Teasel.
 
Kris, Sorry to bother you again, but I got a bit worried last night about William's BG and ended up not giving him anything because his BG still hadn't reached 11.0 by the time his shot was due, it was 10.6 an hour after it was due, and I know you said to give a reduced dose if it wasn't above 11.0, but I wasn't sure if you meant that it had to be AT 11.0 before you could give a dose.(Hope that's not as clear as mud!) I had to go out this morning so couldn't give a dose too late last night because it had to be the same time this morning and I would have been out. So what I'm asking is, does it have to be at 11.0mmol or can it be a bit less and will 3.75 be all right to give him if it's as low as 11.0? I know you've told me what to do already, but I'm a bit paranoid about overdosing him, and just wanted to check with you if I've understood or not. Thank you
 
PatJ said:
does it have to be at 11.0mmol or can it be a bit less and will 3.75 be all right to give him if it's as low as 11.0?
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Yes, it can be a little bit less. The boundary has fuzzy edges. ;) If he's hovering in around 11 you might want to reduce a little. I suggested 3 or 3.25 u up above in post #2. He has a late nadir as seen on the days with blue - at +8. That can mean that he might give you more chances to try this out in the PM cycle. So much of this is guesswork, learning patterns and being a bit daring when you're home to monitor. Each experiment gives you more data for next time. More experiments = more data = more to look at when making a decision.

You WILL end up at some point steering him through a patch of low numbers. It's scary the first time and unsettling after that but the more you do it successfully the more confident you become in your ability to do what's needed.
 
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Thanks very much for such a quick reply. As long as I know that it's safe to dose him around the three mark if he drops much lower than usual ( which he did last night ). I'm just so afraid of making him ill if I give him too much insulin. I've always been nervous about overdosing him so if he's in the high tens or eleven, I'll just give him a little bit less insulin. If his BG's only at 10.0mmol is it still safe to give him a shot? Thanks for being so helpful.
 
PatJ said:
Thanks very much for such a quick reply. As long as I know that it's safe to dose him around the three mark if he drops much lower than usual ( which he did last night ). I'm just so afraid of making him ill if I give him too much insulin. I've always been nervous about overdosing him so if he's in the high tens or eleven, I'll just give him a little bit less insulin. If his BG's only at 10.0mmol is it still safe to give him a shot? Thanks for being so helpful.
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Yes, you can give insulin at a PS of 10 or so but you might want to reduce a bit at least the first time. If that's uneventful you can try a full dose at 10 some other time. There aren't really any carved in stone rules. It's more about getting to know your cat well.
 
Thanks for that. You might be pleased to know that thanks to taking your advice, he's had his first yellow number EVER for an AMPS!
 
PatJ said:
Thanks for that. You might be pleased to know that thanks to taking your advice, he's had his first yellow number EVER for an AMPS!
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Well, isn't that lovely! :) Get a +2 if you can to see where he's heading.

You can give yourself and his ears a bit of a break if you like:
  • get a +2 if you try something different
  • aim to get at least one test in where you see he generally has his nadir - +4 to +8 for most cats on ProZinc (maybe +5 to +9 for your boy)
  • more tests if he's drifting low
  • one before bed
  • AM/PMPS always.
 
I always feel bad jabbing his ears so often, so we'll both be glad to tone it down a bit. Thanks for the again for the good advice. I do appreciate it.
 
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