Need advice ASAP: ProZinc dose, high BG #s

[Robin&BB]

Hi, I'm Robin in northern AZ - new to your Board and pretty unnerved this morning, so need some input from your experienced membership re: ProZinc dosing parameters for my 10-yr.-old (normally feisty) girl, Bat-Bat.

Some background: She'd been in remission since 10.04.13, after just under 2 mos. TR using Lantus + low-carb diet (low-carb ever since). Her return to full-blown diabetic state appeared quite suddenly 5 days ago, with vomiting of golden liquid afternoon of 2.24.15 & again at 4 am on 2.25 - w/little appetite for either dinner 2.24 pm or breakfast on 2.25 (< 1/2 usual ration eaten). Most unusual for her! Alpha Trak2 tested 475 BG at 10 am on 2.25, so went to the vet, where he got a 426 BG.

Vet's testing also showed high WBC, anemia; and in urine, 4+ glucose & 1+ Ketones. He suspcts UTI, so rx'd Orbax 1x/daily, which I gave @ 3 pm after getting a tiny amt. of food in her. He told me she's "…critically ill & prognosis is guarded, so we'll see how the next 7 days go" and that if she were not such a fractious cat, he'd have hospitalized her. But given how badly she reacts in-office, he feared stress would make her worse. Vet had given her 2U ProZinc at 1:30 pm (she hadn't eaten since 8 am). She had to be gassed, as usual, with Isoflurane (<15 min) for the comprehensive exam, as she'll tolerate NO one touching her except for me. (Feral rescue @ 1 mo. of age; has issues with humans!)

She'd lost all bladder control on way home in her carrier - sopping wet up to armpits - & was both groggy and limp. I hosed her down in shower (so sick she just sat there w/no fuss), gently dried her off & spoon fed her a little. Unsure whether she was not throwing off the gas effect in her weakened state or had really gone hypo, gave a tiny amount of syrup and watched her carefully. He'd told me to give her 1U at 7pm if not eating, 2U if she ate, but could NOT get her to eat. As she was still extremely groggy/ weak all night, I didn't dose her at all (too petrified that I'd put her in a coma).

Since then, her appetite has slowly returned, and as of yesterday and this morning is quite good - Bat-Bat's enthusiastically eating close to full ration at am & pm meals. BUT … I'm having trouble getting her dose right. I've attached a list re: the BG #s I'm getting. Vet had me reduce her ProZinc to 1U yesterday am, but her +3, +6 and PMPS BG #s were so high (see below), that I raised it to 1.5U that night. Was dismayed to get AMPS BG @ 490 today, so after she ate 4.25 oz. low-carb food, bumped her back up to 2U. Plan to test her at 3+ and 6 + again today to see if that's working. Do you think that 2U shot was a prudent choice? (I'm starting to suspect that - although he put her on a 12-hr. dosing schedule - Pro Zinc isn't lasting a full 12 hrs. in her system.) My vet's office no longer does on-call, so can't reach him again until tomorrow morning. I'd be so grateful for any advice you can offer! Thank you so much. I have listed her BG #s & dosages, etc. below (NOTE: Had just 3 strips left until Friday; had to make those few last, hence the less-than-optimum testing first 2 days.)

Date BG/ time ProZinc/ time Pre-Shot Amount Eaten
2.25.15 485/ 10:29a n/a 2 oz.
2.25.15 426/ 12:55p 2.0 / 1:30 p @ vet's 1 oz. @ home, post-inj.
2.26.15 522 AMPS/ 7:31a 2.0 / 8:45a 2.5 oz.
2.26.15 no strips left! 2.0/ 8:45p 3+ oz.
2.27.15 165 AMPS/ 8:30a 2.0/ 8:45a 4 oz.
2.27.15 +6 = 198/ 2:35p n/a ---
2.27.15 443/ 8:45p 2.0/ 8:48p 4 oz. (tested BG after food; stupid!)
2.28.15 124 AMPS/ 7:48a ---- 4 oz. finished 8:42a
2.28.15 117 AMPS #2/8:09a ---- ---
2.28.15 172 AMPS #3/8:42a 1.0/ 9:07a - instructed to reduce dose by vet based on #s
2.28.15 +3 = 287 n/a
2.28.15 +6 = 265 n/a
2.28.15 509 PMPS/ 8:18p ---
2.28.15 524 PMPS #2/ 8:35p 1.5/ 8:45p 4.5 oz. by 8:35 p
2.28.15 +3 pm = 492/ 11:42p n/a ---
3.01.15 490 AMPS/ 7:43p 2.0/ 8:10a 4.25 oz. by 8:10a
3.01.15 +3 am = 435 ---- ---
3.01.15 +7 = 349

Bat-Bat will remain on antibiotic Orbax for a 20-day course, once daily.
Two thing of note:
1) Her food consumption increased (4+ oz both am/pm) to much nearer what she should have starting Fri 2/27, and her #s were good until that night, when I accidentally ck'd BG after she's begun eating. Both shots that day were 2U.
2) Those low AMPS #s yesterday were what caused vet to reduce by a unit, so shot 1U that morning after she ate 4 oz . But I think maybe that was too big a redux?

So I did up it to 1.5U on my own that night (noting high 200s at +3 & +6$ but her BG has remained in the mid -to-high 400s & low 500s ever since, except for last BG +7 posted above. Frustrating, as I know the 1.5u I gave this morning was a good shot. (All have been.). As it's still high, do you think I should go to 2U tonight, or wait until I can ck with vet tomorrow morning? She is sleeping aost all the time between meals ... Worries me, esp. considering the 1+ ketones found in her urine at vet on Wednesday.

 

[Sue and Oliver (GA)]

It's hard for me to figure out. When you have time, I hope we can get your numbers in a spreadsheet. It'll be a much clearer picture. If you want help setting it up, I can set you up with one and email it to you. Just start a conversation with me (same as private message)

Early on she seemed to do too well on 2 units, often giving you a pre shot number too low to shoot. This might have been related to her not eating well/feeling well. Is she still on the antibiotic and do you think she is feeling better? Having an infection can certainly impact the numbers upward as can some antibiotics.

Instead of going back up to 2, you could try 1.5 and see what the numbers look like? It seems like one unit could be too little and maybe 2 units too much?

Have you seen our ProZinc protocol. It might be useful.

http://www.felinediabetes.com/FDMB/threads/protocol-for-prozinc-pzi.109077/

 

[Grayson & Lu]

Are you testing for ketones at home? Any chance that your vet gave fluids?

 

[Mitzelplik's Mom]

Hi Robin,
I don't feel like I have enough experience to offer much in the way of advice but for what's worth, I had a similar thing happen with Mitz's numbers recently. She had a UTI, numbers went way up from vet visit stress and I had a hard time getting them to even out for a while. Mitz was on a 14 day antibiotic and my vet thought that was what kept her numbers higher for a time. It's taken about a month, but the numbers are getting much better. I'd be inclined to stick with 2 units with those higher numbers but I'm not using a sliding scale myself. I've learned with Mitz, I can give her normal dose at pre-shot numbers that are usually considered much too low to shoot and it has actually paid off. But, every cat is different...

Sending you and BatBat good thoughts and hope she starts feeling better very soon!

Joan

 

[Robin&BB]

It's hard for me to figure out. When you have time, I hope we can get your numbers in a spreadsheet. It'll be a much clearer picture. If you want help setting it up, I can set you up with one and email it to you. Just start a conversation with me (same as private message)

Early on she seemed to do too well on 2 units, often giving you a pre shot number too low to shoot. This might have been related to her not eating well/feeling well. Is she still on the antibiotic and do you think she is feeling better? Having an infection can certainly impact the numbers upward as can some antibiotics.

Instead of going back up to 2, you could try 1.5 and see what the numbers look like? It seems like one unit could be too little and maybe 2 units too much?

Have you seen our ProZinc protocol. It might be useful.

http://www.felinediabetes.com/FDMB/threads/protocol-for-prozinc-pzi.109077/

Yep, I read that one; too bad there's not one out there that's similar to the Lantus protocol out of AU. That was such a blessing when we went through our first go-round with diabetes in 2013!

 

[Robin&BB]

Hi Robin,
I don't feel like I have enough experience to offer much in the way of advice but for what's worth, I had a similar thing happen with Mitz's numbers recently. She had a UTI, numbers went way up from vet visit stress and I had a hard time getting them to even out for a while. Mitz was on a 14 day antibiotic and my vet thought that was what kept her numbers higher for a time. It's taken about a month, but the numbers are getting much better. I'd be inclined to stick with 2 units with those higher numbers but I'm not using a sliding scale myself. I've learned with Mitz, I can give her normal dose at pre-shot numbers that are usually considered much too low to shoot and it has actually paid off. But, every cat is different...

Sending you and BatBat good thoughts and hope she starts feeling better very soon!

Joan

Thanks, Joan - Is reassuring to know somebody else went through a similar experience w/ UTI & high #s & resolved it. I finally saw a 349 BG at +7 today, but may stick with the 1.5 just for tonight (if we're not back up near 500s by shot time in an hour), but I suspect the vet will want her back up to 2U tomorrow. Maybe I'm just expecting too quick a turnaround based on my earlier experience with Lantus back in Aug 2013. Perhaps it takes longer with Pro Zinc. And we didn't have a UTI going back then, either.

 

[Robin&BB]

Are you testing for ketones at home? Any chance that your vet gave fluids?

I don't think he gave her fluids, but he did test for ketones: She was at 1+. That's why I've been a bit panicky with the high #s since vet had me drop her dosage a full unit down to 1.0 on Saturday. Gosh, I just realized that in my earlier reply to Joan, that i said I was sticking with 1.5U, when in fact I bumped her up to 2U this morning already, which is what I'll give her again tonight. Looks like I'm getting a little punchy from too little sleep these last few days. Duh, no wonder I saw a drop to 349 BG at +7 today That's some better, right? Testing for keytones at home with her is not possible. She won't allow it, nor will she tolerate any litter but pine pellets. Cranky one, my old girl is!

 

[Carl & Polly & Bob (GA)]

Hi Robin,
I don't know what "+1 ketones" means, but ketones scare the hell out of me. My guy Bob was DKA right after he was dx'd.

Yep, I read that one; too bad there's not one out there that's similar to the Lantus protocol out of AU. That was such a blessing when we went through our first go-round with diabetes in 2013!

There is a protocol similar to what I assume you are referring to as the Roomp/Rand or U of Queensland Lantus Tight Regulation protocol. Nobody here, however, follows it or has lots of experience with it.
Dr. Elizabeth Hodgkins developed a TR protocol for PZI a decade or more ago, and it has been modified for use with Prozinc since the old PZI is no longer available.
There are two other FD forums that I am aware of that use the Hodgkins TR protocol. I don't know a whole lot about them but at one time I joined both of them years back.
Diabetic Cat Help and Diabetic Cat Care are the sites.
I just wanted you to be aware of the options...

Carl

 

[Robin&BB]

Hi Robin,
I don't know what "+1 ketones" means, but ketones scare the hell out of me. My guy Bob was DKA right after he was dx'd.



There is a protocol similar to what I assume you are referring to as the Roomp/Rand or U of Queensland Lantus Tight Regulation protocol. Nobody here, however, follows it or has lots of experience with it.
Dr. Elizabeth Hodgkins developed a TR protocol for PZI a decade or more ago, and it has been modified for use with Prozinc since the old PZI is no longer available.
There are two other FD forums that I am aware of that use the Hodgkins TR protocol. I don't know a whole lot about them but at one time I joined both of them years back.
Diabetic Cat Help and Diabetic Cat Care are the sites.
I just wanted you to be aware of the options...

Carl

Thanks, Carl. Yes, it was the Queensland TR protocol I used as a guide when she was on Lantus in 2013. May talk with my vet about transitioning her over Lantus (after we've eradicated her UTI) if we continue having trouble regulating her BG with the Pro Zinc.

 

[Carl & Polly & Bob (GA)]

I used a sliding scale with Bob, which is a part of the Hodgkins protocol, but I only gave two shots a day. I believe the TR for Prozinc allows for TID dosing in some cases. I found it pretty aggressive, and it wouldn't have been an option for me because of my work schedule. Luckily, BID along with the scale worked for Bob and he went OTJ after 10 weeks.

 

[Sue and Oliver (GA)]

There is a protocol similar to what I assume you are referring to as the Roomp/Rand or U of Queensland Lantus Tight Regulation protocol. Nobody here, however, follows it or has lots of experience with it.
Dr. Elizabeth Hodgkins developed a TR protocol for PZI a decade or more ago, and it has been modified for use with Prozinc since the old PZI is no longer available.
There are two other FD forums that I am aware of that use the Hodgkins TR protocol. I don't know a whole lot about them but at one time I joined both of them years back.
Diabetic Cat Help and Diabetic Cat Care are the sites.
I just wanted you to be aware of the options...

Carl

Hi Robin,

Just wanted to emphasize the part by Carl that no one on this forum uses that protocol, is very familiar with it, or in my case, supports it. It suggests that you can dose at low numbers every 6-8 hours and that the cat will never hypo if they are on wet food. I find those ideas dangerous. We do have/have had cats getting shot every 8 hours if they are in higher ranges, but only with careful monitoring and after it is clear the insulin is not lasting long enough in that cat. But it isn't something I would suggest to someone new to the insulin and with a cat who has an active infection likely raising their levels.

Checking for ketones is vital. Our Oliver would never pee when we were in the room. We filled a clean box with aquarium gravel and left him alone. He had to christen the clean box. Then we'd swoop back in and get a sample, as it wouldn't be absorbed.

 

[Elizabeth and Bertie]

Just wanted to emphasize the part by Carl that no one on this forum uses that protocol, is very familiar with it, or in my case, supports it. It suggests that you can dose at low numbers every 6-8 hours and that the cat will never hypo if they are on wet food. I find those ideas dangerous.

Seconding what Sue said.

I did follow the Hodgkins protocol with my diabetic cat Bertie early on in his diagnosis.
Back then (early 2007) there were a few Hodgkins people here at FDMB, and one of those took me under her wing.
There is a 'belief' amongst Hodgkins folks that a cat on a low carb wet diet cannot hypo. It simply isn't true. (I wish it was true!)
Whilst on the protocol my cat - on a very low carb wet diet - suffered a hypo. And when I said to other Hodgkins folks that this had happened the response I got was that I was either mistaken (I wasn't), or that he had eaten some high carb food (he hadn't).
There are some really nice and well-meaning people on those forums, but the reassurance about hypo needs to be taken with a very hefty 'pinch of salt'...

Eliz

 

[Grayson & Lu]

I've not been on the other groups referenced above, but have seen a kitty from there dosed on Lantus or Levemir with a sliding scale. We don't encourage that. The L's operate best with consistent dosing. ProZinc gives a little more flexibility for 11/13 or 10/14 dosing, as well as a sliding scale. Not sure about BCP PZI... I think there is some carry-over, but again, not experienced with that.

 

[Robin&BB]

I've not been on the other groups referenced above, but have seen a kitty from there dosed on Lantus or Levemir with a sliding scale. We don't encourage that. The L's operate best with consistent dosing. ProZinc gives a little more flexibility for 11/13 or 10/14 dosing, as well as a sliding scale. Not sure about BCP PZI... I think there is some carry-over, but again, not experienced with that.

Sue, Carl, Grayson & Lu & Elizabeth - Thank you all very much for your wisdom! I'm used to TR, but agree that sliding scale would be dipping into dangerous waters. Bat-Bat responded fantastically to Lantus under the Queensland TR protocol 8/9/13 Dx, OTJ 10/4/13); however, she didn't have a UTI, trace ketones & anemia as complications back then. (The tricky bit back in 2013 on Lantus was transitioning her from high-carb Hill's w/d, rx'd by vet at start, down to low-carb Purina d/m while still OTJ.)

As Pro Zinc is new to us, I'd rather be conservative in my approach.

After horribly high #s (worst was 524!) after vet-directed redux on Sat. a.m. to 1.0, I inched her back up from 1.5 Sat. night to 2.0 on Sunday and have stayed with 2.0 since. Am happy to report I got an AMPS today of 322; 200 3 hrs later & 173 at 7 hrs. post-shot. So looks like maybe she's settling in at that dose. She's bright-eyed and responsive (although still sleeps a lot) so I am hoping we're turning a corner now & that the antibiotic is doing the trick on her UTI. She is back to normal on water intake, too. Thank you all for your guidance - really helped me through a stressful weekend! Sue kindly put together the spreadsheet for me, which I've updated, but I don't know how to post it here yet. (Duh ... I'm kind of an IT idiot.)

 

[Robin&BB]

Hi Robin,

Just wanted to emphasize the part by Carl that no one on this forum uses that protocol, is very familiar with it, or in my case, supports it. It suggests that you can dose at low numbers every 6-8 hours and that the cat will never hypo if they are on wet food. I find those ideas dangerous. We do have/have had cats getting shot every 8 hours if they are in higher ranges, but only with careful monitoring and after it is clear the insulin is not lasting long enough in that cat. But it isn't something I would suggest to someone new to the insulin and with a cat who has an active infection likely raising their levels.

Checking for ketones is vital. Our Oliver would never pee when we were in the room. We filled a clean box with aquarium gravel and left him alone. He had to christen the clean box. Then we'd swoop back in and get a sample, as it wouldn't be absorbed.

Ha! We tried EVERYTHING during her 1st DB dx in 2013: Different litter, aquarium gravel, you name it: She wouldn't go near the litterbox until I refilled it with pine pellets. Won't let me get near her when she's peeing, either. Bat-Bat is what the vets politely call "...a fractious cat." So I measure her water consumption every 12 hrs. & watch carefully for onset of any symptoms of ketoacidosis. So far, so good.

 

[Sue and Oliver (GA)]

Much better! Glad she is feeling more like herself and that her numbers are better! It often takes a couple weeks for people to see improving numbers - it's like it takes a while for their bodies to adapt to the insulin and "learn" how to use it.

There are some litters that are supposed to be just for ketone readings. And there are meters that will use blood to give you a ketone reading. (Precision Xtra and NovaMax) The strips are really expensive but you would only have to use them once a week or so.

 

[BJM]

Since she has experienced ketones in the past, and ketones show up in the urine 5 days after they show up in the blood, it would be worth it tho have a blood ketone to use if she ever seems lethargic or 'off', isn't eating well, and the glucose is running in the high 200s or more. Do regular dehydration checks, too. (See my signature link Secondary Monitoring Tools for those and additional assessments you may wish to track.)

 

[Robin&BB]

Since she has experienced ketones in the past, and ketones show up in the urine 5 days after they show up in the blood, it would be worth it tho have a blood ketone to use if she ever seems lethargic or 'off', isn't eating well, and the glucose is running in the high 200s or more. Do regular dehydration checks, too. (See my signature link Secondary Monitoring Tools for those and additional assessments you may wish to track.)

Thanks for the links! I am measuring her water intake every 12 hrs. Spoke with the vet yesterday to see what level 1+ ketones is; she told me that's just a trace. But I'll be careful about watching her closely, too - & will think seriously about blood ketone monitoring. Right now I'm just trying not to stress her out any more than I must, given how often I've been pricking her with lancets and needles, and forcing the antibiotic liquid down her throat every day. (See seems to be slowly feeling a little better every day.)

 

[Sue and Oliver (GA)]

We got the PrecisionXtra meter free with strips. You might see if any of the drug stores have a deal. It would mean an extra prick, but not that often. And real peace of mind.

Glad she is feeling better. Remember that any time spent below the renal threshold is a good thing and gives her pancreas the chance to heal. We think the threshold is in the -250 range and you are seeing some numbers there midcycle.

 

[Grayson & Lu]

Much better numbers. Hang in there!

 

[Robin&BB]

We got the PrecisionXtra meter free with strips. You might see if any of the drug stores have a deal. It would mean an extra prick, but not that often. And real peace of mind.

Glad she is feeling better. Remember that any time spent below the renal threshold is a good thing and gives her pancreas the chance to heal. We think the threshold is in the -250 range and you are seeing some numbers there midcycle.

Will look into getting this ketone meter tomorrow morning! Wasn't very happy with her midcycle #s today; was hoping they'd be a bit lower.

 

[Robin&BB]

Much better numbers. Hang in there!

Thanks for the encouraging word, Lu. Just updated her sheet tonight, and we've held at 2 units for 3 days, as of shot I gave tonight. Wondering if I should bump the dose up a little in the morning ... hmm. (Best midcycle # I've seen was yesterday at +7 = 173.)

 

[Sue and Oliver (GA)]

I think you could increase. I'd just be sure I could check her nadir that first cycle. The 173 was nice but she has room to drop.

 

[Robin&BB]

Definitely will check nadir tomorrow; I'm thinking I'll go to 2.5 in the morning - should I be checking her BG more often with a dose increase? Such as cking at +2 in addition to +4 & +6 or 7? Not like I want to do a full curve this early on, but I want to make sure she stays in the safe zone. I wouldn't be fretting so much about repetitive ear pricks if she weren't already dealing with anemia. And speaking of that, is there anything anyone you know here has done to help resolve anemia; i.e., vitamin supplement, etc? Or does that usually resolve once DB is better controlled?

 

[Sue and Oliver (GA)]

No experience with anemia. You might post with that particular question on Health.

If you feel cautious, a +2/3 will give an idea of how the cycle will go. A 5/6 should let you see how low the dose took her.

 

[Robin&BB]

Numbers getting better with 0.5 dose increase today - first time we've had two blue zone #s in one day!

 

[Sue and Oliver (GA)]

Looks like a good day!

 

[BJM]

The amount of blood used in testing is negligible - about 3-5 microliters.

 

[Elizabeth and Bertie]

is there anything anyone you know here has done to help resolve anemia; i.e., vitamin supplement, etc?

Hi Robin,

Did your vet say what the cause of the anemia is? There's different types of anemia and the treatment (if any) may depend on the cause and the severity.

My CRF foster kitty had mild anemia when he first came to us, and I started supplementing his diet with B vitamins.
B12 and B9 (folic acid) are thought to be particularly helpful. (Foster kitty's anemia has now resolved.)

I think there are some folks here whose vets have given their kitties B12 shots.
But if supplementation seems appropriate then you could consider Zobaline, a methyl B12 supplement made for cats, which also contains folic acid.

You may find that the B12 perks Bat-Bat up a bit, and it might increase her appetite also.

As Sue said, it could be a good idea to post on the main health forum to get some other eyes on your question and, hopefully, some other suggestions.

It's nice to see Bat-Bat in those better BG numbers.

Eliz

 

[Grayson & Lu]

grayson took zobaline... help w his mobility n leg strength (neurapathy). he had severe non-regenerative anemia from the eosinophilic leukemia, and had a transfusion. . how low is ihs hematocrit?

 

[Robin&BB]

Thanks for your input on the anemia, everyone. Yes I think I'll post on the main health forum after I call vet's office tomorrow to find out what type of anemia he suspects she has; will let you know what I find out. Appreciate your tips re: B vitamins & Zobaline, Elizabeth & Lu - will ask him about that, too. Bat's hematocrit on 2/25 was 14.7%. I just now looked back at her blood work from her 1st DB dx in 2013 (a different vet, up in Colorado), and she was anemic then, too - but far less so (25.1%). Hmm, makes one wonder if this is, in fact, the non-regenerative type. The vet down here in AZ didn't really say much about it except for "...she's really anemic," but he seemed more concerned with the DB & UTI last week when I saw him. (He told me, at the time, that he wasn't sure she was even going to survive the next 7 days, either - so maybe that's why he didn't go into it with me?)

 

[Robin&BB]

Hurray! Bat's first time in the GREEN on Pro Zinc: 87 @ +4. Maybe will hold the dose for a couple more days to see if her BG keeps dropping some, overall, at 2.5.
(P.S. Still waiting on vet re: more anemia info.)

 

[Robin&BB]

E

Hi Robin,

Did your vet say what the cause of the anemia is? There's different types of anemia and the treatment (if any) may depend on the cause and the severity.

My CRF foster kitty had mild anemia when he first came to us, and I started supplementing his diet with B vitamins.
B12 and B9 (folic acid) are thought to be particularly helpful. (Foster kitty's anemia has now resolved.)

I think there are some folks here whose vets have given their kitties B12 shots.
But if supplementation seems appropriate then you could consider Zobaline, a methyl B12 supplement made for cats, which also contains folic acid.

You may find that the B12 perks Bat-Bat up a bit, and it might increase her appetite also.

As Sue said, it could be a good idea to post on the main health forum to get some other eyes on your question and, hopefully, some other suggestions.

It's nice to see Bat-Bat in those better BG numbers.

Eliz

Hi again, Elizabeth - Vet believes her anemia is regenerative, & agreed that a B12 supplement should help make her perkier/ help resolve the anemia more quickly. Her appetite is very good --- esp. since her BG #s are beginning to head downward. Is actually "talking" again when the alarm goes off at AMPS/ PMPS BG ck. time ... because she knows food with follow!

 

[Sue and Oliver (GA)]

Hurray! Bat's first time in the GREEN on Pro Zinc: 87 @ +4. Maybe will hold the dose for a couple more days to see if her BG keeps dropping some, overall, at 2.5.
(P.S. Still waiting on vet re: more anemia info.)


Lovely! That was a nice cycle with no bouncing!

 

[Robin&BB]

Hurray! Bat's first time in the GREEN on Pro Zinc: 87 @ +4. Maybe will hold the dose for a couple more days to see if her BG keeps dropping some, overall, at 2.5.
(P.S. Still waiting on vet re: more anemia info.)


Lovely! That was a nice cycle with no bouncing!

Hi, Sue - Looks like you spoke too soon ... am I correct in assuming this a.m. # is a bounce? Dang!

 

[Sue and Oliver (GA)]

That'd be my guess. Darn. That 69 was the lowest she has seen and it could have dropped lower later. Still nice numbers overall.

 

[Mitzelplik's Mom]

Hi Robin,
FWIW, I'm finding that it takes Mitz 3 or 4 days to adjust to a change in dose. I'll try to update her SS tonight so you can take a look. Glad you're starting to see better numbers!

Joan

 

[Robin&BB]

Hi Robin,
FWIW, I'm finding that it takes Mitz 3 or 4 days to adjust to a change in dose. I'll try to update her SS tonight so you can take a look. Glad you're starting to see better numbers!

Joan

I don't know if you'd been watching my newer thread (PMPS 83 after bouncing); I was used to Lantus, and some of the others who are very experienced with ProZinc, helped me understand that this one hits her system differently. After our bounce this past weekend (looks like 2.5 was too much for her), it seems that her dose changes need to be a bit more incremental than what the vet had me starting out doing. Since we're coming out of a UTI, too, my main concern right now is keeping her out of the 250+ range so that she's not at risk for spilling glucose into her urine again. So am happy to see her numbers going to back to yellows for AMPS/PMPS & blues around the nadir. While I'd love to see lots more green-zone, I just need to be patient - I know she'll get there eventually.

Will look forward to peeking at your updated SS (don't see all that many other AlphaTrak2 users here). Is your kitty anemic, too? Where did you get your Zobaline supplement & how's that working for Mitz?

 

[Mitzelplik's Mom]

Hi Robin,
OK, Mitz's SS is now updated thru yesterday. I have a 2nd tab called AlphaTrak Color Coding to more accurately reflect what's going on in the blue and green ranges. I learned from other members here that the green zone for AT actually goes up to about 134 and blue to about 234, so that's what I based mine on. And using those ranges, some of Bat's lower blues are technically greens

Mitz is not anemic but she did have a UTI in January. I'm giving her a small daily dose of D-Mannose as a preventative and so far so good. I get the Zobaline from Lifelink.com. It's helping. After about 3 or 4 weeks she was clearly walking more normally, not so low down on her back feet.

Joan

 

[Grayson & Lu]

I asked about a transfusion when G's hematocrit was about 22. They said not bad enough to justify it. I think it was 16 when they finally thought it was low enough. He had a LOT of other stuff going on (mass the size of a coke can, mottled spleen, and eosinophils in liver & blood, as well as mass). His eosinophils were as much as 80x the normal range... The chemo drug that is used for sickle cell anemia in humans, hydroxyurea, was given along with prednisolone. Not sure which was the cause, but he started to experience skin tears the day of his transfusion. A friend's mom had similar reaction to chemo + pred ...

If the transfusion is an option, you may wish to consider it. It helped G a lot, in spite of other circumstances. But keep in mind that any of those other infections could probably be affecting that number as well. There are also some medical options - don't remember the names right now, but maybe someone else will know.

Just a side note - I got a copy of each bloodwork result, and have them in Grayson's binder. It saved me asking the vet 20 questions - I could put the numbers in a spreadsheet and see the changes over time.

 

[Robin&BB]

Thanks for this, Joan. I was actually wondering about that a few days back, as I'd heard read in more than a few veterinary articles that there's a significant difference in BG reference ranges between human glucometers and AlphaTrak.

Hi Robin,
OK, Mitz's SS is now updated thru yesterday. I have a 2nd tab called AlphaTrak Color Coding to more accurately reflect what's going on in the blue and green ranges. I learned from other members here that the green zone for AT actually goes up to about 134 and blue to about 234, so that's what I based mine on. And using those ranges, some of Bat's lower blues are technically greens

Mitz is not anemic but she did have a UTI in January. I'm giving her a small daily dose of D-Mannose as a preventative and so far so good. I get the Zobaline from Lifelink.com. It's helping. After about 3 or 4 weeks she was clearly walking more normally, not so low down on her back feet.

Joan

Thanks for this, Joan. How did you do that 2nd tab on the spreadsheet? Sue (above) kindly plugged all my early #s into a sheet & set it up. (I'm a real spaz with spreadsheets, so any tips you can provide would be helpful.)

The difference in BG reference ranges between human glucometers and the Alpha Trak2 was something I'd read about in several veterinarians' articles - it's really great that you have a separate page coded for Alpha Trak's calibration.

 

[Robin&BB]

I asked about a transfusion when G's hematocrit was about 22. They said not bad enough to justify it. I think it was 16 when they finally thought it was low enough ... If the transfusion is an option, you may wish to consider it. It helped G a lot, in spite of other circumstances. But keep in mind that any of those other infections could probably be affecting that number as well. There are also some medical options - don't remember the names right now, but maybe someone else will know.

Thanks, Lu! Will keep that in mind, for sure.
Our vet here didn't seemed deeply concerned about Bat's anemia, even with that really low HCT # --- said he's fairly confident it will resolve once the UTI's cleared & we get her diabetes back under control. But I won't hesitate to have a transfusion administered if he feels it's needed.

Bat is exceedingly hard to treat in office/hospital. The vet's primary concern for now is to keep her on an even keel/as calm as possible; he knows that she totally freaks out when she's not in her own environment. He said he doesn't want her stressed any more than is absolutely necessary. Bat's a really strange cat - I've never had another one like her. I can poke her with needles 10 times in a day & she's as quiet as a mouse ... but she literally has to be knocked out for anyone else to handle her. Why? I have no idea. (You should have heard her when the vet gave her that 1st ProZinc injection in-office 2 weeks ago: She was screaming & howling so loud, & fighting him SO hard ... it sounded like two tomcats on a backyard fence at midnight, trying to kill each other! )

 

[BJM]

If you right click on the tab at the bottom of the spreadsheet, you can either duplicate the page (if you wanted to set up for another year, for example) or you can add a new sheet and format it as you desire.

 

[Sue and Oliver (GA)]

BJ, how would she do this if the spreadsheet is a World version, which already has the tab set up for the second World page? Long story - bad jet lag when I set up the spreadsheet. Somehow I thought she was overseas.... Robin has only been using the first page as she doesn't need the world version. Should I just start over?

 

[BJM]

If she is entering the data on the US page and not on the World page, just delete the World page.
Use undo if something goes whacko (the curved arrow icon pointing left, or Ctrl-Z)

 

[Grayson & Lu]

Sometimes it takes a little bit for the kitty to get used to having insulin. Then there's also that learning curve (for me, getting enough blood for a test; for others, fur shots). Looks like you've mastered all of them and Bat Bat is looking GREAT!!! I know it's a little scary when you see the mid-greens, but as long as they're still safe (above 50 at nadir IMHO), you've got a dream SS! I would stick with this dose unless/until you start seeing too much action or too soon. You're at the point where it's fine-tuning. Hopefully this will remain a good dose for her. But keep in mind, sometimes the pancreas starts working part-time (or full-time), so keep your dancing shoes handy.

 

[Robin&BB]

Sometimes it takes a little bit for the kitty to get used to having insulin ... You're at the point where it's fine-tuning. Hopefully this will remain a good dose for her. But keep in mind, sometimes the pancreas starts working part-time (or full-time), so keep your dancing shoes handy.

Thanks for your words of encouragement, Lu! BJ put together a new spreadsheet for me - I will be switching that one over to my signature (hopefully tomorrow, if I do it right!) because it reflects the BG#s in true AlphaTrak reference ranges. (Ex: On AT, hypo range starts at <69) So that will really help me a lot, as I'm not good at doing the conversion thing in my head where her numbers are concerned.

After 3 days of Bat heading into hypo zone mid-cycle, she didn't go there at all today! So I'm feeling relieved. Will definitely keep those dancing shoes handy, though!

 

[Mitzelplik's Mom]

Thanks for this, Joan. I was actually wondering about that a few days back, as I'd heard read in more than a few veterinary articles that there's a significant difference in BG reference ranges between human glucometers and AlphaTrak.

Thanks for this, Joan. How did you do that 2nd tab on the spreadsheet? Sue (above) kindly plugged all my early #s into a sheet & set it up. (I'm a real spaz with spreadsheets, so any tips you can provide would be helpful.)

The difference in BG reference ranges between human glucometers and the Alpha Trak2 was something I'd read about in several veterinarians' articles - it's really great that you have a separate page coded for Alpha Trak's calibration.

Hi Robin,
Here are the instructions I got a while back from Rachel (Thanks again, Rachel!) and it worked perfectly:
Mitzelplik's Mom said: ↑
Rachel, how did you add the new tab? I can't figure out how to do that. Spreadsheets are not one my talents
Click to expand...
I understand! I was a Literature major, so as you can imagine numbers and I go together like oil and water! Do you see a tab at the bottom of your spreadsheet? (It might be named Sheet1 or Numbers.) Right-click on that tab and select Duplicate. That will create a new tab with the duplicated sheet, named something like "Copy of Sheet1"; you can right-click on that tab to rename it "AlphaTrak Color Coding" if you want. Once you've done that, you should see an exact copy of your original sheet. Then you can change the coloring like so: 1) click the cell you want to change (say it's that blue 101 Mitz had on 2/7 and you want to make it green), 2) go up to the menu at the top of the sheet and select Format, 3) select Clear Formatting (which will clear the blue coloring and right-align the number in the cell), 4) click the little "Fill color" icon that looks like a pitcher and choose the correct green. Voilà! (If you're OCD like me, you'll want to center the number in the cell, which you can do with the "Horizontal align" icon, three over from the "Fill color" pitcher.) There's probably a way to automate this, but again, I'm not a spreadsheet guru and this works well enough for me! Let me know if you get stuck.
OTJ 14 Jan 15
FF Classics/Weruva • Lantus (TR) • AlphaTrak 2 • Henry's SS
ramonaghan, Feb 20, 2015 Report