Need dosing advice, can't get a steady dose.

Juls and Billy

Juls and Billy

Active Member
Update, we skipped the dose. At +20 minutes it had fallen further, to 147, and he was hungry. We fed him and skipped the dose. I would still like dosing advice. Should we back him down to .75? Should we wait and see? Should we micro-dose if he's under 200?

Billy was diagnosed 12/28, we've been wet food diet from the get go, but slowly lowering carbs. Currently very low carbs. Last night's PMPS was 154, so we skipped dose. This morning's was 243, so we did 1 unit. Tonight we're at 167. He's active, been eating well today, and seems awesome. I just don't know if we should skip again, do a half dose, or a micro dose. I don't like skipping, but I don't want to get him into hypo trouble either. At present, we are not feeding and waiting 20 minutes. Would love some advice by folks that better know what they are doing.

He's on Prozinc, 1 unit, twice a day. We feed many small meals, withhold food 2 hours pre-shot.

Tagging @MrWorfMen's Mom @Bron and Sheba (GA) @Marje and Gracie
 
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I have never used prozinc so don't like to offer an opinion.
Looks like you have decided to skip the shot. Is that correct? as he dropped further.
With 2 skipped shots you may need to reduce the dose so you can shoot both am and pm doses.
Hopefully @MrWorfMen's Mom will be along soon to help you.
Looks like you are doing a great job with Billy!
Marje is away for a week btw.
 
Thanks Bron and Sheba. Lol, I never know who to tag--still getting used to all this. Yes, we skipped the dose, as BGL fell further after our stall and he was yelling at me for food. He heard his Grandma in the kitchen and left me in the dust to go see if she would feed him. So, we skipped, fed, and will keep an eye on him, but he's plenty perky.

My gut reaction is to cut him back to .75 starting tomorrow AM. But I will wait and see what other ProZinc folks recommend.
 
Bron and Sheba (GA) said:
Its fine to tag me or others but for specific prozinc advice it is best to tag someone who has used it. Look on the prozinc page for names
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I started with that, then I tagged you because I saw you were online. I may have freaked out just a little. I know tonight wasn't an emergency, but everything is still so new that I get anxious. We're worried about ketones from skipped doses, but we have a blood ketone meter we can use to check if we need to and he's showing zero signs of distress. In fact, he now purrs when I get the blood testing kit out because he knows he'll get a treat. If only he would stop ducking his head right when I'm about to get that drop on the meter!
 
Juls and Billy said:
I started with that, then I tagged you because I saw you were online. I may have freaked out just a little. I know tonight wasn't an emergency, but everything is still so new that I get anxious. We're worried about ketones from skipped doses, but we have a blood ketone meter we can use to check if we need to and he's showing zero signs of distress. In fact, he now purrs when I get the blood testing kit out because he knows he'll get a treat. If only he would stop ducking his head right when I'm about to get that drop on the meter!
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Itis absolutely fine to tag me if I am online. Even if I can't help, I can maybe suggest something.
It is perfectly normal to freak out especially in the beginning. I certainly did!
Does Billy have a history of ketones?
Having a blood ketone meter is a plus.
 
Bron and Sheba (GA) said:
Does Billy have a history of ketones?
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No, he doesn't. And the last time we had to skip a dose, he was fine. We got the blood ketone meter to be safe and because he is a shy peer. We found that out when he was young and had urinary problems. Never could get a sample at home, no matter what we tried! Any lurking around with spoons and ladles, he won't pee. Any change to the litter box, won't pee. He's my sweet stubborn boy!
 
Actually Billy isn't doing badly at all on the 1u however the fact that you've had to skip 2 doses suggests 1u may be just a wee bit too much. I'd reduce the dose to 0.75u for about 6 cycles provided the pre-shots are shootable numbers (11mmol or 200 US) and BG does not drop much below 90. When you get a little more data collected and understand better how Billy is reacting to the insulin, you can consider reducing the no shot limit a little at a time to further help get his BG down to more normal levels.
 
Thank you, MrWorfman'sMom. I think that sounds like a good plan. His number was up to 336 at PM +7, but I still think .75 might be a good idea, unless I get a crazy high pre-shot reading. I'm not in a hurry to reduce his no shot limit. The one 52 reading we got completely freaked us out, even though he was in no danger at all, lol. When we better know how he'll react, it won't be so scary.
 
Don't be tempted to increase the dose just because Billy has a higher than normal pre-shot. Higher BGs are often from a bounce and increasing the dose on a bounce can be dangerous. Bounces can last several cycles (up to 6) but can clear much sooner and increasing the dose when BG may be on it's way down is not safe especially until you are more familiar with Billy's reactions to the insulin. Dosing should be based on how low a dose drops BG not on how high pre-shots are.
 
I wouldn't have increased on a high pre-test, but I probably would have left the dose at 1 unit, which might have been a mistake, I know. As it is, other than one big reading at PM nadir after his skipped dose, his sugar levels have been yellow and blue. I did a .75 dose at AM, and we'll see where he is at PM dose time.
 
Okay, PMPS was 143, so we skipped his evening insulin for the third day in a row. While I'm thrilled his numbers are coming down, I know he'll do best if he has two doses a day. Considering going down to .5 in the AM. I was planning on waiting 3 cycles, but I wasn't planning on having to skip another dose. Is tomorrow AM to soon to cut down to .5?
 
Yeah, I don't even know what to think of this. Billy is alert, active, and currently gobbling down his post AM test food. (ate entire 1/2 can) We feed him low carb wet food whenever he wants it, and leave him enough at night to free feed until we take it away, 2 hours before AMPS. He ate last night. He's hungry right now. AMPS reading was 105. I had been planning to try a microdose if it was anything over 150, but I'm not even going to do a drop at 105, no matter how much I don't want to skip doses.

Will do a curve today to see if I can catch his nadir.
 
HE's definitely sending you a message he doesn't want the insulin. I agree with skipping this AM.

Nadir refers to the lowest point in the 12 cycles following an insulin shot. Since insulin was not given this AM, there won't be a nadir. You can however try testing about 3 hours post his meal to see if BG has dropped lower at all which indicates pancreas is working better. I'd just do a couple of spot checks rather than a curve today. There won't be a "curve" so to speak without exogenous insulin on board.
 
Numbers started to creep up. Decided to shoot .25 this morning and will do the same at evening dose if Billy's PMPS is high enough. His AMPS was 177, but his mid-cycle numbers were higher than the past couple of days. Will keep a close eye on him, but he's eating like the little piglet he is and is active and alert.
 
Okay, so I did the .25 dose this morning and it was great. Saw some green numbers. Huzzah! Then at PMPS, his BGL was 112, so skipped dose again. Don't get me wrong, I'm loving these lower numbers and glad he is looking like he might get OTJ, I'm just not sure what to do. I know he'd be better off with the same dose every cycle, right? Should I try for a tiny .1 dose, assuming he's reading over 150?
 
This morning we got our first reading in the green on no insulin. It's possible we'll never dose again, but will keep monitoring to make sure this trend continues, and will micro-dose if we're ever high enough.
 
Hi Juls, I simply wanted to make you aware of this.

All the "Sticky" or pinned posts in the Prozinc forum have been updated and there are a couple of new ones.

Highly recommend that everyone using Prozinc or helping those using Prozinc read them thoroughly.

I'll be doing that myself. Been expecting this for some time. Came about a week before I thought it would.
Thanks Marje, and Robert, and especially Djamila for the Modified Prozinc Method. You folks are FANTASTIC!
 
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