Need dosing advice.

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Sev

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I am using Prozinc and moved up to 1.5 units on the the 24. The vet wanted 2.0.
Please see the spread sheet.
Unfortunatley with the Thanksgiving holiday I have had a family visiting from out of state and have missed some critical test time. How ever it looks like a distinct pattern is forming. Kitty is ranging from low 500's to low 200's and then back up to the 500's.
I have not been able to do a ketone test as yet.

Thank you.
 
Sue and Oliver (GA) said:
Whoa. Is the 472 right? Without insulin, he came down 100 points at +12?

I have to assume so. I didnt test a second time.
He has now been feed and received his shot.
 
He dropped 100 points in an hour, with no insulin on board? I'm thinking "bad test" maybe?
Sev, future reference. If you see a big drop between +11 and +12, don't feed or shoot, and check again 15 minutes later. His BG needs to be rising before insulin goes in.... If possible, can you get a +2?

Carl
 
Anytime you get a odd number, test again. It would very unusual for him to go down 100 points in an hour at the end of the cycle. If he really did, I am wondering what that would mean.

I was ready to say raise the dose to 2 units, but a potential 100 point drop makes me a little nervous. Let's see what others say.
 
carlinsc said:
He dropped 100 points in an hour, with no insulin on board? I'm thinking "bad test" maybe?
Sev, future reference. If you see a big drop between +11 and +12, don't feed or shoot, and check again 15 minutes later. His BG needs to be rising before insulin goes in.... If possible, can you get a +2?

Carl

I am looking to get to +4 tonight.
Well if I can keep my eyes open. Its good weekend. ;-)
 
So he got 1.5 tonight. Get any numbers you can and we'll look again tomorrow.

I know we are asking you to do a lot on a holiday weekend with company. Just working to keep your boy safe.
 
Sev,
I likewise was ready to say a dose increase seemed to be indicated. I'll hold out for a +2 or +4 test before advising a dose change.

Carl
 
Sue and Oliver (GA) said:
So he got 1.5 tonight. Get any numbers you can and we'll look again tomorrow.

I know we are asking you to do a lot on a holiday weekend with company. Just working to keep your boy safe.

Its not a problem. I have been in and out quite a bit taking family to caverns, fossil museums and such.
 
So what is the consensus on what we are observing?
I am going to attempt to get a fuller range of readings today.
Kitty banged in @474 this morning and received 1.5 units.
 
Sue and Oliver (GA) said:
So he got 1.5 tonight. Get any numbers you can and we'll look again tomorrow.

I know we are asking you to do a lot on a holiday weekend with company. Just working to keep your boy safe.

I cant find that link on testing for ketones.
 
You have given the dose this am, right? So ponder this until this evening.

There are 3 different approaches. No way to tell which one is right or which one will work. It is just not a science, just experiments.

You can raise the dose to 2 units. You are getting some yellows mid cycle. Raising may lower your overall numbers. It could also make the highs higher if it is not what is needed.

You can reduce the dose (down to .5 units) It may be that he is getting too much insulin and is in constant rebound: Rebound This is really the scariest option. If you are going to try this, it would be only for a few cycles and you would need to monitor blood glucose (but more than that - ketones) on a vigilant basis. Lowering the dose if that is not what is needed can expose him to DKA so testing for ketones is imperative. If it is what is needed, you should see some results fairly fast.

Third option would be if neither of the first two gets you results, IMHO. You could try TID dosing - dividing the amount you are giving into 3 doses and giving it every 8 hours to catch the number as it goes up in the cycle, before it gets super high. This is difficult and time consuming. If you are going to try it, I would urge you to post daily over on the PZI forum and get a dialogue going with the people there who are doing it. viewforum.php?f=24 Here is some info on TID dosing: http://binkyspage.tripod.com/BeyondBID.html

I hate this part. We are not vets, Sev. We just know that different approaches have worked for different cats. Kitty is your cat. You have to decide. When you consult your vet, I would take the information on rebound and TID dosing and see what he thinks too.
 
Sue and Oliver (GA) said:
You have given the dose this am, right? So ponder this until this evening.

There are 3 different approaches. No way to tell which one is right or which one will work. It is just not a science, just experiments.

You can raise the dose to 2 units. You are getting some yellows mid cycle. Raising may lower your overall numbers. It could also make the highs higher if it is not what is needed.

You can reduce the dose (down to .5 units) It may be that he is getting too much insulin and is in constant rebound: Rebound This is really the scariest option. If you are going to try this, it would be only for a few cycles and you would need to monitor blood glucose (but more than that - ketones) on a vigilant basis. Lowering the dose if that is not what is needed can expose him to DKA so testing for ketones is imperative. If it is what is needed, you should see some results fairly fast.

Third option would be if neither of the first two gets you results, IMHO. You could try TID dosing - dividing the amount you are giving into 3 doses and giving it every 8 hours to catch the number as it goes up in the cycle, before it gets super high. This is difficult and time consuming. If you are going to try it, I would urge you to post daily over on the PZI forum and get a dialogue going with the people there who are doing it. viewforum.php?f=24 Here is some info on TID dosing: http://binkyspage.tripod.com/BeyondBID.html

I hate this part. We are not vets, Sev. We just know that different approaches have worked for different cats. Kitty is your cat. You have to decide. When you consult your vet, I would take the information on rebound and TID dosing and see what he thinks too.

So its a crap shoot. :-|
I am hoping todays trend line can further clarify the picture.
 
Sue and Oliver (GA) said:
And it might.

Yes, it is a crap shoot. But at least there are options?

At least I am further ahead of the game now than I was a couple weeks ago. I was really hoping to see some stabilization of his numbers. I am finding these pendulum swings a bit worrisome.

Still he is eating well. Water intake is down and holding steady. His coat is nice and glossy. He looks the picture of good health.
 
Good morning everyone,
I wouldn't say a crap shoot. What you have done is established a baseline. You can see pretty consistent patterns on what 1.5 does. My observations....
You are getting a fairly consistent drop.
He seems to nadir around +5 and is climbing back up by +7 or +8.
Every other day, his AMPS is red, then black, then repeat.
He seems to spike at +1 sometimes (could be a food timing issue)
I don't see any obvious bounces, at least none that throw the next cycle out of whack. There aren't an inverse curves that make it appear that the dose is too high.

Sue laid out three courses of action, and explained each in detail. I had thought that maybe the dose was too high, but I'm not seeing data to convince me of that.

So, I think you can narrow it down to two options:

Raise the dose to 2.0, or consider shooting a TID schedule.

A) It looks like there is room for Kitty to go lower safely at nadir. However, if you increase the dose, he might then go through the "liver panic bouncy" patterns. BG goes lower than his body is accustomed to, liver dumps glucose to compensate, and the BG spikes as a result. That happens a lot, drives you crazy, and you just have to put up with it until his liver calms down. Negatives to that - his PS numbers may stay higher for a while, which keeps him above the renal threshold, so ketone testing becomes even more important and you'd want successful tests every day to make sure he's not ketonic. "Progress" would be evident when his PS readings become consistently lower while the nadir remains in the safe zone, at which time you would most likely be able to begin stepping down in dose while keeping the same smiley shape in his curves.
Things you would not want to do - don't react to the "bounces" by thinking he needs more insulin. They bounces just need to be allowed to clear. Upping the dose makes it worse, making the cycle repeat and you end up with chronic rebound.

B) If you decide to go TID, you should definitely start posting in PZI to get the help of the 3? beans that are currently using TID dosing. Gets confusing to BID eyes. Concept is the same, you just do it three times a day instead of two. You also have to probably play with the timing of meals more to try to get the food and the insulin working better together. It can be pretty overwhelming, but some people find it easier to work into their daily routine somehow. If you were to do that today, you would take his daily insulin intake and divide by three, and that becomes your new "starting dose" every 8 hours. Shooting TID would give you less leeway with shot timing. You pretty much have to do it on a strict 8 hour schedule, because otherwise you will see dose overlap and have to tinker with dose adjustments on a smaller scale based on early or late shots.....gets confusing and like I said, overwhelming.

Personally, I would choose option A, but like with everything..... all we can do is suggest and explain. There are no easy answers, no perfect solutions. ECID. What worked for Bob is not going to work for Kitty, and vice versa.
The ultimate choices on everything come down to what you think, and what works for you given your daily routine and "life" outside of managing feline diabetes. And a lot of it has to do with your cat, because the kitties lead on this "dance". All you can do is follow and try not to step on his paws.

Carl
 
I would sit on the 1.5 for a few more days.....he's moving down even more today. If he doesn't snack between now and later, he might go down even more. If we can keep food out of the equation, then we can see how low he goes on this dose today.
 
carlinsc said:
Good morning everyone,
I wouldn't say a crap shoot. What you have done is established a baseline. You can see pretty consistent patterns on what 1.5 does. My observations....
You are getting a fairly consistent drop.
He seems to nadir around +5 and is climbing back up by +7 or +8.
Every other day, his AMPS is red, then black, then repeat.
He seems to spike at +1 sometimes (could be a food timing issue)
I don't see any obvious bounces, at least none that throw the next cycle out of whack. There aren't an inverse curves that make it appear that the dose is too high.

Sue laid out three courses of action, and explained each in detail. I had thought that maybe the dose was too high, but I'm not seeing data to convince me of that.

So, I think you can narrow it down to two options:

Raise the dose to 2.0, or consider shooting a TID schedule.

A) It looks like there is room for Kitty to go lower safely at nadir. However, if you increase the dose, he might then go through the "liver panic bouncy" patterns. BG goes lower than his body is accustomed to, liver dumps glucose to compensate, and the BG spikes as a result. That happens a lot, drives you crazy, and you just have to put up with it until his liver calms down. Negatives to that - his PS numbers may stay higher for a while, which keeps him above the renal threshold, so ketone testing becomes even more important and you'd want successful tests every day to make sure he's not ketonic. "Progress" would be evident when his PS readings become consistently lower while the nadir remains in the safe zone, at which time you would most likely be able to begin stepping down in dose while keeping the same smiley shape in his curves.
Things you would not want to do - don't react to the "bounces" by thinking he needs more insulin. They bounces just need to be allowed to clear. Upping the dose makes it worse, making the cycle repeat and you end up with chronic rebound.

B) If you decide to go TID, you should definitely start posting in PZI to get the help of the 3? beans that are currently using TID dosing. Gets confusing to BID eyes. Concept is the same, you just do it three times a day instead of two. You also have to probably play with the timing of meals more to try to get the food and the insulin working better together. It can be pretty overwhelming, but some people find it easier to work into their daily routine somehow. If you were to do that today, you would take his daily insulin intake and divide by three, and that becomes your new "starting dose" every 8 hours. Shooting TID would give you less leeway with shot timing. You pretty much have to do it on a strict 8 hour schedule, because otherwise you will see dose overlap and have to tinker with dose adjustments on a smaller scale based on early or late shots.....gets confusing and like I said, overwhelming.

Personally, I would choose option A, but like with everything..... all we can do is suggest and explain. There are no easy answers, no perfect solutions. ECID. What worked for Bob is not going to work for Kitty, and vice versa.
The ultimate choices on everything come down to what you think, and what works for you given your daily routine and "life" outside of managing feline diabetes. And a lot of it has to do with your cat, because the kitties lead on this "dance". All you can do is follow and try not to step on his paws.

Carl

I'm going to have to go with A. I wont have the schedule to be able to do B. Contracting work does not provide for set daily schedules.

A question then.
Since I have been easing him into the changes of dosage would getting .3 U-40 syringes be of any benefit in preventing insulin dumps?
 
Since I have been easing him into the changes of dosage would getting .3 U-40 syringes be of any benefit in preventing insulin dumps?

Not sure I understand the question.....
Are you using u100 syringes with u40 insulin right now?
(probably been over this before, but there are so many kitties and so many threads to keep up with!)
and what is meant by "insulin dumps"?
Carl
 
Nice on the 168, and super on no ketones!

Looking at the 168, I think I would hold off on upping the dose today. Let's see how his cycle plays out.

Carl
 
Hope + (((Baby)))GA said:
I would sit on the 1.5 for a few more days.....he's moving down even more today. If he doesn't snack between now and later, he might go down even more. If we can keep food out of the equation, then we can see how low he goes on this dose today.

I would concur after seeing the 198 and especially the 168 so far today.

Carl
 
carlinsc said:
Since I have been easing him into the changes of dosage would getting .3 U-40 syringes be of any benefit in preventing insulin dumps?

Not sure I understand the question.....
Are you using u100 syringes with u40 insulin right now?
(probably been over this before, but there are so many kitties and so many threads to keep up with!)
and what is meant by "insulin dumps"?
Carl

Sorry. I meant liver dumps.
Gradation is at .3 units rather than 1.0 units. I could further refine the dosage and move up by 1/3 of a unit at a time.
Treat it like a drug addiction and slowly increase the dosage so that the body will accommodate the change with less stress.
 
carlinsc said:
Hope + (((Baby)))GA said:
I would sit on the 1.5 for a few more days.....he's moving down even more today. If he doesn't snack between now and later, he might go down even more. If we can keep food out of the equation, then we can see how low he goes on this dose today.

I would concur after seeing the 198 and especially the 168 so far today.

Carl

Ah damb.

I gave him about tablespoon of as a reward. It was Merrick BG.
 
Nice mid cycle numbers. Time to revise.

So today's cycle "may" indicate that he takes a long time to settle into a dose. (Usually 3 cycles and you see some movement) That is good information to have. The question now is whether he bounces back up into blacks for preshot. (This would not be good - it feels really lousy to go from 160 to 500 within a cycle.) I agree with staying with the dose a little longer and seeing if he bounces and if the bounces clear.

Never a dull moment!
 
Oh,
Pretty sure that the ".3" doesn't have anything to do with how the scale is gradated.... the .3 indicates the total volume of the syringe, which would be .3cc/ml. The scale probably runs from 0 to 30 units, in .5u increments.
For instance, my syringes say .5cc 29g x 1/2" which is a half cc total capacity, 29 gauge needle that is a half inch long. The scale is only in whole units, and the max dose on the scale is 20 units.
The only hash marks you'll see on an insulin syringe are whole unit or half unit marks. If your insulin is u40, you can achieve more accurate "micro" dosing by using u100 syringes, but then you need to use the u40-u100 conversion chart to make sure you have the dose right.

The more accurate and consistent the dose is, the better results you should see. But I've not seen anyone who can completely avoid the liver action glucose dumps that I can recall anyway. That just seems to be a part of the dance.
Carl

Sev, don't worry about the food you just fed. Kitty needs to eat. As long as we know the food is there, we can account for it when looking at the curve. No problems.
 
carlinsc said:
Oh,
Pretty sure that the ".3" doesn't have anything to do with how the scale is gradated.... the .3 indicates the total volume of the syringe, which would be .3cc/ml. The scale probably runs from 0 to 30 units, in .5u increments.
For instance, my syringes say .5cc 29g x 1/2" which is a half cc total capacity, 29 gauge needle that is a half inch long. The scale is only in whole units, and the max dose on the scale is 20 units.
The only hash marks you'll see on an insulin syringe are whole unit or half unit marks. If your insulin is u40, you can achieve more accurate "micro" dosing by using u100 syringes, but then you need to use the u40-u100 conversion chart to make sure you have the dose right.

The more accurate and consistent the dose is, the better results you should see. But I've not seen anyone who can completely avoid the liver action glucose dumps that I can recall anyway. That just seems to be a part of the dance.
Carl

Sev, don't worry about the food you just fed. Kitty needs to eat. As long as we know the food is there, we can account for it when looking at the curve. No problems.

Ok. Got it.

Just read 165.
 
Nice numbers - a later nadir. Wonder if he does take 5 days to settle into a dose or if he was really stressed with the company or did anything change with food today?
 
Sue and Oliver (GA) said:
Nice numbers - a later nadir. Wonder if he does take 5 days to settle into a dose or if he was really stressed with the company or did anything change with food today?


I have about a 20min gap between the AMPS reading and feeding.
Got side tracked ushering out family.
 
That food change shouldn't make a big difference. Wonder if he was more stressed than you thought over the holiday. Cats stressed at the vet can have readings 100-200 points higher than at home.....
 
Sue and Oliver (GA) said:
That food change shouldn't make a big difference. Wonder if he was more stressed than you thought over the holiday. Cats stressed at the vet can have readings 100-200 points higher than at home.....

I didnt think so. Hes a pretty laid back cat.
 
Sue and Oliver (GA) said:
Nice numbers - a later nadir. Wonder if he does take 5 days to settle into a dose or if he was really stressed with the company or did anything change with food today?

You know you may be right. I was looking over the numbers. Notice the first day and todays numbers vs those in between.
 
If only they could talk and tell us how they REALLY feel.....

It wouldn't be unheard of to take 5 days to settle into a dose, but it is unusual.
 
Sue and Oliver (GA) said:
If only they could talk and tell us how they REALLY feel.....

It wouldn't be unheard of to take 5 days to settle into a dose, but it is unusual.

+11 was 294.
8 hours below 300 has got to be good. yes?
 
U-100 means 100 units per mL
U-40 means 40 units per mL

If you use U-100 syringes with U-40 insulin, the ProZinc dose = U-100 syringe marking * 0.40

ProZinc Dose of 0.4 = U-100 syringe mark of 1.0 * 0.40
ProZinc Dose of 0.6 = U-100 syringe mark of 1.5 * 0.40
ProZinc Dose of 0.8 = U-100 syringe mark of 2.0 * 0.40
ProZinc Dose of 1.0 = U-100 syringe mark of 2.5 * 0.40

and so on.
 
Sev said:
Sue and Oliver (GA) said:
If only they could talk and tell us how they REALLY feel.....

It wouldn't be unheard of to take 5 days to settle into a dose, but it is unusual.

+11 was 294.
8 hours below 300 has got to be good. yes?

Yes, any hours under 300 is good. 8 hours is great.

Carl
 
carlinsc said:
Sev said:
Sue and Oliver (GA) said:
If only they could talk and tell us how they REALLY feel.....

It wouldn't be unheard of to take 5 days to settle into a dose, but it is unusual.

+11 was 294.
8 hours below 300 has got to be good. yes?

Yes, any hours under 300 is good. 8 hours is great.

Carl

Well PMPS bumped to 375. However he was about 10 min into eating.
 
375 is good. It's the lowest PS reading on the SS. A good day for Kitty!
Carl
 
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