New again and struggling. Need help with dosing

Treated my diabetic cat Unkie (GA) in 2003, but details are fuzzy in my memory. I did use the FDMB. The board has grown so much and I may have not chosen the best forum to post, when I selected Feline Health. My threads are *Old Newbie needing dosing help* and How about Starting Over* As I continued to read on the board I think this forum is where I need to be posting. I am following the advice I got and staying with the 2.25 units. I wonder if I should be doing more?

Newman was dx in Nov. 2021. I purchased the AlphaTrak2 meter from the vet and he prescribed Vetsulin 3 units bid, and testing once per day. I started with 1 unit and worked up to one for two 3 unit doses. By Feb. 2022, I thought we weren't making progress and from a friend's advice asked him to change us to Prozinc, for it's gentler nature. The vet has not been very helpful.

I started Newman's Spreadsheet, a few days ago, filling in the history from the start of the switch to ProZinc. It is a great resource and with that visual, it looks to me like I'm not doing something right!

This morning with his BG 175. If I read it correctly one option was to go ahead and feed as usual and test in about 2 hours. I am now just shy 30 minutes for that 2 hour mark. Had similar situation 2 days ago.

I guess I'm asking if those familiar with PZI can look at the spreadsheet and maybe the earlier posts I referenced. What do you think and how do I proceed?

I would be very grateful.

 

The usual recommendation when you have a pre shot number that is lower than you are used to is that you do not feed, but wait 30 minutes and retest to see if the BG is rising or falling.

 

If you did not shoot at all this morning and it’s two hours past shot time then that’s really going to impact the 12 hour cycles since insulin should be given every 12 hours when possible- give or take 30 minutes a day. But it’s not your fault as you are new and being extra cautious— and you should be able to get back on track.

 

I don’t think you are doing anything wrong. I think you need to hold this 2.25 dose for a week and then do a curve.

My recommendation with an AMPS of 175 (after stalling not feeding and retesting in 30 minutes). would have been to shoot the 2.25 dose as long as you were going to be around to test and monitor and have supplies available like karo and medium and high carb foods.

Is there a particular reason why you are using an alpha trak meter? Vet? It makes it more difficult to advise since all of our protocols are written with human meter numbers. The test strips for human meters are much less expensive.

 

Stalling would have been better, but I chose the option to feed and wait two hours and test again.

I am using the AlphaTrak as that was what my vet stocks and there was no option given. I used the OneTouch for Unkie and the AlphaTrak is very similar. Once I made the investment, I thought I would stay with it at least until we get Newman regulated.

Thanks, Suzanne, for your input.

 

What’s his number after 2 hours?

 

At this point (since it’s 2 hours past shot time) I would just skip the morning shot entirely and shoot in the pm. What do you think?

 

P. S. Your Newman is absolutely gorgeous and has such a sweet face! Just thought I would add that. I think you are doing a great job getting up to speed with things. I also appreciate how you are reading the material on the Board and making decisions based on that. You would be surprised how many people don’t read the information here.

 

Sorry… one more thing… I can’t tell from the spreadsheet at the moment, but if you did shoot the 2.25 units 2 hours late then please indicate that on your spreadsheet by putting +14. You can put 453 @ +14 under the AMPS column and then manually color code the background color of that box to red. You could add a note under the comments about how you fed/stalled shot, etc.

 

Does that look right to you? And how do I make it red?
Don't be sorry, I need the help to get it right. I'm older and my tech skills.........well. lol

For instance I just scrolled up the page and see that I hadn't read the earlier comments that you had added. I'll do better. And thanks for the encouragement.

I just figured out how to color!

Oh, and I was lucky to get Newman. He was a stray kitten that had been brought to my vet. I was there at the right time and I adopted him. He's goofy and of course, I love him dearly.

 

And you also figured out how to get all the text into that one cell! See... you can do it. I was just sitting down to the computer to tell you how to color the cells. That's the "fill color" (background color)... sometimes when you start getting numbers in the blues and greens you may need to change the text color (which is the box up at the top that is immediately to the left of the "fill color" icon.) Good job.

How's he doing today so far? For tonight's shot, you can shoot him at 11.5 hours and then you can keep doing 11.5 hours until you get back to your regular shot time. Shot times can be adjusted as much as thirty minutes per day without messing things up too much... so it can be 30 minutes all at once or 15 minutes in the a.m. and 15 in the p.m. Of course, sometimes things can't be helped, like this morning, but under normal circumstances our diabetic cats do much better with those regular 12 hour cycles.

 

How old is Newman? You could add this to your signature so I won't keep asking you.

 

Thanks, I improved the spacing in the signature and because I liked the separations you have in your signature, I made those adjustments.

 

I see that you got a pretty blue number today. That’s very good. Now you will need to hold this dose for 8-10 cycles (unless he drops to a reduction point.)

 

I am planning to test and shoot him as you described, ahead by 30 minutes. He has had most of his evening Fancy Feast, but he tends to be a grazer. Am I correct in thinking that I am supposed to wait for 2 hours after eating to do that pre-shot test?

 

Sorry. I am just getting back on the Board. We suggest not feeding for two hours prior to the PMPS test so that we can be certain that the PMPS number is not influenced (i.e. falsely elevated) by the food.

 

So you will be shooting at 11 hours and 30 minutes after this morning’s shot? What time will that be? I am on Eastern time as well (in Georgia).

 

I am in Southeast Florida so EST also. I shot this morning at 10 am so I am planning to test about 9:15 and shoot at 9:30. He would like to eat again right now but I will withhold. He normally grazes. I guess I have them spoiled.

 

My sister lives outside of Jasper, GA.

 

Well, I was about to say that my brother lives in West Palm Beach (Lake Worth) it was an automatic reaction for me …. but my brother died in January 2019 from ALS. I almost sometimes forget that (I wish). But my sister-in-law and nephews and their wives and kids all live in that area still.

 

Since you got a +6 for him today and it was blue, would you be able to test tomorrow at say +4 for the a.m. cycle? If we can start to fill in more time slots on Newman’s spreadsheet, we can get a better idea of when he first starts to drop and when he nadirs, etc. And for tonight, will you be able to get a test in before bed or set an alarm and try to grab a test sometime this cycle?

 

I'm sorry for your loss. I live in Lantana, just south of Lake Worth. Small world.

 

I will be shooting at 9 am so I should be able to test at 1 pm (+4). I have a therapy appointment in the afternoon but the timing should be okay. I have lymphedema in my lower left leg and when it flares I go for specialized massage therapy to reduce the swelling. It requires 3 visits per week for a month. Results of those treatments last for 6-8 months with compression stocking. Just quickly, I have mobility issues due to arthritis and I have used a wheelchair for the past 5 years or so. Fortunately, I have been able to train Newman to come for preshots and insulin. He actually jumps up on my desk an sits patiently. I can usually get random testing, but if he is under the bed or some other place difficult to reach, I may be out of luck. There are treats and bribes involved. I have been a widow for nearly 15 years, but lucky for me I have my son and 22 year old grandson living with me so they do the heavy lifting! So, you will understand that I am ready and willing, but may not always be able. Thanks for your help. It definitely has reduced my stress level.

I'll be up for a little while, but not sure if I can get another test.

 

Wow. You are dealing with a lot. Your sweet kitty sounds amazing! What kind of treats do you lure him with? And you have another cat? What a blessing to have your son and grandson there! So far, you are off to a very good start with the sugar dance.

 

I had three cats, but Elsa crossed the bridge 1-1/2 years ago, congestive heart failure. I miss her, she was the best.

In addition to Newman, I have Ozzie also adopted from my vet as a kitten. He is a 12 year old tabby. He is nuts. Then there is Minnie. She looks like a little border collie and actually tries to herd the cats! I'm not sure how old she is as there are different estimates. Probably 12-15 years? Minnie follows me everywhere, usually walking under my chair! She thought that up on her own.

I have always had pets in my life, especially cats. I got Minnie when my late husband, Gary passed. Minnie made me more comfortable living alone. Mike and Walker did not move in until about 7 years ago. It just seemed to make sense.

I use Wellness treats and Pure Bites freeze dried chicken. About once a week, I give a few Temptations chicken flavor Hairball Control.

 

So now you have a dog and two cats. That’s nice. I like the sound of Minnie! What a character. She must be good company. And you had a diabetic cat before. How many years ago now?

I have a bunch of cats, no dogs, two kids and a husband. It’s enough. . We frequently have the house full of foster kittens as well.

 

It has been almost 20 years ago that I treated Unkie. He was still young when he passed. The vet suspected he had a pulmonary embolism.

 

That’s so sad.

 

Good morning. Just checking, I am about to test and feed. That will be okay as long as I wait to shoot until 9:00, right?

 

Sorry. Just seeing this now. You shot last night at 9:30, so 9 for this morning was good. I hope your therapy today goes well and Newman behaves for you!

 

I'll check in later when you get back (maybe around 1 pm?)

 

I hope he will be available so I can test at 1 pm, before I go for my appointment.

 

I hope so too! It would be so good to see what's going on at +4. Hopefully, he will respond to the sound of a crinkled Pure Bites bag

 

Okay, I got it and posted. I try to poke the sweet spot, which produces the perfect tiny droplet, but sometimes I get a poke that bleeds much more. There's no problem stopping the bleed, but I must be in the vein. Does it make any difference? Newman only has one good ear, because the other one is quite crinkled from an old hematoma. The edge is gnarly and har

 

Darn. I was hoping for a little more action today.

 

That’s basically flat if you consider that there’s a meter variance of plus or minus 20 percent.

 

It won’t make any difference in the BG reading if it comes from the vein or from a small capillary nearby.

 

I can poke him again as soon as I return. It will probably be 4:30 - 5:00, so +7 to +8. Will that be helpful?

 

Yes.

 

Yeah! Just peeked and see 211. That’s better. See how you are filling in pieces of the puzzle.

 

Just tested for PMPS at 8:30pm closer to usual schedule. The result is 238. This is when I want to reduce the dose from 2.25 units or stall again. What is your advice?

 

Using the spreadsheet, I look back to 3/25/22 where he was at 245 and I shot 2.5 and then getting numbers down to 84. Frankly, I am just too tired to stay up very late tonight to do testing. I have not been getting enough sleep.

 

I am going to see if he will eat more of his Fancy Feast. As I said, he is a grazer, so it takes a while for him to finish. I shot at 9:00 this morning so I have a little time, even though I was aiming for 8:30, tonight.

 

Did you shoot yet?

 

No, he ate about 1/3 can of FF. I was about to test again, just to be sure.

 

He is probably rising, but I would like to make sure. Can you leave food out for him tonight for him to eat if he starts dropping?

 

That won't work, as I would have to confine him or the other cat will eat the food. Newman is not an aggressive eater.

 

That’s a shame. A lot of the time leaving food out at night or using timed auto feeders are some of the techniques we use at night to keep them safe.

 

When the guideline says: Above 200 but below the cat's normal pre-shot value, a reduced dose might be wise. I don't know how much to reduce. I think at this point, maybe just a token dose? Maybe 1 unit?

 

I am holding off on another test, now that I understand the food gives a quick boost but not a long term value.

 

I think one unit is going to set you back quite a bit. You could do a standard reduction of .25 units. Or even.5 unit if it makes feel more comfortable- especially if you are not able to test at all tonight.

 

Low carb food like Fancy Feast pates won’t normally give much of a food bump.
But wait - let me get this straight- the 238 was before eating - and then he ate - and what’s his number?

 

But this is why we say to get a test, if it’s lower than expected you can stall and not feed and retest in 30 minutes.

 

So, that would be 1.5 or 2.0 units. I wish I could feel confident about staying up and testing but I don't.

 

1.75 would be a half unit reduction. 1.5 a little more. If you are too exhausted to test, I understand.

 

Did you get a number after the 238?

 

I tested him at 4:30 (+7.5) when I got home from therapy. He was 211. By 5 pm they were all ready to eat so I fed them. The cats eat about 1/3 can and leave. I cover the bowls until they come back. He gets one can AM and PM, so he was eating on that one can up until 6:30, so that I had two hours until shot time. At 8:30 he was 238 which was 2 hours after eating probably 2/3 of a can.

 

No, 238 was the last test actually between 8:15 and 8:30, anticipating shooting at 8:30.

 

Well, you are in control here and We want to keep Newman safe. Hopefully you shot a reduced dose by now. We will see where he goes from here and it will all be useful data to add to his picture. You’re doing a great job for just starting up and I am pleased with that.

 

Thanks for explaining that.

 

No, I have not shot yet. I guess I will shoot 1.5 units. Thanks for the encouragement and of course the help. I wish things were going better. I do appreciate the visual aid of the spreadsheet!

 

Okay. Thanks. I just thought that since you were uncomfortable with the 238 that you might retest to see if he was rising on his own without food - to help you make up your mind about how much insulin to give tonight.

 

Yes. I remember being really intimidated by other people’s spreadsheets before I started my own. But after I got used to it, I found it so helpful to give me a picture of what was going on.

 

It will be okay. And you will gain confidence as you gather data on what Newman’s patterns are. I hope you have a restful night.

 

Gosh, I see it is after 10 pm and I have to draw a new syringe, The old one sat too long and the insulin separated in it. This sucks. What happens to the schedule tomorrow morning? Maybe I should shoot 1 unit and then be able to get back on schedule by 9:00 am.

 

No matter how much you shoot you should space it out by no less than 11.5 hours. Sorry

 

So that would be 9:30 am tomorrow

 

I\Okay, I shot a skinny 1.5 units at 10:15. I had the meter out so I poked him at that time, he is 386. I'm sorry for melting down. I think I am feeling mentally exhausted. Thank you so much for sticking with me.

 

What is the earliest I can test in the morning if I am not going to shoot until 9:30 - 9:45? I normally get up, test, feed and shoot.

 

No worries. I know how it feels to get a number you're not comfortable with at evening time when you're really tired! You worry about what will happen while you are asleep.

Please update your spreadsheet with that 386 (which I guess will really be the PMPS number since that's when you shot, right? It's helpful to put a few notes in the comments section about what he ate and when. Like, the 238 was after he had eaten, wasn't it? So there may have been a slight elevation in that number because of the food (what we call a food bump.) No.... wait... you said it had been two hours since he had finished his dinner about 6:30... so scratch that part about the food bump. You could write that and write about how long after eating the 386 was. I guess my point is that any information like this is helpful to note in the spreadsheet.

 

You can test him whenever you want. Let's say you tested him at 8:15 a.m. this morning -- whatever number you get would go in the +10 column for the PM cycle of 5/6.

What time do you plan to feed him though? This could complicate things. What time do you usually feed the kitties?

 

I just want to add that sometimes in the middle of a cycle you will get a number that you're not comfortable with and you will want to feed Newman little bits of food (a tsp. here and there usually) to keep his numbers up, or to prevent steep drops. We don't really know Newman's patterns yet, so we don't know if he's a "diver" (I hope not) or a bouncer (I also hope not). I'm not seeing him as a bouncer yet, but we will see. When you do this, it is helpful to put something in the cell on the SS and note it right there in the cell... something like 1 t. LC (low carb) or 1 t. MC (for medium carb).

 

Okay, I was waiting until about 9:30 to see if you were shooting/testing. Newman was probably high and you didn't need any help. I hope all is well with you, too, Linda.

 

Oh, I am so sorry that I kept you waiting. I did act this morning, and planned to fill in the spreadsheet to catch it up to post what I actually I did. So, yes I tested him this morning for a fasting BG at 8:15. I got a 515 which was in fact +10 from last nights injection. Knowing that would be high enough to shoot, I went ahead and fed him his usual 1/2 can FF, then held off to 9:30, rechecked for insight, got 572 and shot 2.25.

Personally I am okay, except for working with Newman and those restrictions, generally speaking everything takes me twice as long. Thanks for asking.

 

I usually test between 7-7:30 am. Then I feed all three of them, Newman, Ozzie and Minnie. I monitor the feedings closely as I have been successfully dieting Ozzie. Minnie eats and she is done, whereas the cats are grazers, so I cover their bowls. At that time, based on the AMPS, food intake and usual dose, I shoot. That entire process takes about one hour to complete.

 

Well, we have learned a few things about Newman from last night and this morning. One is that he will go really high without enough insulin. The other is that he doesn’t go up a lot from the low carb food, but he does go up some (although he had about two hours to digest his food by APMS reading of 572). On another evening when you are not so tired and after you have adjusted his shot time back to an earlier time, you can hopefully get a few evening tests.

 

Yes, normally I would be able to get some evening tests.

Since he is a grazer, it's good to know that it's not having any great effect on his BG.

 

Actually since he’s grazing on low carb food, it’s probably a good thing.

 

Suzanne, I hope you will see that beautiful blue AMPS on the spreadsheet. I went ahead and fed the usual FF pate figuring it will not effect that number by a lot, or so it seems. That first test was at 8 am, so I will test again at 9.

On a side note, when is it time to start a new thread? Has this one gotten too long? I don't want to lose you.

The 9:00 test is 222.

 

Did I make the wrong choice?

Based on 'how to handle a lower than normal PS number there are 3 options' I chose #3 to feed as usual, test in a couple of hours and make a decision based on that value.

Then I remembered stall feeding and retest in 30 minutes.

Well, I blew it.

 

I plan to test again at 10:00 and decide on what dose to give. I'm thinking 1.0 unit, based on the limited info on my spreadsheet, his response is not rapid.

Change of plan. I am shooting 2.0 based on the 222 after seeing it charted on the spreadsheet.

 

You didn't blow it, just something to remember for next time

Stalling lets you see if/when he's on the rise and what kind of duration he's getting. As you learn his patterns it'll help you feel more confident and comfortable shooting lower PS numbers.

Prozinc onset for most cats is around +2 so you're really shooting what the BG will be in 2 hours. As the last shot is wearing off the next shot is kicking in and this is part of what helps to keep the overall BG down.

 

Thank you.

 

I am glad you shot 2 and nothing less. No worries.

 

I did think that you were trying to work his shot time backwards though.
I got excited kooky for the blue amps but it’s yellow!

 

Right? He heard me say I was trying to get back on schedule. The 152 was what I thought was the pre-shot, but you are correct, it moved back to +11 and 222 is yellow. I'm still thinking positively in that it was't black! Maybe we can just have a good day.

 

I wish you had shot 2.25 whole dose this morning. It looks like he needed it. But it's okay... now you can see that the yellow AMPS would be safe to shoot, if you get one again.

 

How's it going this evening? I hope you had a nice Mother's Day, Linda.

 

I had a nice day, how about you?

I am having a hard time figuring out how to post on the spreadsheet properly. It will be easier once I get on a more consistent schedule, I'm sure. Today for instance, I poked him when I got up this morning at 8 am and got that 152 so I entered that at +11 on yesterday's PM record. Then I tested at 9 am he was 222 but, I shot him at 9:45. First check was at 11:30 he was 366, then 3 pm he was 335. I can't get the hang of changing real time to the shot + time. And, can numbers that aren't on the half hour like 9:45 be bumped up or moved back to the half hour? Yikes.

 

I had a very nice day today. We went to church this morning and went to a lovely French Restaurant afterwards. Sometimes you just have to cram a few numbers/times into a single cell. Sometimes, you have to put it into an adjacent cell.

 

Sometimes you just have to pick a box that is closest to the hour and then note in there the + time. It can be tricky

 

What time were you able to shoot tonight?

 

I shot him at 9:00. 2.25 units

 

Yes. I saw that you shot on the spreadsheet- I was just hoping that you had been able to advance his shot time a bit.

 

Perhaps I did not post it properly, I shot him this morning at 9:45 and this evening at 9:00.

 

That’s good.

 

You did fine. I didn’t see the post about how you shot at nine. My phone (and even when I was on my laptop) has been acting weird for me tonight with the FDMB. I will get an alert, and when I click on it, there’s nothing there. Sorry to ask you when you already told me!

 

I'm not looking for an apology. I am in the learning phase and I'll take all the questions and double checks you care to give!

Have a good night.

 

256 this morning? Maybe you can shoot at 8:30 a.m.

you know, about the spreadsheet — some people like to put the time that they shot in the comments section of the spreadsheet. Some people actually have made a column next to the AMPS and PMPS where they put in the actual time of their shot. I think it helps keep them straight.

 

My plan was to shoot at 8:30 and maybe I still can. I tested at 7:30 and fed a few minutes after. Newman sometimes regurgitates and of course that happened this morning! As usual he is back, unphased to eat again. I have given him 1/4 of the can and he ate most of it. What do most people do, can I go ahead with the planned 2.25 units?