New, Help with errors/rebound?

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cmw

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Hello,

Sorry for the lack of previous introduction, or details.

Feeling rather overwhelmed and out of my element in general, with very little sleep for a variety of reasons.

My 14yo female Dusty was dx'd and began PZ insulin three weeks ago. Financial considerations lead to starting her at home and in all honesty I think we went right off the tracks from the beginning.

I'm now 99% convinced that she has been rebounding since her first dose (while I've been juggling protocols/scales/etc trying to smooth out ocean waves). My recent realization is that her BG numbers are far worse now than before insulin but after switching to very low carbs. In fact this morning she was 477 PS which is higher than her 450 at diagnosis -in the vet's office!

I know I've posted no data, so am looking for general thoughts at this point on how do we back-track?

I have yet to find any info on how to back of doses in the case of rebound ~where the BG numbers are so scary I just want to shoot to knock them down.

ANY info/thoughts/kind( or other) words will be greatly appreciated.

Chris
 
Hi Chris & Dusty! You are definitely in the right place to get back on track & getting Dusty feeling better.
Yes this is very overwhelming! It gets better with time. Promise!

Ok so you are home testing? Good! Are you testing for ketones? How many units are you giving right now?
Sometimes shooting more insulin into high numbers to just get them to go down isnt the right approach. I have a perfect example of this. Baxter had a couple of higher numbers. The vet said increase. I increased. It did nothing but, give Baxter higher BG with flat cycles. His BG never would move out of the high. With help from PZI insulin support board I now have Baxter on a dose that is very small that produces great numbers. Now ECID, but this something to think about. Maybe it's to much insulin? Cats need sometime to settle into a dose.

It's sounds like you have the low carb diet down. What about treats? Are those low carb as well?

So you ask how do you get back on track?
Record your BG test results. The more data you have the better we can help you with dosing.
Are you on a 12/12 schedule?
Come over to the PZI insulin support board. There are lots of experienced members who would love to help you with dosing.

Jenn & Baxter
cat_pet_icon
 
cmw said:
Hello,

Sorry for the lack of previous introduction, or details.

Feeling rather overwhelmed and out of my element in general, with very little sleep for a variety of reasons.

My 14yo female Dusty was dx'd and began PZ insulin three weeks ago. Financial considerations lead to starting her at home and in all honesty I think we went right off the tracks from the beginning.

I'm now 99% convinced that she has been rebounding since her first dose (while I've been juggling protocols/scales/etc trying to smooth out ocean waves). My recent realization is that her BG numbers are far worse now than before insulin but after switching to very low carbs. In fact this morning she was 477 PS which is higher than her 450 at diagnosis -in the vet's office!

I know I've posted no data, so am looking for general thoughts at this point on how do we back-track?

I have yet to find any info on how to back of doses in the case of rebound ~where the BG numbers are so scary I just want to shoot to knock them down.

ANY info/thoughts/kind( or other) words will be greatly appreciated.

Chris
Click to expand...

What dose are you giving now?
If Dusty has no other health issues like ketones or past DKA that may cause a concern with less insulin, I imagine you could go back to 1unit BID, depending on the current dose.

I was told here to take my cat's dose right back down to 1u BID despite his high BG and then rule out any overdosing/rebound.
 
Welcome to the FDMB family, Chris and Dusty! cat_pet_icon

When you get a chance, pop on over to the PZI board for more help with dosing questions. We don't always check the Health board (shame on us!).

It's great you appear to be doing home testing! Rest assured, there are many variables that can cause a kitty's BGs to go high, even higher than at the vet's office. Without knowing more, it's hard to give suggestions or ideas as to what may be causing it for Dusty.

How much and how often are you giving insulin? What, how much, and how often are you feeding? How often do you test and what are the numbers? What are the litter box activities and amounts? How is the grooming and playing going? Are there any other health issues? All these answers play a part in what is happening with Dusty. :-D Yeah, I know. Lots of information, isn't it? :-D
 
Thanks everyone.

She is on 1u BID ~but I've been chasing her BG numbers a bit trying to be -very- conservative in trying a famous(?) protocol from a very dogmatic FD message board.

So she's generally gotten .75 to 1.25 usually around +8 to +10 hours when the numbers start to get scary again.

Last night she was 456 and got 1.0 (8pm)
221 at +4
277 at +6
Gave her .5 at +7 because I knew the morning was going to be problematic
477 at +15/+8 1.0u ---seemed like a bad/fur shot (edit)
590 at +2 ---shot .5u because of above, this new high scares me
No ketones in her urine to date ~though not easy to catch did get a (splash) sample this morning.

Last time her numbers were good she was getting .5u to .75u

So that's where we are right now. Again, not a lot of detail I know but I have to get out of the house sometime here for test strips at least...

She eats nothing but low-carb fancy feast, and now EVO canned, considering letting her have some EVO dry.

With highs in the 450+ range now I'm scared to back off - really getting whipped back and forth.

Again, any comments or thoughts at all are appreciated. I got a very nice phone call from a local member on the support list and she was very positive and supportive ~enough so I don't feel like running away into the wilderness screaming and yelling...

Chris
(ETA the 1.0u at 477bg)
 
I would be very careful shooting off the 12/12 schedule until you have more data. If you get a curve, with numbers at +3, +6, +9 and then +12, it will give you an idea of how the insulin is working. Then you adjust the dose.

Two things could be working here. If she goes down midcycle at night, she should be bouncing and that could be part of the higher numbers. This can turn into a rebound cycle that is very confusing. And although PZI does not have a shed, you run a risk of overlap shooting before +8, at the earliest.

Can we help you set up a spreadsheet? If you need help, send me a pm. That will help you and us see the patterns more easily.

I would also suggest visiting the PZI forum and checking out the spreadsheets of people there. We tend to be very systematic about changing doses and base it on bg numbers - both preshot numbers and the lowest number in the cycle. We generally give the dose several cycles to settle so we can really see what is happening.

I am glad you got some support. I hope it was general advice. We have had some issues lately of people giving dose advice off the board. This is completely against the rules of the board- all dose advice needs to be peer reviewed. If someone disagrees with the advice I am giving you, for example, they need to be able to read it here and respond on the board.
 
Here is the link to help you to set up a spreadsheet for Dusty when you get a moment http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=50130 this will help others to help you and Dusty.

I don't use the same insulin but I have never heard of any protocol that would advise to shoot more insulin 2 hrs after the last shot :shock: or even 7 hours after. If you have been following Dr Hodgkins protocol I believe the earliest you are supposed to shoot again is at +10 if you have rising numbers.

I agree with you - I think you are right off track. So glad you found your way here. It is all very overwhelming to start off with but the board will help you get on track :smile:

p.s. I wouldn't recommend introducing the EVO dry Dusty will be much better off if you stick to low carb canned food.
 
I do hope to do a spreadsheet to document this whole sordid mess to date.

The Hodgkin protocol specifies testing and dosing at +6 to +8 on rising numbers with dose based on a starter scale. In retrospect, given my current impressions, it's a good thing I decided there was no way I would shoot even half of the recommended doses.

This is not to excuse my nearly blindly going along, but a clarification of why I was doing it...

As for the .5u at 2+ this is the first time I've tried to make up for a fur-shot -the initial 1.0 shot didn't seem right at all and had me cursing under my breath. Still not an easy decision

So right now I'm off to buy syringes and test strips -thank goodness for Walmart.

My current desire is not so much to knock down the BG numbers, but ideally to ensure an appropriate (nearly minimum) amount of insulin while things calm down.

Stern comments welcomed -it saves me the energy of kicking myself for a few minutes :-D
 
While I don't use PZI, one thing that just jumped out at me and I want to clarify...You said you were headed to Walmart to buy test strips and syringes...Are you using U-100 (human) insulin syringes or U-40 syringes (animal)?

From my understanding of what I have gleamed over the time I have been on the board is that PZI is a U-40 insulin and while you can use U-100 syringes you have to use a conversion chart to make sure you are getting the right dose. If you have been using the syringes that are sold at Walmart then those would have been U-100 syringes and if you haven't been converting your dose to compensate for the difference, you may also been under-dosing.

Just making sure we are all on the same page. :-D

Mel, Maxwell, Musette & The Fur Gang
 
(stuck waiting a bit to get going)

Good catch -yes I am using u100's sometimes and doing the conversion to get the intended dose.
 
I just want to say my vet told me Dr.Hopkins protocol won't work with PZI. Now my vet could be wrong. He doesn't know everything when it comes to FD. I use a sliding scale that is customized to Baxter only. It is based of his BG numbers & the results he gets from the dose.

I had the same mind think oh I will catch Baxter before he gets to high which was around +10. It seriously back fired on me. He went longer through one cycle with insulin & without on the other cycle. In the beginning you need to have some consistency. Especially, when you don't have much data.

Chris you are going to get on track very fast. Good for you on going to Walmart to purchase supplies.
Can't wait to see some BG results. Remember you always want to test before food.
 
Ya know, we all started when we had too as well, not before we were experts or thought we knew it all. So...no kicking yourself for learning. Ok? :-D And, wow! How much you've learned! Good on you! :-D

Yes, the numbers are scary, especially when we're talking about our fuzzy loves. Every time I take a PS reading, DH laughs at me as I mutter under my breath, "Under 300. Under 300. Please be under 300." It's not always under 300. Especially lately. :evil:

One of our mottos in PZIville is "Start low, go slow". Depending on the cat and numbers, starting at 1 unit bid and shooting as close to 12/12 as practical is what we normally recommend. While starting on that dose, testing PS and around nadir gives us numbers to guide us on where to go from there - up? down? Unless lower numbers say down sooner. As you have said, Dusty has been doing pretty well with .75-1.25 units. I'd stick with the .75u, get numbers, and then see where to go after at least a few cycles.

A fur shot is especially frustrating and irritating. Even so, we always say "another 12 hour cycle is coming soon" and wait until next shot time to give insulin. The reason being, we can't really be sure how much insulin got into the cat with a fur shot. Adding more after a fur shot can lead to too much insulin. "Once insulin is in the cat we can't get it back out." Yeah, we know higher numbers are likely. "Better high for a bit than too low once."

One more thing about those high numbers...it's really tough to not shoot into them. "See a high number? Raise the dose" seems to be instinctual to us beans. It's counterproductive for our kitties - if the higher numbers are from a bounce. Bounce? When a kitty goes lower than they have been (notice I didn't say in the lower double digits or hypo numbers? I said lower than they have been) their liver thinks to itself "Oh no! Kitty is in trouble! Look at the BG number drop!" and dumps additional glucose into kitty to "save" kitty's life. We, us beans, look at the numbers differently. If we see a PS at 310 and at +5 it's 200, we're thinking we should have seen more of a drop. Mr. Liver is seeing over a 100 point drop and can panic. It's not used to seeing the lower number. Especially in the beginning! So what on earth are we to do? We stay the course for at least a few cycles so things calm down, Mr. Liver gets used to the lower numbers, and we gather data. Make sense?

Again, no kicking yourself. :-D We've all been where you are, learning, and I've not yet met a person who couldn't learn more. :-D
 
Dr. Hodgkins' protocol was set up to work with the original PZI which is no longer available. The insulin that most people here use is ProZinc. There is a compounded form of PZI (BCP PZI) that is available but thought to be different from the "old" PZI.

My understanding is that Dr. Hodgkins is not longer affiliated with YDC, the forum that advocates the protocol. FDMB advocates a start low, go slow approach. We think it is safest and most likely to produce results. We have had people come from YDC and start again with SLGS and be successful. One spreadsheet that might be helpful is Cello's. They started with YDC and then switched with great success. Cello is now in remission.

https://docs.google.com/spreadsheet/lv?key=0ApRoVAkSuXuUdDltSnA3ZFVHQ3BUdlNLanJYRkQzSnc
 
Hi Chris! I'm so glad to see your post here. I'm the one who he contacted via pm, being local, and he really needed moral support. I told him about my experiences with my two diabetics, and asked him questions about Dusty (ketones? neuropathy? how many units of PZI). My advice was pretty general and since I had no experience with PZI I asked him to post here on the board.

Chris, keep forging on. You are doing a wonderful job. You are getting excellent advice from others here. Good luck, you are a great dad-bean to sweet Dusty. (she sounds like a princess...you've got to get a pic of her sometime and post it!)
 
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