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LovingOpie

LovingOpie

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Hello to everyone. I am looking forward to getting some input about my Opie. I have been at this for a year and a half and he is still not regulated. My vet has no ideas but I am hoping that there might be someone out there who can help. I can't get the numbers down and if I raise the insulin his numbers tend to go higher. He is staying pretty much in the 300's regardless of what I do. Also, his nadir time changes from 4 hours to 12 hours, is that unusual?
 
I see a few inconsistencies. Like the day he went below 50 and you raised the dose instead of reducing. Anytime your cat goes under 50 it earns a .25 unit reduction. I’m not sure what you’re basing your dose adjustments on. I also notice you’re not getting any pm tests in and that’s like missing 1/2 of the data because you don’t know what’s going on overnight. Do you think you can try to get a +2 or +3 every night?

And if you’re following SLGS, he actually would get a reduction anytime he goes under 90.

I’m tagging a prozinc user here for you @Suzanne & Darcy
 
I agree with Ale try and get a few tests in after you test Opie's PMPS , we really don't know what's going on during the night cycle.
If you are going to follow up the SLGS doing method can you please add that to your signature and your spreadsheet up top where it asks you.
Please read the dosing method link Elise ( tiffmaxxe) gave you
 
Can you tell us what criteria you’ve been using for the dose adjustments? Is it according to your vet? The good news is I think you may have missed the ideal dose, as in past right through it, and once we get you following the dosing protocol, your cat will get regulated :cat:

I would also suggest that instead of giving no shot when you get a lower preshot number than you’re used to seeing, that you give what we call a token dose which is 10-20% of the regular dose. Let’s see what Suzanne thinks of your date so far.
 
We have no dosing criteria and go with what we feel based on what we were told initially by our vet. When we get a low number we were told to give 1/2 dose and if around 100 to try 1 unit instead of none.
 
I will start over from scratch following the prozinc protocol that tiffmaxee sent the link to. It is awful to think we have done wrong all this time. Do you suggest that we start tomorrow am or tonight? and do we test only ps for that first week?
 
I’m nit a Prozinc user. I used lantus. However you don’t want to start totally over. My gut reaction is to continue with the current dose and increase or decrease following one of the methods used here for Prozinc.


After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change).

Test at amps and pmps and try and do spot checks when possible so you know how the dose is working. M not sure I you should increase now. I’m tagging a Prozinc user.
@Suzanne & Darcy
 
I agree with Elise. I’d keep the current dose especially since you’re not switching insulin. Start to do the daily spot checks in addition to the preshot tests. So you want an average of 4 tests a day at least. Amps, then either a +4,+5,+6 (and alternate these so you can start to see when his nadir is which should be around one of those times), pmps and at least a +2 or +3 depending at what time you go to bed and when his shot is
 
LovingOpie said:
Thank you @tiffmaxee. I am thinking that going down to 0.5 suddenly might not be right but am unsure what to do since the dose we have him on isn't doing anything whatsoever and numbers remain flat.
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You’ve been changing the dose very often so maybe stay at 2 units. I know it’s hard not to rush to so s dose adjustment but you need to be patient. And you’re not alone on feeling like I should have known about all of this sooner. It took me a long time with Minnie and when Bobo became diabetic I knew what to do right away. The good news is you’re here now and we can get you on track. I’m curious to see his evening numbers
 
I think would start with 2.25 IF you can get spot checks to see how low he goes. If more comfortable with 2.0 you could try it. It’s just that unless you see a drop under 90 you will not change the duse fir 7 days.
 
Right now I think maybe 1 unit since it is like starting over from the beginning. I am also moving insulin time up one hour to give me room to check test before bedtime. Any other thoughts?
 
LovingOpie said:
Right now I think maybe 1 unit since it is like starting over from the beginning. I am also moving insulin time up one hour to give me room to check test before bedtime. Any other thoughts?
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I think that would be a huge mistake. It will take a longer time to get o a good dose. @Wendy&Neko
 
1 unit would be too low to start over again. You shot 1.75 units this morning, why not just stick with it for 7 days (unless he goes under 90), so you can gather enough data to see how he's doing on it. And do try to get those night time before bed tests. At one point, Neko went three months in a row bouncing during the day and going low and earning reductions at night. If I'd got by her day numbers I would have increased. At this point we can't say that's what Opie is doing, until we see that night data.
 
Hi, I know I just started on the new idea of SLGS and holding to 1.75 units for one week but I am getting scared because Opies numbers still remain stuck and since they have been stuck for a long while before this I am concerned. On the info provided it mentions glucose toxicity. What is this exactly and do you think it sounds like him or is it just still soon to tell? My vet has retired and I don't have a new vet to take hime to that I trust or would even take me right away. You are all I have at the moment. Glad to have you.
another thing. . . I don't know how often to test right now and figure that he needs time to adjust before I go with the full curve?
 
Glucose toxicity results from their bodies getting used to higher numbers. More info on it here: Glucose toxicity: What is it & what should I do about it?

For now, I could continue to shoot 1.75 units for another day, and continue the testing you've been doing. If Opie was bouncing because he was going low previously, then it can take six cycles or the bounce to resolve. Meaning, after six cycles and the data you've been getting, we'll know if his numbers are high because you missed a low number and he subsequently bounced. If we don't see him come down after those six cycles, then the higher numbers are because his dose is too low.
 
I don't understand his numbers at all. He is getting higher after the shot. Does this mean it is too much or too little?
 
Morning, I can't give dosing advice but what I would do is change your title to read like this
? 5-12 Opie AMPS 343 +2 352 should I can increase his dose
To do this tap on the word to the right that says Thread Tools , then tap on Edit Title and erase what you have now and put what I said, then tap save it will draw more attention :cat:
 
Lantus doesn’t kick in for most cats until +2. Since he’s fed at amps the +1 shows a food spike which is to be expected. Today it is flat. Meters are allowed to vary by 20% so a few points up or down means nothing. I suspect an increase will be needed but with all the dose changes we can make that decision tomorrow.
 
Diane Tyler's Mom said:
Morning, I can't give dosing advice but what I would do is change your title to read like this
? 5-12 Opie AMPS 343 +2 352 should I can increase his dose
To do this tap on the word to the right that says Thread Tools , then tap on Edit Title and erase what you have now and put what I said, then tap save it will draw more attention :cat:
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Do you mean that I should change the title of this whole continuing post every time I want to ask something?
 
No, we don't have title naming conventions on the Feline Health forum - you don't need to change the title. The only convention we have is that we ask you start a new thread if it gets up to 50 posts.

LovingOpie said:
I don't understand his numbers at all. He is getting higher after the shot. Does this mean it is too much or too little?
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Or it could just mean he's bouncing. Nothing in the data you've gathered so far shows lower numbers indicative of the dose being too high. The test right after AMPS you did today could also show an influence from the breakfast meal, and Prozinc not starting to work yet. As I suggested a couple posts above, if you don't see anything below 200 today, I think you'll be OK going up to 2.0 units tomorrow. I suspect the reset back in dose was not needed, or set back too low.
 
The prozinc information and SLGS suggested that when the nadir remains above 200 that the dose should be raised by .5. What are your thoughts on this? Also the original comments said a full week was needed before change so are the 6 cycles enough?
 
The description of SLGS says always 0.25 unit increases. The Modified Prozinc Method (a different dosing method from SLGS) is the one that has the comment about larger increases. MPM is only recommended for more experienced members.

The reasons I suggested a quicker increase are two fold. First, I think you reduced the dose too much, so an increase would make it up a bit. Second, if he was bouncing from lows you weren't seeing (as others suggested), by the seventh cycle of this dose, any bounce would be cleared and you would see a low again if it were happening. So far the data does not suggest he's going low. If you don't see him diving down by tonight's second test, you are OK to increase.
 
Your extra testing over the last few days has been awesome! If you can keep it up, should really help tell us what's going on.

What time zone you in & what are your shot times? And, curious how old (or new) is your vial of Prozinc and are you gently rolling the vial before each draw?
 
Shelley & Jess said:
Your extra testing over the last few days has been awesome! If you can keep it up, should really help tell us what's going on.

What time zone you in & what are your shot times? And, curious how old (or new) is your vial of Prozinc and are you gently rolling the vial before each draw?
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I am in central standard time zone and shoot at 6:30. Our ProZinc bottle was opened Jan. 5th and is just about gone and yes, we know how to roll it gently etc. thank you for asking.

amazing numbers today!
 
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