New to Prozinc

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Thank you for taking the time to help with the spreadsheet. Over time it'll be like second nature to me--until then I'm navigating my way through.
 
Teenuh said:
I will test prior to injection. IF she is under 200 then don't inject. I'm guessing I hold off on food until after test? What about the days that I can't give the second shot and test? Should I inject to be safe?

I can test mid cycle a couple days a week. It'll vary each week though, but it is something I will work in on the days I am home longer. I'll plan on testing at +4, +5, +6 ,+7 for the first few weeks just to help you and myself and others see when she reaches nadir.

I free hand poked yesterday. I guess it'll vary. I'll go ahead and order those too though. MUCH cheaper!!!

PS: SS is up. Still learning input stuff.
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Your situation is going to be a little on the unique side given your schedule, but don't worry - we'll figure out how to make it work!

First of all, Sequence: Yes, you are correct. The order is test, then feed, and then give the injection. She doesn't need to eat her whole meal, she just needs to show you that she's willing to eat. If a diabetic cat stops eating it is an indicator of a bigger problem, so we use this order to make sure the kitty is okay for the day.

Eventually you'll be able to shoot under 200, but at first we need to be certain of Gracie's reaction to the insulin so that you can know she'll be safe while you're at work. So for the first week no shots under 200, but we'll change that after you have a couple of days when you can get the mid-cycle tests done and we know where she's at.

Prozinc wears off after about 12 hours, so giving more on the days you can't do the 2nd shot doesn't help. It will still be gone by the 12 hour mark. All that's accomplished by giving more insulin is putting her in danger of going hypo. So it won't help, and it could really hurt.

On the days you can test during the middle of the cycle, I would suggest doing a +4 and a +6 OR a +5 and a +7, but not all four tests. That's just a lot of little jabs and all four aren't necessary. Of course if Gracie is one of those cats that just sleeps through the test and you're just curious, then go for it. ;)

Okay, now for the spreadsheet, the first column that says AMPS is morning (a.m.) pre-shot (p.s.). That's where you put the blood glucose (BG) number for the first test. Then in the U column you put the number of units (how much insulin did you give?). Then in the +1, +2, +3, etc. columns, those are for the hours after the injection. So if you don't do a test, you leave the cell blank, when you do a test, you put it in the appropriate column. We do it that way since we are all in different time zones. I'm guessing you already got that part though since you said you'll test at +4, etc. ;):p Sorry, sometimes I over explain things. :rolleyes:

So I think I'm understanding from your posts that you've already been giving insulin, is that correct? If so, then starting at January 1st (dont' worry about it if you were injecting before then), go ahead and put the units you gave for the AM and PM cycles so we can start to see the pattern of which cycles you can shoot and which cycles you have to miss. On the cycles you skip, put NS (No Shot) in the U column. And also put in that 214 you got the other day so we can see where that falls in the cycles.

I know it's a lot. It's so much to learn and remember at the beginning. Please don't worry about it. Step by step, and ask and re-ask your questions as much as you need to. You're absolutely right that in no time this will all be so much easier. It's just a lot when it all comes at you at once!:bighug:
 
I would rather have you over explain then under explain. I will let you know when I get my spreadsheet up and running fully. I'm going to work on it at work tonight. Usually there is a little down time.

Yes, I have already started using insulin. I had my own little notepad of the days I gave 2 shots versus 1.

The only concern I have--but it really isn''t a concern is the fact that I generally leave food out all the time for Gracie. She free eats. The only time that there is "generally" no food left is when I work. I leave a little extra out--just to hold her over. By the time I get home (the next day at approximately 8:30a) she's got a full appetite and ready to eat.

So, my thought is--the most accurate preshot will be the days I work? The only other potential problem is--she could have just finished the last bite 20 mins before I got home--so the test won't be as accurate I'm guessing?

Side question: is 12hrs the max you can be between shots? I was looking at my schedule and it looks like I can actually give 2 shots on a couple extra days, but there would be about 13.5-14hours in between.

and the other days I could give 2 shots, but there would only be 7.5 hours in between the first dose and second dose.

I hope that made sense. I was rambling on and on.

Also, I tested her BS a little bit ago, It was high! 466, but she's been free eating off and on all day and I gave her monthly dose of Revolution--which tends to make her a little tired and blah the day of.
 
Ah food...the single most important, and most difficult part of managing feline diabetes.

The easiest way to make sure you get that two hours food-free window is to use a timed feeder like this:
https://www.chewy.com/petsafe-eatwell-5-meal-timed-pet/dp/48080

Of course that is yet another expense. The trick then is to leave the last section empty and have it turn to that empty section two hours before you'll be testing. The one that's linked above also has a little compartment underneath that you can fit a small ice pack which helps to keep wet food fresh longer. The compartments in general really help with free feeding wet food since they keep it a little less exposed to the air so it doesn't dry out as quickly (adding extra water to the food really helps with that too). You can get that same feeder off of Amazon if you prefer buying from there.

Until there is room for that in the budget, don't stress too much about it. Yes, it may impact the pre-shot numbers, but odds are she eats most of the food earlier in the day anyway when it's fresher.

Also, have you been able to check the carb content for the foods you're feeding on the food chart? Cats who are on a low carb wet diet have about a 70-80% chance of going into remission (depending on which study you read). Cats on a higher carb diet have almost no chance of going into remission. It is really super important to make sure all of her foods are under 10% carbs, and that food list is the most reliable way to be sure. For more background on that you can read catinfo.org.

If you discover that any of her foods are higher carb, you'll need to take her off of it carefully because for some cats it can have a big and rather sudden impact on her blood glucose. Hopefully they're all low carb, but if you find one that isn't, post and we can help you figure out the best way to transition.

Shot times: They can be more than 12 hours apart. The problem comes in the next cycle when you only have 7.5 hours left before the next shot. You usually can't shoot that early. In some cats it's possible to safely shoot a little early (+9-+10ish), but we'll need to get to know Gracie's patterns first. So for now you can either shoot at +13.5 and skip the next shot, or skip the late shot and shoot the next one at the normal time.

Great jog getting the spreadsheet going!
 
I think that is probably the hardest thing about being a diabetic in general-is food. I have investigated the food list. I have cut out all dry food--now she won't even eat it. At times I find it almost a headache, as it would be easier at times.
She WAS eating what the vet recommended. The Hills Science diet specifically for diabetic feline--that was until I saw the carb amount. I was pretty upset. I argued with my vet and the dietitian there. We still don't agree.

She eats Fancy Feast Pate. The carb content is very low. She was eating Nulo--another low carb content, but recently hasn't been a fan of it. So, FF it is. I want to try Friskies too.
I had some left over Glycobalance from Royal Cainin (14g) and now she isn't a fan of that. I put the FF on top of it and she refused to eat it. I've wasted a few cans to say the least. She wants the bowl clean and washed thoroughly before she will eat out of it again. Almost like its contaminated.

Glad I asked about the shot times. I'll keep doing what I've been doing--or adjust like you said above.

I have an Amazon Prime account. I'll look into getting the feeder in the next couple of weeks. It is another investment, but at least it is reasonable.
 
It does start to feel like I spend more money buying things for my diabetic cat than for myself sometimes. :rolleyes: At least Friskies and Fancy Feast aren't terribly expensive! And that's a good point that food is one of the hardest things for human diabetics too.

Sounds like Gracie has a good sense of what is making her feel better, and what is making her feel icky.

And yes, dry food is a lot easier. I miss those days too. I'm so glad my kitties are happier and healthier, but dry food was so convenient!
 
Good news: I did my first AMPS and inputed. Bad news: Still on the high side. :(

Is insulin supposed to make it be within "normal range"? I know I'm still early in treatment. I just wish I saw better numbers.

Timed feeder is ordered!
 
Great job! Yes, insulin should bring her to a normal range, but it takes time. We say around here that this is a marathon, not a sprint. She will come down, but it won't be with one shot...but it does happen! I promise!
 
Woot! Woot! Nice job!!! Not so great about the number, but as Rachel said, in time it will get better. Also, most of the good numbers are going to be while you're at work. The pre-shot numbers are usually the highest numbers of the day, so try not to get too discouraged about that. When is the first cycle when you are planning to get the mid-cycle tests? It will be great to get a sense of how much she's responding to this dose.
 
Really? It seems odd that the pre-shot numbers would be the lowest. Maybe I'm thinking of someone fasting & trying to compare to two.
I'm going to be home most of tomorrow actually. I was thinking maybe tomorrow? But...I will be gone from 2-4:30pm. I should be home by 8:30/8:45am.

Let me know what you think? If not...the next time I could do is the 20th or 21st--since my semester starts back up next week. :nailbiting:

If you think I should give it a go--could you leave me specific instructions? Especially if I need to remove food after her first shot or if you think I should pickup food when I leave for the 2.5 hours.
 
Okay, assuming your shot times is still around 9am/9pm (am I remembering that correctly?), you'll test before the injection, then go ahead and leave her food out as usual. The mid-cycle tests, it's okay if they are grazing/snacking. You want the mid-cycle tests to reflect whatever is happening on a typical day. So I would say to get a test just before you leave at 2, and then get another test as soon as you arrive home around 4:30 - so if I'm calculating this right, that should be around +5 or a little before, and +7.5ish.

And the pre-shot numbers aren't the lowest, they are (usually) the highest. The reason is that the insulin is pulling the blood glucose down during the cycle, then starts to wear off towards the end of the cycle. So if you were to test every two hours throughout the cycle (a full curve), and then graph it, it should look like a smile - higher on the two ends, lower in the middle. So it would look something like this:

upload_2018-1-8_20-53-19.png
 
Rachel said:
Great job! Yes, insulin should bring her to a normal range, but it takes time. We say around here that this is a marathon, not a sprint. She will come down, but it won't be with one shot...but it does happen! I promise!
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Ugh. I know . . . well technically I don't, as I had to ask. I can't wait to see the day she comes down.

This makes me question her number last year. I typically do a blood panel at my yearly vet visit. I think I missed the panel the first few years, but I know I did one last year. I might do a little investigation and figure out how much its changed.
 
Yes. Shot times are about those times. I added a reminder in my phone-to hopefully prevent me forgetting.

Would you say it is common for the curve to look like that? And very uncommon for it not to? I remember when my vet tech was telling me about curves...I asked how long it would take and she stated it's usually an all day thing. She stated it partially depends on the cat too. She then said that day none of the cats were curving...and if that happens you generally have to come back.

Uh hello. They are probably stressed out.
 
Common? yes and no. Before a cat is regulated, you'll commonly see a lot of flat curves while you increase to the "right" dose. I put right in quotes because it changes all the time. So the dose that is right at that moment. Anyway, so you'll see curves that look like this:

upload_2018-1-9_4-57-39.png


Or even a little like a frown - the BG might even go up during the cycle when the insulin dose is too small.

As you increase the dose, eventually you'll get to a curve that looks like this:

upload_2018-1-9_5-0-7.png


Here the kitty has dropped low and bounced back up high. Now usually the low isn't as low as this chart shows (48 is too low), so just look at the shape - a steep drop and then a sharp rise. We usually call that sharp rise a "bounce"

The problem is that kitties are bad a bouncing, so they bounce up, and then they stay there. So after a lower-than-normal number they will look like this for a few cycles again.

upload_2018-1-9_4-57-1.png


So we wait, and usually somewhere around 3-6 flat cycles later, you get that nice, smile shaped curve, and you can see if that dose is really a good dose - if the nadir is in the greens or low blues, you're doing well and hold the dose a bit longer. If the nadir is mid-blues or yellows, you increase the dose.

Of course, every cat is different, so no guarantees Gracie is going to follow this pattern, but it's a pretty typical pattern, so you'll likely at least see some elements of it, even if she doesn't follow the whole cycle exactly.
 
Good visuals. Thank you for including and give an brief example. THIS helps.

I won't expect a perfect curve today, as I assume her dosing still may need to be adjusted. I'm also guessing with my partly inconsistent schedule it might be more difficult to get her fully regulated.

She was a little more hungrier this morning than normal. Normally I give her a small can and she eats some then walks away. This morning was the first time she ate some--followed me to the bedroom then went back and finished it. I'm wondering if I didn't leave out enough food.

And she was a little more irritated that I was poking her today . . . I think because she was more hungry, but she was moving around a bunch too. Very antsy.

Her BS was definitely not low this morning. Higher than yesterday even.
 
Whoa! Is that 51 right? Are you using the pet meter or the human meter? That’s too low on a pet meter. Can you test again to make sure that’s accurate? If it is, please give her some higher carb food to eat as soon as you can.
 
YES!!!! I tested twice because I couldn't believe what I saw. I'm using the AT.

I gave her some Glycobalance. I can go to the store and buy something with higher carbs if needed.

She's eating OK. Doesn't appear wobbly. Just irritated cuz I tested twice.
 
Teenuh said:
YES!!!! I tested twice because I couldn't believe what I saw. I'm using the AT.

I gave her some Glycobalance. I can go to the store and buy something with higher carbs if needed.

She's eating OK. Doesn't appear wobbly. Just irritated cuz I tested twice.
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How many hours past this morning's dose are you right now? When did she get the Glycobalance - right after that lime green number?
I suggest you test her again because she might not yet be a nadir.
 
We've been in touch with Teenuh on Facebook, and she called me just a moment ago, wanted to give you an update as she's busy taking care of her kitty.

She hasn't managed to get another test after the 51 (which she double-checked) over an hour ago. Her kitty is acting normal. She fed her HC and also some karo/honey (didn't ask which). She made an appointment an hour from now with her vet. I suggested it was really important she test again as soon as possible, but given she was not managing, I suggested giving her more karo/honey (better safe than sorry if you're "blind") and going to the vet earlier if she was worried. Even though this is probably the kind of situation that is manageable at home, between the fact she is not managing to test and that she is "starting out" with the sugar dance, I felt the vet course was the safer option and told her as much.
 
Stephanie & Quintus said:
We've been in touch with Teenuh on Facebook, and she called me just a moment ago, wanted to give you an update as she's busy taking care of her kitty.

She hasn't managed to get another test after the 51 (which she double-checked) over an hour ago. Her kitty is acting normal. She fed her HC and also some karo/honey (didn't ask which). She made an appointment an hour from now with her vet. I suggested it was really important she test again as soon as possible, but given she was not managing, I suggested giving her more karo/honey (better safe than sorry if you're "blind") and going to the vet earlier if she was worried. Even though this is probably the kind of situation that is manageable at home, between the fact she is not managing to test and that she is "starting out" with the sugar dance, I felt the vet course was the safer option and told her as much.
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I'm really glad you were there to help. Stephanie. If she's having difficulty testing the vet clinic is the safest place. She also has a really complicated school/work schedule.
 
Djamila said:
Whoa! Is that 51 right? Are you using the pet meter or the human meter? That’s too low on a pet meter. Can you test again to make sure that’s accurate? If it is, please give her some higher carb food to eat as soon as you can.
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Thanks guys. This post below is for Djamila. I appreciate the help.



Yes, you read that right. I tested twice, as when I got the first got the reading I thought I was seeing things. I gave her some food with gravy and a little honey.

Actually taking her to the vet right now to get tested with my monitor. I will keep you posted.
 
Stephanie & Quintus said:
We've been in touch with Teenuh on Facebook, and she called me just a moment ago, wanted to give you an update as she's busy taking care of her kitty.

She hasn't managed to get another test after the 51 (which she double-checked) over an hour ago. Her kitty is acting normal. She fed her HC and also some karo/honey (didn't ask which). She made an appointment an hour from now with her vet. I suggested it was really important she test again as soon as possible, but given she was not managing, I suggested giving her more karo/honey (better safe than sorry if you're "blind") and going to the vet earlier if she was worried. Even though this is probably the kind of situation that is manageable at home, between the fact she is not managing to test and that she is "starting out" with the sugar dance, I felt the vet course was the safer option and told her as much.
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Thanks Stephanie. I need a break right now.
 
Hi Teenuh! I hope everything went well at the vet today! Please no rush on responding to anything - you guys had a rough day today - but I wanted to mention that Gracie is likely to be quite high tonight after that low number. Assuming she is, please lower her dose to half a unit, or one unit (let's see what other folks think is best). Two units is clearly too much for her. If she isn't high tonight, you may need to skip tonight completely.

I believe your dosing time is around 9pm Pacific Time Zone, and there aren't a lot of people around here at that time. If you need help and no one responds here, post out in the Main Health forum http://www.felinediabetes.com/FDMB/forums/feline-health-the-main-forum.28/ And there is almost always someone keeping an eye out there - even in the middle of the night. :)
 
I agree that a dose reduction is needed and she'll be insulin sensitive after the lows today. For that reason I think 0.5 u is safest for tonight if the pre shot BG is high enough.
 
Djamila said:
Hi Teenuh! I hope everything went well at the vet today! Please no rush on responding to anything - you guys had a rough day today - but I wanted to mention that Gracie is likely to be quite high tonight after that low number. Assuming she is, please lower her dose to half a unit, or one unit (let's see what other folks think is best). Two units is clearly too much for her. If she isn't high tonight, you may need to skip tonight completely.

I believe your dosing time is around 9pm Pacific Time Zone, and there aren't a lot of people around here at that time. If you need help and no one responds here, post out in the Main Health forum http://www.felinediabetes.com/FDMB/forums/feline-health-the-main-forum.28/ And there is almost always someone keeping an eye out there - even in the middle of the night. :)
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Hi!
We are home.

The vet visit went well. I'm glad I went--I was able to see MY vet (Dr.Thomas). I had to show up crying and in panic, but it worked. It was not the most ideal route to go, but it worked and it got the job done. The vet who prescribed the insulin was not Gracie's regular vet (her name was Dr.Benedetto--I just found out she switched practices). We reviewed dosages and notes. She was not approving of the 2u's. She didn't understand why we wouldn't try the 1u first and then recheck.

She also said NO CURVES. She said that due to the fact that my schedule is a bit inconsistent she is suggesting a fructosamine in 3 weeks--instead to see how her body is adjusting and handling the insulin.

She was trying to feed my cat the Science Diet--specifically for diabetics. I told her she wouldn't eat it. They ended up giving her what I sent her with.

She is advising again't home tests until after the next test. She thinks numbers will not be what I like and I will likely freak myself out again.

The thing is--we wouldn't have made this adjustment without the home test.
 
You are absolutely right that without home testing you wouldn't have known she was that low. You are doing the right thing. It's nice of your vet to worry about your feelings, but not testing is just dangerous.

Glad to hear she's going to be on a lower dose. Curious to see what her BG is tonight after all of this....?
 
Teenuh said:
The thing is--we wouldn't have made this adjustment without the home test.
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This.

Speaking from absolutely terrifying personal experience, I think that dosing 'blind' and not having a clue about whether or not one's cat is at a safe BG level - in real time - is far less 'likeable' and is liable to freak a person out far, far more than seeing a test result that's higher than one might wish for.

Pound to a penny your vet would be highly unlikely to advise a parent not to test their human diabetic child.


Mogs
.
 
Well, she went from 439 to 51 in two hours today, so I wouldn't shoot 1 unit no matter what number tomorrow. That was a really fast drop. 0.5u is probably not going to be enough long term, but I think you need to give her a little rest for a couple of cycles and let her body reset. Vets can't tell you to do half doses because Prozinc is sold with whole unit syringes by the manufacturer. So they have to suggest whole unit doses. We are under no such obligation. :p

Is tomorrow a day when you're home all day, or a day when you're at work?
 
I am taking your advice. I want her little body to reset.

Would you say I should hold off on dosing tonight too then?

"Have to" that is just greed on their part.
 
Teenuh said:
What should BG be to give 0.5 vs 1 or none for tonight?
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I agree with Djamila’s recommendation of 0.5 u. At this point I would say no insulin unless the pre shot BG is over 200 if you’re using a human meter. If you’re using a pet meter, I’d raise that no shot number to 250. As you accumulate more data, you’ll be able to lower your no shot number.
 
Kris & Teasel said:
I agree with Djamila’s recommendation of 0.5 u. At this point I would say no insulin unless the pre shot BG is under 200 if you’re using a human meter. If you’re using a pet meter, I’d raise that no shot number to 250. As you accumulate more data, you’ll be able to lower your no shot number.
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Jinx! :smuggrin:
 
Djamila said:
Well, she went from 439 to 51 in two hours today, so I wouldn't shoot 1 unit no matter what number tomorrow. That was a really fast drop.
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That drop was possibly worse than what Vetsulin/Caninsulin can do! :eek:

@Teenuh - while things are in flux dose-wise, it's probably a good precaution to regularly test for ketones. (You can use Ketostix or similar for this.) More info:

Testing cat for ketones

Urine collection tips



Mogs
.
 
Critter Mom said:
That drop was possibly worse than what Vetsulin/Caninsulin can do! :eek:

@Teenuh - while things are in flux dose-wise, it's probably a good precaution to regularly test for ketones. (You can use Ketostix or similar for this.) More info:

Testing cat for ketones

Urine collection tips



Mogs
.
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I'll definitely look into this. I just ordered an automatic/timed feeder--that should be there tomorrow.
 
Teenuh said:
This stuff happens from being on too high of a dose I'm guessing?

PS: I forgot to get her recent lab work from Dx. They tested all kinds of stuff. I think I saw a place to input on the spreadsheet.
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Yes, there is a tab with reference ranges in the speadsheet. Do you know which lab they use? My vet uses IDEXX which has slightly different references than the ones that are already in there - so if you notice a difference, that might be why.
 
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