Nico the newbie, numbers all over the place

Emily Tuomey

Emily Tuomey

Active Member
:oops:Good morning everyone. Nico was started on Prozinc two weeks ago at 1.0u Prozinc BID, but had since been fast tracked [incrementally] up to 2.5u BID. Since that dose increase his numbers have been all over the place. He had been extremely high — black, with an occasional red thrown in — but since the latest dose increase he’s all over the map. Last night +4 was 198 (blue), and this morning AMPS was 324 (purple), two days ago he had a 228 (yellow) reading in his daytime mid. Is this normal with a Prozinc dose increase? Admittedly I’m not a pro at the insulin injections just yet and have had (sometimes questionably) a bunch of fur shots, so also possible those numbers sometimes are reflective of operator error :oops: Can someone(s) weigh in on this? I’ll attach the link to Nico’s previous threads, just in case it’d be helpful to see what we’ve been doing for him since his diagnosis. Thanks team. -Em & Nico

https://www.felinediabetes.com/FDMB...gnosis-nico-ma-suga-butt.238630/#post-2681183
 
Hi Emily,

From nosing at other cat's SS it seem like Nico is spending more time in the black than usual. Deb always say, blacks and reds are almost always rebounds. That seems to be the case for Hercules. Is it possible that Nico is going low in the night and rebounding in the morning? Or perhaps he is getting stressed out about the whole process. which is shooting his BG up?

I am a newbie, so hopefully someone with more experience will come along and weigh in. Just didn't want to leave you without replies :bighug::bighug::bighug: Hang in there!
 
Emily Tuomey said:
:oops:Good morning everyone. Nico was started on Prozinc two weeks ago at 1.0u Prozinc BID, but had since been fast tracked [incrementally] up to 2.5u BID. Since that dose increase his numbers have been all over the place. He had been extremely high — black, with an occasional red thrown in — but since the latest dose increase he’s all over the map. Last night +4 was 198 (blue), and this morning AMPS was 324 (purple), two days ago he had a 228 (yellow) reading in his daytime mid. Is this normal with a Prozinc dose increase? Admittedly I’m not a pro at the insulin injections just yet and have had (sometimes questionably) a bunch of fur shots, so also possible those numbers sometimes are reflective of operator error :oops: Can someone(s) weigh in on this? I’ll attach the link to Nico’s previous threads, just in case it’d be helpful to see what we’ve been doing for him since his diagnosis. Thanks team. -Em & Nico

https://www.felinediabetes.com/FDMB...gnosis-nico-ma-suga-butt.238630/#post-2681183
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Hooray for the pink preshot this morning!!!! That's much better than black!!! And I REALLY love that blue you got last night!!! I look forward to seeing what tonight brings. You weren't able to get a mid day today?
 
Hercule's mum said:
Deb always say, blacks and reds are almost always rebounds.
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Yes, I do say that. But in Nico's case he was in black numbers almost ALL the time. So we suggested that the dose be "fast tracked" or increased more rapidly than our dosing protocols usually call for.

At least now with the 2.5U dose, Nico is seeing some movement downward in the BG levels. He'll still bounce, undoubtedly, but he does look a teensy bit better, BG number wise.

Nico seems to be one of those cats that is slooooooow to react to a dose increase. He'll probably need another increase in a few more cycles. But lets give him a couple more cycles on the 2.5U dose to see how his BG levels react.

p.s. Em, see responses in your Feline Health thread too.
 
:(:(:(:(
JanetNJ said:
You are definitely not the first person on here to start in the blacks.
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JanetNJ said:
Just to make sure he stays hydrated and keep flushing ketones, if you aren’t already doing it, be sure to add extra water to his food.
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This is more challenging for me mentally than I anticipated, if I’m honest. I feel like a fish out of water. I guess I just have to keep putting one foot in front of the other, even when I feel like I can’t. Sucks.

He’s definitely staying hydrated, and I do put water in his food, and keep that going throughout the day, as he finds it way more enticing that way (not that he’s not eating by any means).

I took a reading in the middle of the night last night and was red. By this morning he was back to HI. :( Shot in his flank, which he actually dealt with better than the scruff, so hopefully it’ll work a little better. I’m gonna take a few readings today, so again hopefully he gets a little more relief.
 
*** +5, 287 ***
*************
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Nico is showing you that he CAN get to lower numbers. Celebrate each small step in the right direction.

Have you ever tested yourself? It's a quick way to test your meter. Human normal without any food for at least a couple of hours is usually < 120. If you have just eaten, or it's a couple of hours after you have eaten, your BG levels will likely be higher.

Yes, we've seen other cats that start in the black and red BG ranges and seem to stay there for too long.
It's why we are suggesting that you "fast track" the dose, increasing faster than the protocol calls for.

With that drop to the yellow BG range (287), I'd expect Nico to bounce back up to the black BG ranges at pre-shot tonight, 11/18/20. So don't let it stress you out if that happens.
 
Deb & Wink said:
Have you ever tested yourself?
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I did actually, early on, because his numbers were so high. I read 79, so I know it isn’t the meter.

Deb & Wink said:
With that drop to the yellow BG range (287), I'd expect Nico to bounce back up to the black BG ranges at pre-shot tonight, 11/18/20. So don't let it stress you out if that happens.
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He has already. I ran a bg at +9 and he’s 505. At least now I’m prepared for it— though it’s still hard to know he’s feeling unwell. Normally I can see it in his face before we even test. Thoughts?

Also, should I check in with his vet this week, or just leave it? She told me I didn’t need to until after his curve (at home) sometime early next week. But, I sorta feel like I should give her a heads up that he may be at 3x or 4x the dose she prescribed by the time we do his curve.
 
Send her here, to look at the dosing protocols we use for Prozinc. Point her to the "Sticky" or pinned posts at the top of the forum.
Although these protocols have never been published in a scientific journal, they were developed based on the experience of hundreds of cat caregivers and diabetic cats. They were recently updated this spring of 2020 also. So quite current.
 
Deb & Wink said:
Send her here, to look at the dosing protocols we use for Prozinc. Point her to the "Sticky" or pinned posts at the top of the forum.
Although these protocols have never been published in a scientific journal, they were developed based on the experience of hundreds of cat caregivers and diabetic cats. They were recently updated this spring of 2020 also. So quite current.
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Ironically she sent me here to begin with. Hahahahaha! I will send her a message tomorrow.
 
Emily Tuomey said:
I shot 3.0u at 7a (PST). 600+HI for AMPS this morning.
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Glad to see that you DID increase the dose again. I was kind of on the fence for a 0.25U increase or a 0.5U increase.

Going up to 3U was good.

Nico is still too high. We need to help you get those BG numbers back down. So a bigger increase, like Janet said to do, was a good idea.

Emily Tuomey said:
Ironically she sent me here to begin with. Hahahahaha! I will send her a message tomorrow.
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Ok!!! Glad a vet knew about us and sent you here for some day to day help with the insulin management.

Did your vet get back to you yet?
 
Deb & Wink said:
Nico is still too high. We need to help you get those BG numbers back down. So a bigger increase, like Janet said to do, was a good idea.
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Agreed. He’s still not staying down though. I can pretty much guarantee he will be 600+ by PMPS, which is still 2.5hrs away... I just keep hoping he will stay down, but seemingly it’s only very briefly on his mids that he gets a semi-okay number. I’m not an expert, but I don’t like him being that high. At all.

Deb & Wink said:
Did your vet get back to you yet?
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No word from the vet yet because she’s not back in the office until tomorrow, but hopefully by end of day tomorrow. Why do you ask?
 
Emily Tuomey said:
No word from the vet yet because she’s not back in the office until tomorrow, but hopefully by end of day tomorrow. Why do you ask?
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Just wanted to see if you had considered asking your vet about using lantus insulin? It's a depot type insulin, instead of an in-and-out insulin like Prozinc. Some cats can do better on lantus, and get back to a more even keel, BG number wise.
 
Deb & Wink said:
Just wanted to see if you had considered asking your vet about using lantus insulin? It's a depot type insulin, instead of an in-and-out insulin like Prozinc. Some cats can do better on lantus, and get back to a more even keel, BG number wise.
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I’ve not, but she did suggest Lantus in the beginning, citing that it was equally as effective (depending on your cats body) as Prozinc, but that PZI was cheaper. We chose to see if he would respond favorably to the cheaper prescription then move to Lantus if he didn’t have good results. He’s scheduled for a [home] curve next week, so once I report those numbers to her I’ll ask if she recommends a med change.

Can you explain to me the difference though? I guess I’m not familiar with the lingo (“in and out” etc.)...
 
Emily Tuomey said:
Can you explain to me the difference though? I guess I’m not familiar with the lingo (“in and out” etc.)...
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Ok. I'm giving a super simple explanation here. See the Lantus Forum for more specifics.

An in-and-out insulin normally does not last beyond a 12 hour dosing cycle, some where in the range of 6 - 14 hours, depending on the particular in-and-out insulin.
A depot type insulin has a gentler onset, and can have more of a carryover effect into the next cycle. Some of the insulin stays underneath the skin and does not go to work right away, but gets slowly released. That forms a bit of a "storage" area which we refer to as the insulin "depot". So you don't see the full effect of the insulin dose until that storage area has built up. This "Sticky" from the lantus forum talks about the insulin depot and explains it better.
Sticky What is the Insulin Depot?

Depot type insulins tend to have a gentler, smile shaped curve once they start working well for a cat.
In-and-out insulins have a sharper, more V shaped curve, with steeper dives in the beginning of the cycle and higher rises in BG towards the end of the cycle.

If you do decide to try lantus, we recommend ordering from Marks Marine Pharmacy, if you live in the US. Prices are much, much less in Canada, and many members here have used this pharmacy. More info on Marks for you is here>>>>>> Ordering Lantus, Basaglar, or Levemir from Canadian pharmacies.
 
Thank you for all of this. I will continue to educate myself, and ask my vet what her opinion is early next week; she may say to switch anyway. I just feel so bad for him because he clearly isn’t able to sustain the low number, yet; I guess he still could though! I’ll let you know what she says.
 
HAPPY NEWS TO REPORT THIS MORNING!! Nico was 461 AM PRE-SHOT!!!! I’m so excited for him! He’s alwayyyys 600+— such big steps forward for him. And, he now purrs during be testing and not even a flinch for his injections. My sweet boy is a diabetes ROCKSTAR ❤️❤️❤️ Love him so!!! I’ll grab a +5 and +7 today from him for you guys as well. Happy Friday!
 

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Omg. CC just walked into the living room and puked the BIGGEST PILE OF KIBBLE I ever saw. Apparently my partner was feeding the outside ferals some kibble and LEFT THE CONTAINER open.... And cc helped herself to high carb kibble!!!! Thank God she puked a lot of it up!!! she probably still digested some but if she ate all of that she would have been 600!
 
JanetNJ said:
Omg. CC just walked into the living room and puked the BIGGEST PILE OF KIBBLE I ever saw. Apparently my partner was feeding the outside ferals some kibble and LEFT THE CONTAINER open.... And cc helped herself to high carb kibble!!!! Thank God she puked a lot of it up!!! she probably still digested some but if she ate all of that she would have been 600!
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OMG HYSTERICAL!!!! Good thing you caught her too, or it would’ve been a mystery 600! Those mystery numbers mess with my head, I don’t know about you.. :joyful::joyful::joyful: Actually, Brooklyn (Nico’s sister) had herself a little vomiting kibble moment this morning— Nico gets “poke treats,” which is just 6 or so Dr Elsey’s Cleanprotein dry kibble. Well, this morning Brooklyn helped herself to his “treats” and ate too fast and puked all the wet food, in addition to the kibble, she’d just eaten. I was like “wow, really??!” “KARMA.” :joyful: Nothing like a little puke at 7am to get your day started on the right foot!!
 
Unfortunately not great news to report back. 600+ for PMPS. 3.0u Prozinc given. :oops: I’m trying to be patient, but it’s hard coming off of a good day. :blackeye:
 
Up down up down up down. Just when I think it’s going well he’s back into black by the end of his cycles (last night and this morning), but was 300s overnight, so I don’t know.. it’s a rollercoaster.
 
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