PMPS 83 after bouncing - ADVICE???

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Robin&BB

Robin&BB

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Crazy BG day, this one! Our first bounce on Pro Zinc - I just fed her after seeing this low PMPS.
Could someone look at her SS & advise*? I'd think I wait a bit, retest, then shoot? Is this correct?
I hesitate to reduce the dose, as I think she's trying to "settle" into the 2.5, and I can monitor her closely tonight! Please advise ASAP? Thanks, y'all!

*Given super-low # last night before the bounce this a.m., I don't want to send her into hypo - I'm just not very familiar with Pro Zinc yet.
 
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Well, you have to be sure she is rising - she has been falling so far. So, the usual thing is to wait 20 minutes without feeding, then retesting in 20 minutes until she is higher. Since you can monitor, you could be a little more adventurous, but I don't think I would shoot under 180.

And if 2.5 gave you a low pmps after 12+, I would plan to reduce the dose. If she would get to 180, then maybe 1.5?
 
Sue and Oliver (GA) said:
Well, you have to be sure she is rising - she has been falling so far. So, the usual thing is to wait 20 minutes without feeding, then retesting in 20 minutes until she is higher. Since you can monitor, you could be a little more adventurous, but I don't think I would shoot under 180.

And if 2.5 gave you a low pmps after 12+, I would plan to reduce the dose. If she would get to 180, then maybe 1.5?
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Just got a 104 on retest after 20 min. Should I feed a little more & wait another 20, then test again?
 
Robin&BB said:
Just got a 104 on retest after 20 min. Should I feed a little more & wait another 20, then test again?
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If I get a 180, soon couldn't I just drop her 0.5U? I guess my concern is that she was getting really bad numbers at 1.5, better ones at 2U.
What do you think? Is it possible that some cats need a lower dose at night and a higher one during the day? This is so weird!
 
This is one of the ways ProZinc is different than Lantus. You can shoot lower numbers on Lantus because it has a shallower curve. With ProZinc, you have to shoot at higher numbers because it's likely that she could drop lower faster than with Lantus. I wouldn't shoot under 180 and then would reduce the dose and monitor. Having said that, I am a cautious advice giver. Some people shoot as low as 150, but only if they have a lot of data and could predict what might happen. She's new to the insulin and moving downward pretty fast.

It would be nice if you didn't have to skip. You could watch the number and once she is high enough, give a dose and plan to shoot again 12 hours later (possible?). Or watch the number and give a tiny dose (like .5) to keep her from going high?

You could just reduce by .5 but she had a really long low cycle which is an indication the dose is too high. You hold the syringe; you decide. Just be sure you have some higher carb food and honey in case you need it.

Yes, she might need a different dose day and night. But I am guessing her body is adjusting to the insulin and you'll need to start reducing.
 
Just now got a 142 (@ 8:42pm). Will check her again in 1/2 hr. or so. I'm going to agree with you and err on the side of caution: Once we hit 180, I'm going down a full unit to 1.5 tonight. Yes, I can shoot again 12 hrs. after whenever (?) I'm able to give her tonight's dose. Thanks for explaining the difference between Pro Zinc & Lantus, as I was accustomed to much smaller increases/ reductions with Lantus. Didn't realize that there's that big a difference between the two types. I'd rather the reduction be a little too much than too little, as it would be horrible if she hypo'd while we were asleep!

Think I'll be setting alarms, though, throughout the night - because I want to see what her levels looks like overnight. I'm pretty spooked by such a low # at 12 hrs. post-insulin. Makes me wonder if she didn't go way too low last night around +7 or +8. Yikes.
 
Robin - that looks like a good plan. Hope YOU got some rest and so did BatBat. My "do not shoot" number on ProZinc was 250, though my vet told me I could've shot down to 180. Because there isn't a shed w/ ProZinc, each cycle is "a new day". It may be that her infection is clearing, and thus the need for a higher dose is going away. That's not a bad thing!!!

The first few months that Grayson was on ProZinc, we had a bit of a roller coaster ride. There were some cycles that he went 18-24 hrs in great, unshootable numbers; I had to be extremely flexible. Fortunately ProZinc is flexible like that. Like Sue said, you're holding the syringe. Bottom line is "better safe than sorry". I usually let my gut influence my dosing decision, as I have to be able to function at work the next day. Likewise, you don't want her to "swim in a sea of pinks" (or reds), so as long as you can keep an eye on things, you can be more aggressive if you think that's best.

I think you're doing very well. And I like your reduction. Keep up the good work!
 
Lost my post...

Reader's Digest version: Good job! Good choice of reduction. I think the infection is clearing. It may be that that was the source of the problem, and now with low carb foods and that, she may be moving toward being "diet-controlled" as my boy Herb is, and former foster Chloe was. My mom is dealing with the same thing - her BG was over 500 and now she's holding about 110... primarily because of a change in her diet.

Keep up testing, and reducing as needed. Data is knowledge!
 
Grayson & Lu said:
Lost my post...

Reader's Digest version: Good job! Good choice of reduction. I think the infection is clearing. It may be that that was the source of the problem, and now with low carb foods and that, she may be moving toward being "diet-controlled" as my boy Herb is, and former foster Chloe was. My mom is dealing with the same thing - her BG was over 500 and now she's holding about 110... primarily because of a change in her diet.

Keep up testing, and reducing as needed. Data is knowledge!
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Thanks, Lu - Given her AMPS, I fed her --- & would doing an "overlap" now, shooting 1.5U be ok? (As her AMPS is actually a +10)
 
Ummm. Might want to attenuate it just a touch - say 1.0 to 1.25, since you are reducing and more overlap tends to act like maintenance or increase of a dose. It might wobble high for a bit, then stabilize as you get on your regular schedule.
 
Followed my gut and gave her 1.5U at her +10 (@ 8:10 a.m.) since her BG was already well up there. Ha, I think Bat-Bat got waaaay more sleep than I did overnight.

Thought just occurred to me: She's been low-carb since her first dx in 2013, and ever she went OTJ that Oct., I had been dividing her daily ration of Purina dm into THREE feedings per day (7:30 am/ 3:30 pm/ 10:30 pm) all along. Am wondering if switching her to just two feedings/day since starting Pro Zinc may have factored into her bottoming out on us by pre-shot time last evening. (She was getting the proper amount of food then, too, just in 2 larger portions.) I guess doing a full curve today will give me a better idea of what's happening as regards to timing of food, & whether this dose reduction turns out to be spot-on regardless of how I divide up her daily ration.

Thank goodness I took Sue's wise advice last night to heart --- because if I had only reduced her by 0.5 unit (my dumb idea!), last night could have been "get-out-the-Karo" time, instead of just steering her with small snacks after her +2 and +3 tests ... even so, was kind of a nail-biter until we hit that +6.
 
BJM said:
Ummm. Might want to attenuate it just a touch - say 1.0 to 1.25, since you are reducing and more overlap tends to act like maintenance or increase of a dose. It might wobble high for a bit, then stabilize as you get on your regular schedule.
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See my earlier post. I'll check her at +2, unless you think I should check sooner. But she doesn't seem to metabolize her food all that quickly after a meal ...
 
Glad she did well last night. Sorry she did better than you did. :( I'm with LuAnn. I think things are changing and so her insulin needs may be harder to predict for awhile. If the infection is clearing and the insulin starting to work for her, that original dose of 2.5 may be too much, even for numbers that were okay with that dose earlier. A curve is a great idea.

So now you know 1.5 on a yellow is going to give you safe, nice numbers where 2.5 gave you the same range a few days ago. And 2.5 on a 300+ is now too much. I would guess this morning might be a little bounce but your dose looks okay and you will monitor. BJ has a good point about the overlap but you'll be watching.

Good job last night! Every time you have to figure out what dose might be safe, you learn a little bit more about the insulin and how it works for her.
 
Sue and Oliver (GA) said:
Glad she did well last night. Sorry she did better than you did. :( I'm with LuAnn. I think things are changing and so her insulin needs may be harder to predict for awhile. If the infection is clearing and the insulin starting to work for her, that original dose of 2.5 may be too much, even for numbers that were okay with that dose earlier. A curve is a great idea.

So now you know 1.5 on a yellow is going to give you safe, nice numbers where 2.5 gave you the same range a few days ago. And 2.5 on a 300+ is now too much. I would guess this morning might be a little bounce but your dose looks okay and you will monitor. BJ has a good point about the overlap but you'll be watching.

Good job last night! Every time you have to figure out what dose might be safe, you learn a little bit more about the insulin and how it works for her.
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Thanks, Sue! Is funny how adrenalin can substitute quite nicely for coffee in the middle of the night. :nailbiting: (Bat-Bat was unfazed throughout.)

Kinda knew what kind of an AMPS I'd get today when she actually jumped up on the kitchen chair and assumed the position for her BG check - she was ready for her breakfast!
 
For only her fourth cycle seeing green (that you know of), 333 isn't too big of a bounce. Thinking she likes the dose.

One thought about the food. Some vets still believe 2 meals a day is good. Well, Grayson was a ravenous boy. And so is Spartacus and Herb. They used to free-feed. So pretty much every time I go in where they eat, if they seem interested, I put a little food down. Grayson had a Pet-Safe 5 auto-feeder. I programmed it to rotate it's tray for a 1/4 can of FF at +2, +4, +6, and +8. The thought behind that is that if they have a steady eating schedule you minimize the food spikes in his numbers. Just like with human diabetics, you want multiple healthy mini-meals throughout the day. The feeder was set at the same times overnight (you could program 9 different times in a 24 hr period)... that way, he didn't wake me up to feed him. He LOVED his feeder!!! He also knew when it was about to rotate, and would sit in front of it waiting!!!

Got the feeder at local Petsmart - they price-matched the online Petco ad I brought with. $49 (saved $15!) Don't ever be reluctant to ask - worst thing they can do is say no - but most of the time, you'll end up saving considerably!
 
Grayson & Lu said:
For only her fourth cycle seeing green (that you know of), 333 isn't too big of a bounce. Thinking she likes the dose.

One thought about the food. Some vets still believe 2 meals a day is good. Well, Grayson was a ravenous boy. And so is Spartacus and Herb. They used to free-feed. So pretty much every time I go in where they eat, if they seem interested, I put a little food down. Grayson had a Pet-Safe 5 auto-feeder. I programmed it to rotate it's tray for a 1/4 can of FF at +2, +4, +6, and +8. The thought behind that is that if they have a steady eating schedule you minimize the food spikes in his numbers. Just like with human diabetics, you want multiple healthy mini-meals throughout the day. The feeder was set at the same times overnight (you could program 9 different times in a 24 hr period)... that way, he didn't wake me up to feed him. He LOVED his feeder!!! He also knew when it was about to rotate, and would sit in front of it waiting!!!

Got the feeder at local Petsmart - they price-matched the online Petco ad I brought with. $49 (saved $15!) Don't ever be reluctant to ask - worst thing they can do is say no - but most of the time, you'll end up saving considerably!
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Thanks for the feeder tips, Lu! Just checked her +8 BG; at 330, looks like we're, indeed, still doing a bit of a bounce today. Am hoping that settles down - maybe tomorrow, if we're lucky. Now I'm feeling really hesitant about any change in her dose. Usually you try to hold it for 3 days, am I right? So tell me:
If we're hitting 300s only at AMPS & PMPS, and getting at least into the blues mid-cycle, does being in the blues help her pancreas recover some?

Hate to sound like a nervous-Nellie, but I'm dreading doing a test @ +10, fearing she'll be in the 400s by that time. Yet it sounds like attempting any overlap could just make things even more complicated, in the long run. The good news is her water intake is well within normal limits; she's only had about 2/3 oz. since 8:30 last night.

Would appreciate any thoughts that any of you (the Pro Zinc pros!) can offer me before it's time for PMPS. :)
 
It's hard to tell whether she is still adjusting after the long, low cycle or whether the 1.5 isn't quite enough for a 300+. Depends. You could try a fat 1.5 for the pmps or 1.75 if you feel adventurous (Fat is when you draw up more than 1.5 but not up to 1.75) I would plan to get at least a before a bed test if you increase. If you aren't adventurous, you are more likely to get a full 8 hours?
 
Yeah, I'm not sure what is going on. Will you be able to test overnight? Considering the long night last night, I realize you may need a bit more sleep tonight. I agree with Sue's dose thoughts....it's really up to you, but those options both sound good.

As for feeding, my babies all free feed. I tried meal feeding when I first started wet food, but no one ate all the food at once. Mine like to eat a bit, go away, eat some more, go away, etc. They usually finish it all sometime in the 12 hour period. Leaving food out meant that they got enough, and if Gypsy needed a bit of food to help steer her numbers from going to low, she could grab some. I was also considering a petsafe feeder, but never got around to it.
 
Thanks, Sue & Rachel. I got a +10 BG of 352, so I think I should definitely go with your suggestion re: a fat 1.5 tonight & monitor. (But not full curve.) Depending on what we see for AMPS, maybe a 1.75 in the morning? Thoughts on how many times/ when to test tonight?

*UPDATE* Just got a 373 BG PMPS.
 
Ok, I just gave her a fat 1.5U - really closer to a 1.75U - at 8:14 pm.
Given high 300s now, am thinking we might do okay just with checks at +4 & +6 overnight, unless she trends super-low at those hrs (then I'd steer with a little food & recheck after 30 min.)
 
A fat 1.5 sounds like a plan! I'm not sure what your time frame looks like...will you be up for a bit? Could you grab a +3 before bed maybe? That might tell you where she's headed overnight and give you an idea of when else to test. I always like a good +3 since food influence usually wears off then and you can see if you're in for an active night or maybe a calmer one where you can get more sleep. Beyond that, depending on that number, maybe a nadir? That way, you see how that dose affects her.

Just saw you posted while I'm posting lol. Yeah, +3 or +4 should work...whatever is better for you really. Then you can decide from there!

I think a 1.75 in the morning could be good depending on the number. I'd say if in the upper 200s or in the 300s go for it if you can monitor ( I know, I know, that's all we ever say!)
 
Until we get this under control, I'm Bat-Bat's slave! :)
Thanks for the good counsel tonight, Rachel & Sue - you've helped me feel much less unnerved by this whole wonky cycle she's going through.
 
Relieved to see some better #s overnight & this AMPS, so gave her equal to/ slightly fattened 1.75 this morning - as it appears she does somewhat higher daytime #s in general. Will check her today a couple of times, @ +4 and +7. Will scout the local pharmacies today for a Precision Xtra meter so I can test for blood ketones weekly.
 
Forgot to add: Bat-Bat was actually scampering up & down the hallway today before breakfast ... for the first time since starting treatment.
(Spending less time asleep now, too.) Maybe we're starting to turn the corner. :joyful:
 
Vet called last night: said Bat-Bat could go to 2.0, but agreed that "inching" her in that direction is prudent, given her wild weekend bouncy thing. He was REALLY impressed at the savvy guidance all of you gave me over the weekend to help me ease her out of that bounce. Thanks again for walking me through it, and for your patience with someone who is only now learning that ProZinc behaves rather differently in her system than Lantus had.

FYI, the change in dose this a.m. is just a slight bit more than what she had last 2 injections, moving more to a "skinny" 2.0 rather than a "fat" 1.75. Will see what that does for her around nadir today. (I guess slow & steady really does win the day, huh?)
 
Yep. Sometimes just that little "fat" or "skinny" makes the difference.

I just bought some long needles (I prefer short) last night for Spartacus. His skin is SO thick, I think that's been part of his recent problem. We'll see. First dose with them seemed to make a difference. It's those little things that can!
 
Robin - can you change your font color for the blues to white or a lighter color so it's legible? You should be able to click on the uppermost left corner which hightlights the entire SS, then format, then conditional formatting, then font color. Or you can change the blue to a lighter blue so the black font is visible. (I use pastels because they print easier to read).

Thanks!
 
Grayson & Lu said:
Robin - can you change your font color for the blues to white or a lighter color so it's legible? You should be able to click on the uppermost left corner which hightlights the entire SS, then format, then conditional formatting, then font color. Or you can change the blue to a lighter blue so the black font is visible. (I use pastels because they print easier to read).

Thanks!
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I tried, in conditional formatting - it's not applying the new rule. So must be doing something wrong. Will try to get it figured out tomorrow, but right now am dealing with dosing conundrum for Bat's pm shot. (Am about to post on other thread.)
 
You're climbing, so if you're still awake, and the time isn't going to really mess with your schedule, I would be inclined to do a token dose of .5 u. 1.5 appears to be a little too much, but if you can get SOME insulin on board you'll have less of a recovery. If you've gone to bed already, then I would still be considering a reduction in the morning.
 
Grayson & Lu said:
You're climbing, so if you're still awake, and the time isn't going to really mess with your schedule, I would be inclined to do a token dose of .5 u. 1.5 appears to be a little too much, but if you can get SOME insulin on board you'll have less of a recovery. If you've gone to bed already, then I would still be considering a reduction in the morning.
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Hi, Lu - Bat had actually been reduced to 1.0U (see other thread w/ 3 BG #s in title) but 2 things were happening: going hypo and hanging onto the insulin way past 12 hrs. Even after a full meal @ noon, looked like she never got above 230 & was actually dropping to 220 at time of PMPS. I thought about doing .5 tonight, but vet said to wait until morning; that even if she spikes high by then, better not to risk a hypo overnight.

I do expect she'll need that 0.5u by morning, though.
 
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