? PMPS going down from +11, to 153. Tempted to just skip tonight's dose and starting in the morn?

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StarburstMom

StarburstMom

Member Since 2021
Starburst has been coming down to the blues nicely the past few days. We are getting close to AMPS (am hour away) and she will likely be < 200 for that. We stalled a few days ago but the following cycle she never went below 200. It appears the duration is lasting longer, almost too long.
Based on her SS do you think she can "shoot low numbers" (if I'm understanding that right....giving a dose under 200 PS) or is it too soon to tell?

@JanetNJ
 
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I’m not a Prozinc user so hopefully one will be along soon.
Have you read the SLGS Prozinc method?
From the SLGS Prozinc method:
Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
    • a.) give nothing
    • b.) give a token dose (10-25% of the usual dose)
    • c.) feed as usual, test in a couple of hours, and make a decision based on that value
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
  • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
 
Bron and Sheba (GA) said:
I’m not a Prozinc user so hopefully one will be along soon.
Have you read the SLGS Prozinc method?
From the SLGS Prozinc method:
Until you collect enough data to know how your cat will react, we suggest following the guidelines in the FDMB's FAQ Q4.4:
Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options:
    • a.) give nothing
    • b.) give a token dose (10-25% of the usual dose)
    • c.) feed as usual, test in a couple of hours, and make a decision based on that value
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
  • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.
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Yes I read it, thanks, about 100 times. However it conflicts with a different suggestion to stall (no food) and test in a different part of the document.
 
Your lowest preshot to date is 197 a couple of days ago which is 25 points higher than 172.
It is up to you whether you give the full dose or a reduced dose.
Also consider if you are going to be able to monitor the whole cycle and have plenty of test strips and higher carb food.
I’m not going to be around as it’s late here in Australia.
 
I'm of the old school shoot low to stay low philosophy. With the Libre, you have a ton of test data. If you are comfortable, then shoot. However, before you do so, what does the notation in your dose column mean (i.e., 3.4 (U100 - 8.5))? I'm assuming you're using a U40 syringe? If you're shooting that large of a dose, I would stall and see if numbers are spontaneously rising.

Have you considered having Starburst tested for a high dose condition. We typically suggest testing once the dose is over 6.0u (on a U100 basis).
 
Sienne and Gabby (GA) said:
I'm of the old school shoot low to stay low philosophy. With the Libre, you have a ton of test data. If you are comfortable, then shoot. However, before you do so, what does the notation in your dose column mean (i.e., 3.4 (U100 - 8.5))? I'm assuming you're using a U40 syringe? If you're shooting that large of a dose, I would stall and see if numbers are spontaneously rising.

Have you considered having Starburst tested for a high dose condition. We typically suggest testing once the dose is over 6.0u (on a U100 basis).
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She is currently at 3.4U of Prozinc, but I've had questions of how it can be 3.4 so I added that notation to try and explain that I am measuring using a U100 syringe. Based on the conversion chart 8.5 U100 syringe=3.4 U40. I can add the word syringe in that box to make it clearer as I keep getting this question and am not sure the best way to address it preemptively.
I did go ahead and dose her, BG was 186 at ~ 12.75. I will be home all day and hopefully the libre won't stop today.
Thanks
 
What I would suggest is to put a note in your signature. Hopefully, people will notice and stop repeatedly asking you what the info in the dose column means. I did the math so I kinda figured out what was going on.
 
Sienne and Gabby (GA) said:
What I would suggest is to put a note in your signature. Hopefully, people will notice and stop repeatedly asking you what the info in the dose column means. I did the math so I kinda figured out what was going on.
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Sorry, I hope it didn't come across as complaining about being asked, because I'm glad you all want to understand what that meant. I will add it to my signature and did add it to the insulin line at the top of the SS.
I also keep forgetting that with the Libre I am continuously monitoring her so as long as it doesn't tank I can catch a hypo. That should impact how comfortable I am with these choices. Seeing curves and trends is pretty cool (I work in data analysis so I love data and trends and such).
 
Bron and Sheba (GA) said:
Hope you and Starburst have a good day. I figured you were using the conversion chart when using the U100 syringes.
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Thank you for your help! I am getting more confident in general but these lower preshots are a new thing. She barely broke 100 a few days ago so I hope she won't go too low. And oh my gosh she was so hungry, ate like a racehorse.
You have a great night!
 
@Sienne and Gabby (GA) @JanetNJ
If these insulin durations keep spilling into the next cycle, is that signaling a needed dose reduction or is a BG under 90 the only indicator to reduce dose? Something has really changed (breakthrough dose?) with her the past few days that is keeping her pretty low and not swing so high like before....but now I feel like I'm hoping the duration would shorten a tad.
 
It may be a break through dose. However, having the duration is a good thing. It keeps the cycles flatter, It likely wouldn't be quite as noticeable if you weren't using the Libre.

One other possibility is that Starburst does have a high dose condition. If she has insulin auto-antibodies, the condition is time limited. Once you get ahead of the antibodies, insulin requirements can change abruptly.

I'm tagging @Wendy&Neko so she can have a look.
 
Sienne and Gabby (GA) said:
It likely wouldn't be quite as noticeable if you weren't using the Libre.
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This leads to another question (sorry, I always have questions). I just scanned her and she is 89. Her actual reading is due in 15 minutes so if this is the nadir (and we weren't using the Libre) it likely wouldn't have been caught using standard BG testing. Does the 89 on a Libre still require a 0.25 reduction (would have to be either 0.2 or 0.4 with my dosing setup)?
Thanks for the info
 
Well, you don't know if the reading would have been missed. It looks like Starburst was 88 at +7. So, that's a dose reduction. With Prozinc dosing, people are generally using a U40 syringe. You want the closest reduction that is equivalent to 0.25u. Have you considered getting UU40 syringes so you don't drive yourself crazy with the adjustment for a U100 syringe?
 
Sienne and Gabby (GA) said:
Well, you don't know if the reading would have been missed. It looks like Starburst was 88 at +7. So, that's a dose reduction. With Prozinc dosing, people are generally using a U40 syringe. You want the closest reduction that is equivalent to 0.25u. Have you considered getting UU40 syringes so you don't drive yourself crazy with the adjustment for a U100 syringe?
Click to expand...
She went further to 76 at 7.25 so it would seem 89 was not the nadir.
I bought 200 syringes that are U100 because they are smaller gauge and needle length and I didn't see any U40 like that without a prescription at the time. Eventually I will switch back over but I gotta use these syringes first.
 
You might be able to find someone who would buy the syringes from you!

FWIW, it may help to remember that there's 20% variance with any test due to the meter and/or the strips. The difference between 76 and 89 is negligible - they are pretty much the same number. Either way, it means that Starburst gets a dose reduction!
 
@JanetNJ @Sienne and Gabby (GA)
Starburst was heading up like expected this afternoon but at 11 she had 175 and now seems to be at 153, I know this is likely variance and essentially the same reading, BUT with the hour stall this morning this curve is like a phantom curve of her normal shot time. I don't know. Anyway it looks kinda cool (again I haven't given her her PM dose yet)
https://linksharing.samsungcloud.com/rKTESdQQ5eDf
So I don't want to shoot low again after her getting down to 76 unless she truly doesn't move in the next few hours. I know the ProZinc guidelines recommend reducing shot to 25% as an option in these cases but in all the threads I've looked at it seems the concensus is more in line with 50-75% of normal dose. Has that been a change that just hasn't been updated in the dosing sticky?
 
StarburstMom said:
I'm tempted to skip the dose and start at 3.2 again in the morning.
@Bron and Sheba (GA) can you look at my previous post and this one...do you think one option is better than another at this point?
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Wait until an hour past. I wouldn't totally skip, but you could reduce a bit (2-2.5 maybe) if the number still is on the low side. If it's over 200 I'd shoot 3-3.2
 
JanetNJ said:
Wait until an hour past. I wouldn't totally skip, but you could reduce a bit (2-2.5 maybe) if the number still is on the low side. If it's over 200 I'd shoot 3-3.2
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@JanetNJ she's holding steady so far (164 just now). Ok, at +1 past I'll give her 2 if she doesn't come up to 200. Thank you
 
Looks like the 2 u was a good call.... She stayed nice and steady. I didn't want to see you skip and then she's back in the pinks. Good job. :)
 
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