Poncho... Another strange pre shot BG # What to do next???
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Hillary & Maui (GA)
Member Since 2009
which insulin are you using?
I see you are skipping a lot of shots AND changing the dose with each shot. Honestly there is no need to do either of these things.
Before I answer more, please advise which insulin you are using and are you TID or BID dosing? As I see you have done both.
I see you are skipping a lot of shots AND changing the dose with each shot. Honestly there is no need to do either of these things.
Before I answer more, please advise which insulin you are using and are you TID or BID dosing? As I see you have done both.
christoph
Member Since 2015
I'm using Prozinc. My new vet just started me doing a curve and staying with fixed 1 unit dose when shootable. 1st curve attempted day before yesterday with unexpected +12 number. Last night I was worried I gave a little too much insulin so retested and fed every 2 hrs 20 ml Hills ad and expected a shootable +12 number to begin 2nd curve. Using BID spread sheet.
Hillary & Maui (GA)
Member Since 2009
OK -- all the numbers you have ARE shootable numbers.
The don't shoot if below 200 is only for new people, just starting out and unsure what they are doing. You have been doing this for a while and are testing, there is no reason why you can't shoot consistently.
So, here's the rule of thumb:
1) if BG drops below 50 - reduce the dose by 1/4 unit
2) if BG stays high and consistent without any changes after 6 cycles (3 days), increase dose by 1/4 unit
3) if pre-shot test is above 50 and you will be home to monitor and test - give regular insulin dose
4) if pre-shot test is below 50 and you won't be home to monitor - skip shot
5) if you are uncertain, give a token dose (such as 1/2 of normal dose)
Bottom line - give insulin consistently and don't skip shots
The don't shoot if below 200 is only for new people, just starting out and unsure what they are doing. You have been doing this for a while and are testing, there is no reason why you can't shoot consistently.
So, here's the rule of thumb:
1) if BG drops below 50 - reduce the dose by 1/4 unit
2) if BG stays high and consistent without any changes after 6 cycles (3 days), increase dose by 1/4 unit
3) if pre-shot test is above 50 and you will be home to monitor and test - give regular insulin dose
4) if pre-shot test is below 50 and you won't be home to monitor - skip shot
5) if you are uncertain, give a token dose (such as 1/2 of normal dose)
Bottom line - give insulin consistently and don't skip shots
Hillary & Maui (GA)
Member Since 2009
Have you been to the PRozinc forum and read the stickies?
http://www.felinediabetes.com/FDMB/threads/protocol-for-prozinc-pzi.109077/
http://www.felinediabetes.com/FDMB/threads/protocol-for-prozinc-pzi.109077/
Critter Mom
Member Since 2014
For information, Poncho threw ketones a couple of weeks ago and threw them again in the last couple of days. Here's the link to the thread about the latest ketone incident:
http://www.felinediabetes.com/FDMB/threads/urgent-help-poncho-ketones-moderate-range.134489/
.
http://www.felinediabetes.com/FDMB/threads/urgent-help-poncho-ketones-moderate-range.134489/
.
christoph
Member Since 2015
Hillary & Maui (GA)
Member Since 2009
If he is ketone prone - that is another reason, why you don't want to skip shots!
Grayson & Lu
Member Since 2012
ProZinc protocol:
Starting Doses
The recommended starting dose for ProZinc or BCP PZI is .5 units or one unit twice daily. It is suggested that if the initial numbers are high, doses can be changed every three cycles, increasing by .5 at a time. If the initial numbers are in the 200-300 range at preshot and midcycle (nadir) numbers are not too low (not 50 and under), increases can be made .25 units at a time. During this early period, especially if wet low carb food is replacing higher carb dry, monitoring is very important. Insulin plus a diet change can result in sudden low numbers or in a gradual lowering of numbers overall, depending on the cat.
Over time, as data is collected and nadir numbers are available, doses can be adjusted more confidently.
If the cat is in the 250+ range at preshot and does not drop 50% or more for nadir, a small adjustment could be considered, if monitoring is possible.
If the cat is in the 250+ range at preshot and drops below 50% at nadir, bouncing is a possibility (bouncing occurs when the cat’s body perceives a drop that is below what has been occurring and releases extra glucose, resulting in an “artificial” rise in numbers) Bouncing most often involves a lower midcycle number than the cat has experienced previously. If bouncing is suspected, any increases in doses should be tiny and monitored carefully.
If the cat is high and flat during the entire cycle, the dose could be raised .5 units, as long as monitoring is possible.
ProZinc and PZI are unique in that they can be dosed in two ways, depending on how the car responds. Some cats seem to do best if a specific dose is held for several cycles. It seems to take that long for their numbers to really change. Some cats respond to a sliding scale, getting a different dose for different preshot numbers. Collecting data will help you see which regiment works best for your cat. If you need help with a sliding scale, ask people on the PZI forum to guide you.
Low Preshot Numbers
The general recommendation for new diabetics is not to shoot a preshot under 200, but to wait 20 minutes (without feeding as food raises blood glucose levels) and retest. If the number is rising and above 200, then a shot can be given with perhaps a little less insulin given.
If midcycle (nadir) numbers are in the 40-50 range, the cat should be carefully monitored for the next couple of hours with tests given every 30 minutes as long as the cat stays low. First small amounts of low carb food can be given to raise the blood glucose levels. If that doesn’t raise the levels, higher carb food should be given. If the levels are dropping and below 40, then honey can be put directly on the cat’s gums. If the numbers still aren’t rising, a trip to an emergency vet is probably necessary.
If one preshot is above 200 and shootable, and one preshot is too low to shoot, it probably means the dose is a little too high and lasting more than the usual 12 hours. Try reducing by at least .25 to see if you get two shootable preshot numbers (ideal) rather than one that is too high and one that is too low to shoot (not ideal)
If you are using U40 syringes and find yourself trying to eyeball doses under .5, you may want to consider using U100 needles and the conversion chart. (Conversion chart) This will allow you to give mini doses.
It is important to test for ketones regularly, at least once weekly even if the cat is eating well and has no infection present. Test daily if any infection is present, the cat is not eating well and/or is in higher ranges. Testing for ketones can catch DKA early. Cats with DKA should be seen immediately by a vet.
Starting Doses
The recommended starting dose for ProZinc or BCP PZI is .5 units or one unit twice daily. It is suggested that if the initial numbers are high, doses can be changed every three cycles, increasing by .5 at a time. If the initial numbers are in the 200-300 range at preshot and midcycle (nadir) numbers are not too low (not 50 and under), increases can be made .25 units at a time. During this early period, especially if wet low carb food is replacing higher carb dry, monitoring is very important. Insulin plus a diet change can result in sudden low numbers or in a gradual lowering of numbers overall, depending on the cat.
Over time, as data is collected and nadir numbers are available, doses can be adjusted more confidently.
If the cat is in the 250+ range at preshot and does not drop 50% or more for nadir, a small adjustment could be considered, if monitoring is possible.
If the cat is in the 250+ range at preshot and drops below 50% at nadir, bouncing is a possibility (bouncing occurs when the cat’s body perceives a drop that is below what has been occurring and releases extra glucose, resulting in an “artificial” rise in numbers) Bouncing most often involves a lower midcycle number than the cat has experienced previously. If bouncing is suspected, any increases in doses should be tiny and monitored carefully.
If the cat is high and flat during the entire cycle, the dose could be raised .5 units, as long as monitoring is possible.
ProZinc and PZI are unique in that they can be dosed in two ways, depending on how the car responds. Some cats seem to do best if a specific dose is held for several cycles. It seems to take that long for their numbers to really change. Some cats respond to a sliding scale, getting a different dose for different preshot numbers. Collecting data will help you see which regiment works best for your cat. If you need help with a sliding scale, ask people on the PZI forum to guide you.
Low Preshot Numbers
The general recommendation for new diabetics is not to shoot a preshot under 200, but to wait 20 minutes (without feeding as food raises blood glucose levels) and retest. If the number is rising and above 200, then a shot can be given with perhaps a little less insulin given.
If midcycle (nadir) numbers are in the 40-50 range, the cat should be carefully monitored for the next couple of hours with tests given every 30 minutes as long as the cat stays low. First small amounts of low carb food can be given to raise the blood glucose levels. If that doesn’t raise the levels, higher carb food should be given. If the levels are dropping and below 40, then honey can be put directly on the cat’s gums. If the numbers still aren’t rising, a trip to an emergency vet is probably necessary.
If one preshot is above 200 and shootable, and one preshot is too low to shoot, it probably means the dose is a little too high and lasting more than the usual 12 hours. Try reducing by at least .25 to see if you get two shootable preshot numbers (ideal) rather than one that is too high and one that is too low to shoot (not ideal)
If you are using U40 syringes and find yourself trying to eyeball doses under .5, you may want to consider using U100 needles and the conversion chart. (Conversion chart) This will allow you to give mini doses.
It is important to test for ketones regularly, at least once weekly even if the cat is eating well and has no infection present. Test daily if any infection is present, the cat is not eating well and/or is in higher ranges. Testing for ketones can catch DKA early. Cats with DKA should be seen immediately by a vet.
Grayson & Lu
Member Since 2012
My "Do not shoot" number on ProZinc was 250, though my vet told me I could've shot a 180. Grayson's first month was a roller-coaster, so I would always err on the side of caution. He was also ketone prone, so I needed to find a good balance. I would NEVER shoot ProZinc on anything less than 150 unless I had several months of data AND would be around.
ProZinc generally is shot with consistent dosing. When the kitty's number zooms after +8 (like 100-200 points), you could consider TID dosing... but that is assuming you are getting the 50-60% drop from preshot to nadir, and +8 is near your preshot range. Kim and Nancy (long time members), each shot TID. Most others have been on 12 hr schedules. However, ProZinc can be used with a sliding scale. I think it's too early for you to try something like that, but the sliding scale and an 11/13 schedule may be options after you've been at it for awhile and have enough data to justify doing so.
I know you've been at it for about 6 weeks, but I would still be conservative. One thing, however, that I would do, is avoid skipping, if possible. I found a token dose, even 25-50% IF THEY ARE RISING, would keep them in better numbers for the next cycle. I felt like we would lose ground if we skipped. Just my 2 cents.
Lu-Ann
ProZinc generally is shot with consistent dosing. When the kitty's number zooms after +8 (like 100-200 points), you could consider TID dosing... but that is assuming you are getting the 50-60% drop from preshot to nadir, and +8 is near your preshot range. Kim and Nancy (long time members), each shot TID. Most others have been on 12 hr schedules. However, ProZinc can be used with a sliding scale. I think it's too early for you to try something like that, but the sliding scale and an 11/13 schedule may be options after you've been at it for awhile and have enough data to justify doing so.
I know you've been at it for about 6 weeks, but I would still be conservative. One thing, however, that I would do, is avoid skipping, if possible. I found a token dose, even 25-50% IF THEY ARE RISING, would keep them in better numbers for the next cycle. I felt like we would lose ground if we skipped. Just my 2 cents.
Lu-Ann
christoph
Member Since 2015
Unfortunately the vets I've been using had no shoot zones. Most of what useful info I've learned has been from this forum. I wish I had known about it before the damage was done. I just pray I can turn things around. I was able to get good advice lately from a vet I used in St Louis for many years.
christoph
Member Since 2015
Thanks for all the good info. Thanks to this forum I have some working knowledge. I did finally get some good advice from my old vet.....pretty much in sync with the forum, although he did have a no shoot zone of <150 which I wont follow.
Critter Mom
Member Since 2014
And we'll pray with you, Christoph. I'm really glad that you have such a great relationship with your St Louis vet and that he's helping you now.
christoph
Member Since 2015
Thanks Aine. Actually my old vet steered me in the right direction esp. with curving and some education on ketones and said good luck.....so that's the last time I feel comfortable asking him for help.....he's a busy vet and a great guy. He's in it more for the animals and their owners than $$$.
Hillary & Maui (GA)
Member Since 2009
Well glad you are now learning and will start shooting the numbers you get, especially as you don't want ketones to happen again or turn into DKA.
When you have time, take a look at other's spreadsheets and you will see that people do shoot the lower numbers.
When you have time, take a look at other's spreadsheets and you will see that people do shoot the lower numbers.
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