? Prozinc dosage and glucose after hypo episode on Saturday night

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Nervous Pervis and Terri

Nervous Pervis and Terri

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I'm posting on this board since Nervous Pervis is just getting back on his ProZinc after a hypo episode on Saturday night. I just did his very first tests beginning on Saturday, and discovered that his numbers were in the low 30s. He just returned from an overnight stay the ER vet on Sunday night and I started back on ProZinc at around .75u dose this morning. The ER vet prescribed Lantus, which I just ordered that today, so it will be a few days or a week before I receive it and start him on that. He was just diagnosed in late January and was already up to 8u twice a day and I was told by alot of people on the main forum that was a lot of insulin for a newly diagnosed cat and they were right. Being a newbie, I had no idea.

Today his AMPS number was 491 and the low was 357 at +4. I also started to increase of his FF canned food to around a teaspoon mixed with his dry food. He was previously getting just around 1/2 teaspoon 2x/day, but he really wasn't eating all of the canned food.

My question is on his dosing. I am going to give him around .75u again this evening. I only have u40 syringes and need to get different syringes and convert, so I can measure more precisely. How long do I continue at the .75u dosage? Will there be an issue switching him immediately from ProZinc to Lantus or is that something that is a gradual change? I'm going to post on the Lantus forum too.

Any advice you can provide would be helpful.

Thanks so much. The FDMB saved Pervis.
 
We put together a protocol for ProZinc. It is in my signature in blue. Changing diet can make a big difference (100 points lower overnight for my cat) so it's good you are staying on top of his numbers

You might stay with 0.75 for another cycle. Then, on the first cycle you can monitor, increase to one unit

You want a shootable pre shot (over 200 to start) with a nadir (low point in the cycle) above 50 with a human meter and 68 on a per meter. That's your first goal - regulated numbers

You are doing great. It's wonderful that you caught the low number!

Let us know how we can help
 
Sue and Oliver (GA) said:
We put together a protocol for ProZinc. It is in my signature in blue. Changing diet can make a big difference (100 points lower overnight for my cat) so it's good you are staying on top of his numbers

You might stay with 0.75 for another cycle. Then, on the first cycle you can monitor, increase to one unit

You want a shootable pre shot (over 200 to start) with a nadir (low point in the cycle) above 50 with a human meter and 68 on a per meter. That's your first goal - regulated numbers

You are doing great. It's wonderful that you caught the low number!

Let us know how we can help
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Okay, I'll stay at the .75 for another cycle. I am monitoring his numbers today, posting them on my spreadsheet, and am trying, but not succeeding at testing every hour. I am doing the pre shot testing, but like most people, I go to work, so I won't be able to test throughout the day forever.

Thanks for your input.
 
I never could test throughout the day. I used to run a curve every couple of weeks (testing every 2 hours) on a weekend day. However, it's not necessary to do that every day. I'd recommend testing at mid cycle (nadir) whenever you can, but I usually could only get that on weekends or occasionally overnight. We do what we can. :)
 
Clearly he needs more than 0.75. Lowering the dose from 8 units to 0.75 was probably too drastic a reduction but I am sure you were erring on the side of caution. I would raise the dose by 0.5 every 3 cycles any cycle you can monitor at the beginning and near nadir - as long as he stays in the Reds and blacks (This testing while moving the dose may need to be at night - a before bed test just to be sure there isn't a fast drop, and then setting an alarm at night 5-7 hours after the shot - unless you are a person of a certain age and up then anyway). You don't need to test every hour. As Rachel says, pre shot and nadir with a curve every few weekends is usually enough to see what is happening. While you are raising the dose, a nadir would be important to see how the dose is working before you increase.

It is important he not sit in these high ranges and moving up the dose in a measured, monitored fashion is likely best. Does that make sense?
 
Rachel said:
I never could test throughout the day. I used to run a curve every couple of weeks (testing every 2 hours) on a weekend day. However, it's not necessary to do that every day. I'd recommend testing at mid cycle (nadir) whenever you can, but I usually could only get that on weekends or occasionally overnight. We do what we can. :)
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Good to know. Pervis will be grateful for that. He fights me a bit, but doesn't hiss or bite, he just gives a pitiful, deep 'oh crap' moan.
Sue and Oliver (GA) said:
Clearly he needs more than 0.75. Lowering the dose from 8 units to 0.75 was probably too drastic a reduction but I am sure you were erring on the side of caution. I would raise the dose by 0.5 every 3 cycles any cycle you can monitor at the beginning and near nadir - as long as he stays in the Reds and blacks (This testing while moving the dose may need to be at night - a before bed test just to be sure there isn't a fast drop, and then setting an alarm at night 5-7 hours after the shot - unless you are a person of a certain age and up then anyway). You don't need to test every hour. As Rachel says, pre shot and nadir with a curve every few weekends is usually enough to see what is happening. While you are raising the dose, a nadir would be important to see how the dose is working before you increase.

It is important he not sit in these high ranges and moving up the dose in a measured, monitored fashion is likely best. Does that make sense?
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Makes total sense. His AMPS was 424 this morning and he was at 220 at +2 this morning.
 
That 220 is encouraging and an early drop. Maybe 0.75 isn't so terribly low....let's see what his nadir looks like (if you can get a number in the +5-7 range). Dropping 50% at +2 might mean it will be an active cycle and he could possibly drop lower later or he could bounce up from a low he is not used to...

Generally we think a cat is regulated (the first step in this sugar dance) when he is in the mid 200s at preshot and double digits at nadir (but not below 50 on a human meter or 68 on a pet meter - ranges approaching hypo, as you know).
 
Sue and Oliver (GA) said:
That 220 is encouraging and an early drop. Maybe 0.75 isn't so terribly low....let's see what his nadir looks like (if you can get a number in the +5-7 range). Dropping 50% at +2 might mean it will be an active cycle and he could possibly drop lower later or he could bounce up from a low he is not used to...

Generally we think a cat is regulated (the first step in this sugar dance) when he is in the mid 200s at preshot and double digits at nadir (but not below 50 on a human meter or 68 on a pet meter - ranges approaching hypo, as you know).
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I wasn't able to get a +5-7 number today, but tonight his PMPS was 231. I'll test it at +2
 
@Sue and Oliver (GA)
I had originally suggested the low dose out of concern for increased sensitivity to the insulin following the hypo, plus she's working on the food transition which can drop 100-200 mg/dL off the numbers in some cases.

@Nervous Pervis and Terri
If the canned food isn't going well, you might try Young Again (internet only) or Evo Cat and Kitten Dry.
 
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@BJM it looks like that is going to be a pretty good call. I am surprised dropping from 8units to less than one, even with the hypo, got such good numbers.

Terri, if he is under 200 in the morning, stall instead of giving the shot. Wait 20 minutes without feeding, to be sure he is rising and above 200. Even then, you might reduce the dose to 0.5. He is responding very well to a low dose.
 
Probably not. Often cats go up a little after the shot, usually a reaction to the food. And meters are considered to have a 20% variance either way on the same spot of blood. So a rise of just 30 points isn't much, in the scheme of things.

Another often repeated phrase around here is " It's just one number, it's just one cycle". Try not to worry about one number or one cycle, but to look at the big picture. Not only the big picture of movement (in Pervis' case a big movement downward on a much smaller dose) but his overall health (does he seem to be happier, moving around more, grooming more, playing, eating better ).

You both are doing great!
 
Sue and Oliver (GA) said:
Probably not. Often cats go up a little after the shot, usually a reaction to the food. And meters are considered to have a 20% variance either way on the same spot of blood. So a rise of just 30 points isn't much, in the scheme of things.

Another often repeated phrase around here is " It's just one number, it's just one cycle". Try not to worry about one number or one cycle, but to look at the big picture. Not only the big picture of movement (in Pervis' case a big movement downward on a much smaller dose) but his overall health (does he seem to be happier, moving around more, grooming more, playing, eating better ).

You both are doing great!
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Thanks Sue. Okay, I'll not worry so much about the individual numbers or cycles. Yes, he's moving around more. Yesterday and today, he came and sat with me while I was working, which hasn't happened for a really long time. Plus, he's been venturing out to sit/sleep on the couch and he let our 16yo exchange student come up to him and pet him, which hasn't ever happened before. Haven't seen him grooming more. He used to do his grooming while he played in his water bowls. I'll have to see if he's wanting to play.

Thanks again. I can't say thank you enough to you and everyone on this forum. :bighug: I'd be lost and NP would have gone to kitty heaven too soon.
 
I hope the food transition is progressing. With the lower numbers you're seeing already, plus changing to low carb food, he could actually wind up not needing insulin for much longer - we've seen it happen.
 
I haven't given NP his second shot tonight. His PMPS was 105! I didn't take any other readings today [ ADDED: I did take a AMPS and a +2], but wouldn't his readings have been below that? I want to get some advice before proceeding with his shot, which is due about now. Any advice is appreciated.
 
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Wow! I think you have to skip unless you can get off schedule. You could stall for 2 hours, see if he is up to 200 and shoot a smaller dose. But that means your shot tomorrow morning would need to be 12 hours from this one.

105 is too low to shoot. Few ProZinc users shoot under 180, even if they have lots of data.

Did you sure get a second test just to be sure the first was accurate?
 
Sue and Oliver (GA) said:
Wow! I think you have to skip unless you can get off schedule. You could stall for 2 hours, see if he is up to 200 and shoot a smaller dose. But that means your shot tomorrow morning would need to be 12 hours from this one.

105 is too low to shoot. Few ProZinc users shoot under 180, even if they have lots of data.

Did you sure get a second test just to be sure the first was accurate?
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Nope, I didn't get a second test. Poor guy hates it so much.
ADDED: I can get off schedule with his shots tomorrow, but not for the entire week. I'll test him again around 10:00.
 
Ok. The idea of the two hours is to let the impact of the food lessen so you will be looking at a "true" number, not one impacted by food. (I am assuming you fed him after the test?) We suggest not shooting below 200, but I'm thinking he will be up by then. And I do think I'd lower the dose regardless. We can't be sure whether the 105 was the lowest number in the cycle or whether he was lower than that midcycle. But if the 0.75 gave you 105 for an pmps, maybe try 0.5?

He is responding very well! Do you have a treat he loves that you reserve for testing? That's the secret of this - get him excited enough be about the treat that he puts up with the poke.
 
Sue and Oliver (GA) said:
Ok. The idea of the two hours is to let the impact of the food lessen so you will be looking at a "true" number, not one impacted by food. (I am assuming you fed him after the test?) We suggest not shooting below 200, but I'm thinking he will be up by then. And I do think I'd lower the dose regardless. We can't be sure whether the 105 was the lowest number in the cycle or whether he was lower than that midcycle. But if the 0.75 gave you 105 for an pmps, maybe try 0.5?

He is responding very well! Do you have a treat he loves that you reserve for testing? That's the secret of this - get him excited enough be about the treat that he puts up with the poke.
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No, the only treats he ever liked was a high carb one. Nothing else I've tried has appealed to him. He didn't like Parmesan cheese, chicken breast, freeze-dried lamb liver, freeze-dried ocean whitefish. I'll test again and if over 200 will give .5. Thanks so much! Oh, I just thought of something he does like, raw rabbit cat food kibbles. I'll get a few out of the freezer now.
 
Nervous Pervis and Terri said:
No, the only treats he ever liked was a high carb one. Nothing else I've tried has appealed to him. He didn't like Parmesan cheese, chicken breast, freeze-dried lamb liver, freeze-dried ocean whitefish. I'll test again and if over 200 will give .5. Thanks so much! Oh, I just thought of something he does like, raw rabbit cat food kibbles. I'll get a few out of the freezer now.
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Just tested and he was a 134, so I'm skipping tonights shot and I'll test AMPS. Thanks everyone.
 
Wow! What a number!!

Yep, finding a treat works well. It got to the point at my house that everyone looked forward to poke time!
 
BJM said:
Wow! He's been surprising us!
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@BJM - It really has been amazing, so far.
Rachel said:
Wow! What a number!!

Yep, finding a treat works well. It got to the point at my house that everyone looked forward to poke time!
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@Rachel - Nothing enticing yet. Luckily, the pet food store I go to, has a great return policy, so I'm returning the ones he didn't like and may go to the Asian markets to find Bonito flake since I heard they're much cheaper than those package for kitties.

His AMPS was 218 this morning. Gave him .5u. Have a good day everyone. :coffee:
 
Are you using U-100 syringes? They can help you meaure lower doses of the ProZinc, plus may be used for Lantus when you get it (if you still need insulin at that point).
And calipers can be used, too, to get more consistent/precise dowe measurements.
 
BJM said:
Are you using U-100 syringes? They can help you meaure lower doses of the ProZinc, plus may be used for Lantus when you get it (if you still need insulin at that point).
And calipers can be used, too, to get more consistent/precise dowe measurements.
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No, not yet. I haven't had a chance to go pick them up yet. I'll try and do that over lunch today and use the conversion chart for it. Well, I'm crossing my fingers that I won't need the Lantus. Thanks BJM
 
I hope you'll get some tests in today. That is a nice low amps. He is dropping overall daily so the doses may do more than we might predict.

Very good news and very encouraging but a little challenging staying in front of him!
 
Sue and Oliver (GA) said:
I hope you'll get some tests in today. That is a nice low amps. He is dropping overall daily so the doses may do more than we might predict.

Very good news and very encouraging but a little challenging staying in front of him!
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Just tested him. This drop is making me a bit uncomfortable. At +5, he is at 52 and 54, I tested him 2 times because it was so low. I mean, I like that he's dropping but...
[ADDED]: I also fed him a different food that is 5.45% wet matter carbs.
 
Do you have some gravy food if you need the gravy to bring him up? If not, do you have some Karo syrup? He should be starting up in a hour or so (a number that low early in the cycle would be very worrying) but you will want to monitor carefully and get 3 rising tests before you relax.

Looks like NP wants off insulin! (Anti jinx)
 
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Sue and Oliver (GA) said:
Do you have some gravy food if you need the gravy to bring him up? If not, do you have some Karo syrup? He should be starting up in a hour or so (a number that low early in the cycle would be very worrying) but you will want to monitor carefully and get 3 rising tests before you relax.

Looks like NP wants off insulin! (Anti jinx)
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Just sent DH to the store to get some high-carb treats that NP loves and he's getting Karo syrup plus some gravy food. I fed NP some dry food and he had a bit of the wet food I just mentioned. I'll be ready to test him in about 15 since I just gave him that canned food.
 
I wouldn't overdo it. I know the hypo earlier was scary but this one is not too low yet and is coming just before the nadir range. Maybe just the gravy off some food. I'd wait on the dry food and treats unless he drops lower. The ideal is to give him just enough carbs to surf along and not drop lower. If you can do that, he is less likely to bounce up high for pmps from the carbs.
 
Sue and Oliver (GA) said:
I wouldn't overdo it. I know the hypo earlier was scary but this one is not too low yet and is coming just before the nadir range. Maybe just the gravy off some food. I'd wait on the dry food and treats unless he drops lower. The ideal is to give him just enough carbs to surf along and not drop lower. If you can do that, he is less likely to bounce up high for pmps from the carbs.
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He is up to 61.
[ADDED] I'll test him in an hour.
 
Good. I'd test again in 30 minutes. The carbs can make the levels go up temporarily and then he could drop again. Or he may just continue to climb, which would be good.

Tonight, as long as he is above 200, you could give a little bit of insulin. (It'll be good to keep him in lower ranges as long as you can, so his pancreas can heal.). I think you might consider pulling up 0.25 and then even letting out a drop. If he is under 200, I'd stall - not feed and retest in 20 minutes. You want him rising and over 200.

You are doing a great job keeping him safe! So glad you are hometesting. I have to leave for awhile. It doesn't look like anyone else is on PZI, so if he drops and you need help, post on Health where there will be more eyes. Paws crossed that he will slowly rise for pmps.
 
Sue and Oliver (GA) said:
Good. I'd test again in 30 minutes. The carbs can make the levels go up temporarily and then he could drop again. Or he may just continue to climb, which would be good.

Tonight, as long as he is above 200, you could give a little bit of insulin. (It'll be good to keep him in lower ranges as long as you can, so his pancreas can heal.). I think you might consider pulling up 0.25 and then even letting out a drop. If he is under 200, I'd stall - not feed and retest in 20 minutes. You want him rising and over 200.

You are doing a great job keeping him safe! So glad you are hometesting. I have to leave for awhile. It doesn't look like anyone else is on PZI, so if he drops and you need help, post on Health where there will be more eyes. Paws crossed that he will slowly rise for pmps.
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Will do. Thank you. :bighug:
 
Sue and Oliver (GA) said:
Good. I'd test again in 30 minutes. The carbs can make the levels go up temporarily and then he could drop again. Or he may just continue to climb, which would be good.

Tonight, as long as he is above 200, you could give a little bit of insulin. (It'll be good to keep him in lower ranges as long as you can, so his pancreas can heal.). I think you might consider pulling up 0.25 and then even letting out a drop. If he is under 200, I'd stall - not feed and retest in 20 minutes. You want him rising and over 200.

You are doing a great job keeping him safe! So glad you are hometesting. I have to leave for awhile. It doesn't look like anyone else is on PZI, so if he drops and you need help, post on Health where there will be more eyes. Paws crossed that he will slowly rise for pmps.
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NP was only up one to 62. I'll test after 30 min. has passed.
 
A tip for letting a drop of insulin out: slowly twist the plunger while gently pushing.

(GO NP!)
 
Okay, I had to wait and test 2x because the first time he was under 200. The second time, about 1/2 hour later he was at 266. I used a U100 and gave him what seemed like miniscule amount of insulin, just under the .5u mark.
[Corrected] - second reading was 266, not 221 as stated initially.
 
Sue and Oliver (GA) said:
So a 0.2 dose? ( You want to give us the U40 dose when using u100 needles. ) That should be a good dose. He is looking good!
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Yes, a .2 dose.

NP likes us to make him a blanket "tent" on our bed, which he can sleep in during the day. He likes us to lift the covers at night and he just goes in and out, never sitting and getting nervous if we let the blanket drop on him. Today, for the first time ever (during my much needed de-stressing nap), NP fell asleep under the covers right next to me. I think that was his way of saying thank you. I'm sure if he could, he'd thank everyone on this forum too.
 
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