Prozinc, Kit, and low BGs

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Hi, I simply wanted to make you aware of this.

All the "Sticky" or pinned posts in the Prozinc forum have been updated and there are a couple of new ones.

Highly recommend that everyone using Prozinc or helping those using Prozinc read them thoroughly.

I'll be doing that myself. Been expecting this for some time. Came about a week before I thought it would.
Thanks Marje, and Robert, and especially Djamila for the Modified Prozinc Method. You folks are FANTASTIC!
 
Hello Joji and Kit! I was just looking at Kit's spreadsheet, because I'm nosy like that. Her cycle is looking pretty flat. Ignore me if you've gotten better advice, but it might be time to bump that dose a little higher again.
 
Juls and Billy said:
Hello Joji and Kit! I was just looking at Kit's spreadsheet, because I'm nosy like that. Her cycle is looking pretty flat. Ignore me if you've gotten better advice, but it might be time to bump that dose a little higher again.
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hi Juls and Billy Thank you for checking in on us. Please continue!!! Yes she’s been flat but it’s been a relief that she’s not bouncing up and down. That takes a toll on all of us. She also seems to be ever so slightly trending downward. We do plan to increase soon. She has such a sensitive system that we’ve gone beyond .25 increments and into the realm of skinny and fat doses. Despite being high-ish and flat she has been acting SO much more Kit-like. Today she has been trending lower. We have to get used to relaxing around lower numbers. It’s a whole brave new world down there. Thank you for checking on her SS and please don’t hesitate to post to us. It is extremely comforting!!!
 
Kit's SS
Do you realize you have 2020 as the year for those December dates? At the beginning of the SS?

Before you think of going with the next suggestion, be very sure you do not have any air bubbles in the insulin syringe. Use the "finger flick" technique to help with that.

Have you ever considered measuring the doses with calipers? Yes, it's a real thing to try and help people measure a consistent dose. With Kit being sensitive to the doses, you might give that idea some serious consideration. Syringes can be very inaccurate from batch to batch, from manufacturer to manufacturer, from box to box, from one syringe in a box to the next.

Here is the link on how to use calipers:
Dosing with Calipers

I could not do it these days, too much shake in my hands to hold the calipers steady. Can't even really use calipers for bird banding anymore. Afraid I'd poke a songbirds eye out. :(

I was about to say the skinny 2 wasn't cutting it for Kit and then scrolled down to today, 2/26/20 and changed my mind.

p.s. Grew up "upstate" and kept moving east. Not much further I can go, without living on a houseboat or stepping into the ocean.
 
Deb & Wink said:
Kit's SS
Do you realize you have 2020 as the year for those December dates? At the beginning of the SS?

Before you think of going with the next suggestion, be very sure you do not have any air bubbles in the insulin syringe. Use the "finger flick" technique to help with that.

Have you ever considered measuring the doses with calipers? Yes, it's a real thing to try and help people measure a consistent dose. With Kit being sensitive to the doses, you might give that idea some serious consideration. Syringes can be very inaccurate from batch to batch, from manufacturer to manufacturer, from box to box, from one syringe in a box to the next.

Here is the link on how to use calipers:
Dosing with Calipers

I could not do it these days, too much shake in my hands to hold the calipers steady. Can't even really use calipers for bird banding anymore. Afraid I'd poke a songbirds eye out. :(

I was about to say the skinny 2 wasn't cutting it for Kit and then scrolled down to today, 2/26/20 and changed my mind.

p.s. Grew up "upstate" and kept moving east. Not much further I can go, without living on a houseboat or stepping into the ocean.
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thanks Deb! I’m up a ladder now but will get back to you after work!!!
 
Even using an Alphatrak , that 208 is not too low.
You have to at some point lower that pre-shot threshold you are using.

1.75 sounds ok to me.
Are you able to get a couple of tests in for this PM cycle?
 
Thank you deb! Sorry to drag you from your dinner. Yes, we will definitely do some PMs. Likely after 2hours and then she'll get "second dinner" and depending on the +2BG another at +4
Thanks for being there!
 
Deb & Wink said:
Even using an Alphatrak , that 208 is not too low.
You have to at some point lower that pre-shot threshold you are using.
Click to expand...

Thanks for that. We need to get more comfortable down in the lower numbers, for sure! I mean, it's where we want to be but it's a whole new world.
Where upstate are you from? Lots of beautiful snow up there now. We have zero in the Hudson Valley!
 
I grew up out in lake effect snow country, by Chautauqua Lake, then moved east to the Oneonta area for college. Stayed in several small towns in the vicinity for a while but moved to MA in 1984. Not much snow here either - this year. Thank goodness! As I've gotten older, having to shovel all the white stuff gets harder and harder.

You didn't take me away from my dinner. I simply stepped away to get my "second course" and give my little Dancer girl her second supper.
 
@Deb & Wink , @Juls and Billy If you have time today could you be watching us? We have had every color of the rainbow over the last week. taking the dose from a skinny 2 and now a regular 2. This morning she went into green at +4 and dropped below 90. the prozinc sticky guidance says if nadir below 90 to drop the dose by 0.25 unit. But we've been so bouncy, not sure if that's the right thing for kit right now? Maybe back to a skinny 2?
 
Ok, some of my reasoning and perhaps some of the reasoning behind dropping the dose by 0.25U if your cat drops below 90 (<90) when on Prozinc.

1. Safety. Avoid hypo's
At least part of the reason is to keep your cat safe.
If you "catch" a BG <90, there is always the possibility that your cat was even lower during the cycle.
We want to prevent hypoglycemic episodes, always. Symptomatic hypos with severe symptoms as well as hypos with moderate symptoms.
Since Prozinc has a steeper curve than lantus, Prozinc drops the BG levels lower sooner and steeper, it's safer for your cat to stay a bit higher.
That is why a nadir of 90 or lower has been chosen as the point at which you need or should do a dose reduction.

2. Intense monitoring
When you cat is in lower blood glucose numbers/ levels, when you get a test that is lower, you need to monitor more closely for those variances in BG levels. Not everyone is home all the time, or can stay up all night long to monitor and see what the BG levels are doing.

So we err a bit on the side of caution. Be a little bit safer with the BG levels.

Some people are able to monitor the BG's more closely. Some people have a second person to help them monitor, or have a day off when they can check more. Or they rearrange their work/life schedule to track the levels more closely. That monitoring might not be every day. It might not be every night where that extra monitoring is possible. But sometimes it is. Then you get more tests.

3. Feeding the curve/feeding the low's
If you are needing to feed to bring the BG levels up to a safer level, that is part of what we call "feeding the curve" or "feeding the lows". Again, you won't always be home or awake to know that your cat needs food.

So, if you find yourself doing that, propping up the numbers with food, especially earlier in the 12 hour cycle, it's a good idea to reduce the dose.
Many cats will naturally seek out food when their BG levels drop lower than they are used to. It's great if your cat will do that. It's also why having a timed feeder, or leaving out a few previously frozen chunks of food to defrost when you are away can be helpful. Something for your cat to "snack" on.

The food needs to defrost sufficiently that it will be available when your cat needs to eat. So taking out a couple of those "frozen hockey pucks" of food the night before, leaving them in your fridge overnight to start to defrost, and then leaving them out in a dish next to where your cat usually eats can be helpful.

4. Emotional/ financial/ social toll on caregivers.
The constant worrying is very tough on a diabetic cat caregiver. We are always afraid something will happen to our cat when we are away. We worry about what they are doing when we are asleep. We worry about how much this is costing us, in test strips, in lost work days, in lost time with friends and family.

So reducing the dose can help to cut down on that worry a little bit.

5. Find the balance, for you and your cat
Treating feline diabetes can take over your life if you let it. You need to find the balance between taking care of your cat to reduce the worry, and maintaining your own sanity and the rest of the responsibilities in your life.

So again, reducing the dose in this instance, following the Prozinc dosing protocol, can help to restore some of that semblance of balance to your life.

Hope that helps. Not very eloquent or well written. But it's what I got. Juls could write it up better, or do it in different words to make it more understandable.
 
Deb! Your writeup and words were perfect and hit exactly on all of what we are dealing with. It's super helpful to have protocol reinforced by people in the know (you! and others) who can flesh out the details a bit. I know you have to do a lot of repetition here, and I'm sorry if I'm adding to that burden. I'll bet it gets a bit old, and makes you wonder "why don't they just follow the wonderfully written protocol??" It's funny, but because you and Juls were the first real connections for us on this forum, I need to hear it from you. We'll get better, I promise!

In the meantime, we will reduce her dose tonight. While I was away, she was riding flat and pink and yellow and feelin' fine! Maybe that's the way to go for a good long while instead of thinking blues and greens are the only measure of success. (and...maybe I need to take another trip!)

Thanks again for being there. Kit sends snuggles and purrs to you.
 
Deb & Wink said:
Juls could write it up better, or do it in different words to make it more understandable.
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Don't sell yourself short. You are awesome and you know all the things! I'm better at emotional support and cheerleading.

And Joji, don't learn to equate higher blood sugars with feeling good. Yes, those lower numbers can make a kitty a bit sluggish at first, but then the body adapts to the healthier change. I saw the same thing with Billy, and worried about it, but it passed. Now that Billy is all greens and low blues, he's feeling fine and doing happy little behaviors that we haven't seen him do in such a very long time. Kit will adjust too, I promise you.
 
JOJI and Kit said:
I know you have to do a lot of repetition here, and I'm sorry if I'm adding to that burden. I'll bet it gets a bit old, and makes you wonder "why don't they just follow the wonderfully written protocol??"
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Do you mind if I swear? Heck no, I never mind saying things again or in a different way. Helps me as well as you.
Don't you ever dare think that you are a burden. Not now, not ever. That is absolutely not the way this message board works. Ever.

You hear me loud and clear? Say "Yes master Sargent. No apologies ever again master Sargent.":)

The written protocol is a starting point. Not the be all and end all of how to use Prozinc, or any insulin for that matter. There are nuances that are not in there, and even I'm still learning all the nuances.

Remember that ECID? You're probably sick and tired of hearing it but it's true. Every Cat is Different, Every Cycle is Different, Every Caregiver is Different. :bighug::bighug::bighug:

p.s. Maybe I should bookmark this post for future reference. So those points on why the 0.25u reduction were needed are at my finger tips.:nailbiting: Not the nail biting ones, don't do that anymore, but that was the only smiley that showed fingers.
 
Juls and Billy said:
Don't sell yourself short. You are awesome and you know all the things! I'm better at emotional support and cheerleading.

And Joji, don't learn to equate higher blood sugars with feeling good. Yes, those lower numbers can make a kitty a bit sluggish at first, but then the body adapts to the healthier change. I saw the same thing with Billy, and worried about it, but it passed. Now that Billy is all greens and low blues, he's feeling fine and doing happy little behaviors that we haven't seen him do in such a very long time. Kit will adjust too, I promise you.
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Juls, I think for Kit the inconsistency is what gets to her. Super highs then lows, up and down. When she was riding low pinks and yellows last week she was more "normal".....not that we want to stay at those levels! I so hope she is not a forever bouncy kitty, and that we'll get to something steadier. She's barely 5 years old with so much life left in her. Thanks to you and Billy for being in the cheering section! It really helps!
 
Deb & Wink said:
Do you mind if I swear? Heck no, I never mind saying things again or in a different way. Helps me as well as you.
Don't you ever dare think that you are a burden. Not now, not ever. That is absolutely not the way this message board works. Ever.

You hear me loud and clear? Say "Yes master Sargent. No apologies ever again master Sargent.":)

The written protocol is a starting point. Not the be all and end all of how to use Prozinc, or any insulin for that matter. There are nuances that are not in there, and even I'm still learning all the nuances.

Remember that ECID? You're probably sick and tired of hearing it but it's true. Every Cat is Different, Every Cycle is Different, Every Caregiver is Different. :bighug::bighug::bighug:

p.s. Maybe I should bookmark this post for future reference. So those points on why the 0.25u reduction were needed are at my finger tips.:nailbiting: Not the nail biting ones, don't do that anymore, but that was the only smiley that showed fingers.
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So Deb, You had one of us crying and one of us laughing out loud here from your response!
Kit was like...eh? ; )
We gotcha, loud and clear master Sargent! :)

And oh!! ECID is for more than c for cat!! C for clever!
:kiss:
 
Hi Joji! I'll hang out until Deb checks in. Yes, a stall would be great here, ad Kit is almost to 200. If your schedule allows, stall for 20 minutes without feeding and test again. What's your no-shot or stop and think number? 200? If she's over 200 after 20 minutes, go ahead and give her the shot. If her numbers drop lower, re-access then.
 
One more stall and retest in 20 minutes.
Are you able to monitor a bit tonight? If you shoot, I'd definitely get a +2, to see which direction Kit is headed.
If you can monitor a bit, 1/2 the current dose or less would keep Kit from bouncing too high in the morning.
If you skip the shot entirely, the BG's will shoot really high in this cycle and for a few more.

If dosing tonight, then, another test after the +2, around +4 and maybe +6 too.
 
ok. we are doing one more stall and retest. yes we can monitor tonight as long as needed.

Deb & Wink said:
1/2 the current dose or less would keep Kit from bouncing too high in the morning.
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so does that mean regardless of the new number at next retest we give something like 0.9 units? or?
 
Deb & Wink said:
If you shoot, a small meal at +2 could help Kit to keep from dropping too low this cycle.
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yes, we typically give small meal at +2 and+4 both AM and PM.
this morning the timer boxes didn't open so her +2 got fed at +6 when joji came home to take the +6 BG
and the +4 didn't get fed at all. hope that makes sense ... (hi, i'm the SO :)
 
JOJI and Kit said:
ok. we are doing one more stall and retest. yes we can monitor tonight as long as needed.

so does that mean regardless of the new number at next retest we give something like 0.9 units? or?
Click to expand...

If you feel you can monitor and "feed the curve", then yes, somewhere around a skinny 1U dose would be good.
A skinny dose is having the end of the plunger that is closest to the syringe needle be below the 1 unit line on the insulin syringe.

Hi JW!!
 
Deb & Wink said:
If you feel you can monitor and "feed the curve", then yes, somewhere around a skinny 1U dose would be good.
A skinny dose is having the end of the plunger that is closest to the syringe be below the 1 unit line on the insulin syringe.
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cool. yes, we have done skinny dosing. thanks for the clarification. t-4:30 to the stall. seems eternal. ^jw
 
If next pre-shot test is <100, then I think you want to skip the dose.
If the next pre-shot test is >150 then I think you want to go ahead and give the reduced dose.

p.s. Contingency planning here.
 
Yes, I'd skip the dose tonight.

Kit will undoubtedly bounce without an insulin shot tonight. Expect that in the morning.
If you can, it would be a good idea to still test at +2, +4, and a +6 if you possibly can.
That would be good data to collect. To see how she does without the shot and eating so late in the AM cycle.
 
Deb & Wink said:
Yes, I'd skip the dose tonight.

Kit will undoubtedly bounce without an insulin shot tonight. Expect that in the morning.
If you can, it would be a good idea to still test at +2, +4, and a +6 if you possibly can.
That would be good data to collect. To see how she does without the shot and eating so late.
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got it. thanks for the clarification, quick responses, and all love and support. :kiss::bighug:
and yes, +2, +4, and +6
setting alarms now.
^jw
 
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