ProZinc users? Big swings in PS#'s

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alicia.1771

alicia.1771

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Can those who use ProZinc on their kitty drop in and say hi? I want to take a look at your kitty's SS and learn more about your experiences in using ProZinc and adjusting dosages.

Please take a look at Beau's SS and let me know if you have any input in why he getting such a big swing in PS#'s? It would seem that he is doing so well one day but the next his # is high again. I am trying to hold a dose for at least 4 cycles to see a pattern, but maybe that's not long enough?
 
Those preshot differences is what I term an oscillating pattern. It usually indicates to me that you are at or near an optimal dose and your kitty's body is going in between allowing the insulin to work like it should and fighting it/dumping glucose. Try holding the course the best you can and hopefully things will eventually even out as his body gets more and more used to the dose.
 
Everybody is different, I have better lluck with Shakespeare when I hold his dose for a least a few days
but he also has really good days, then he has a few days that his body fights the insulin,
then we go back to good days


enise and Shakes
 
Hi Alicia,
Once again you are good at testing! It is hard to make any suggestions because Beau (and you) are so new at this dance .... but I think he did much better on the lower dose of 0.80-1u but it wasn't kept long enough to tell.

Also, in the beginning ProZinc takes awhile to even out ..... I think the manufacture says 45 days, but this isn't written in stone because ECID. (every cat is different)

Because Beau can go so low, I do worry about the higher numbers recently because of the swings. I have a big gulper and that makes it much easier with dosing sometimes but I don't like the recent blacks with Beau and I'm not sure that means he is settling in to the dose. If your PMPS is in the black I would drop back because whatever the reason ..... he can't live in the black range and with my Payne, extreme higher #'s mean too much insulin. (ECID)

Also, there is no RIGHT answer, sorry. The more data you compile, the more you observe Beau, the more you learn what happens when you do, X,Y,Z ..... the more you will come up with the right answer. Dosing is the hardest part of all this but I would want to get him out of the blacks, regardless.

Nancy and Payne
(who can gulp 12u a day!)
 
Nancy and Payne said:
Because Beau can go so low, I do worry about the higher numbers recently because of the swings. I have a big gulper and that makes it much easier with dosing sometimes but I don't like the recent blacks with Beau and I'm not sure that means he is settling in to the dose. If your PMPS is in the black I would drop back because whatever the reason ..... he can't live in the black range and with my Payne, extreme higher #'s mean too much insulin. (ECID)
Click to expand...

That was my impression too looking at her SS, so glad to hear I wasn't the only one. The jump at the PS's really looks like too much rather than a bounce but I'm still learning here. My gut reaction would be to take the insulin back a touch and let Beau settle in a bit more before increasing. If you go down and the cycles flatten out entirely, then that would suggest too little insulin, but the wide swings I'm seeing look like Shaikha when she gets too much. :?
 
I agree that you need to back down off the dose. I would go back to the .8 unit and let him settle into it for a while and let the big swings stop. You want to get him out of the blacks.

Once you stop the swings you can evaluate the dose again. I firmly believe that shooting the same dose into a black number and then the next day shooting the same dose into a blue number is not a good idea. Look where it has gotten you so far.

If you are unsure of what to shoot on a lower PS, please come back and ask here. We'll be watching for you.
 
Thank you everyone for your input. I was really unsure whether to increase or decrease his dose based on his swinging curve these past few days and I was getting advises to go either direction depending on how the curve was interpreted. Since we are still so new to this insulin I don't really know what he is trying to tell me... nailbite_smile I just don't want to make things worse for him instead of getting him on the right track to be regulated.

I will be posting his PMPS# shortly between 7:00pm to 8:30pm PST since I may need to do more than one testing based on his #'s. Please keep an eye out and offer dosing advise (wish to dose between 8:30pm-8:50pm PST).

It sounds like this time everyone is encouraging for a reduced dose. Would this apply if his PMPS is in the 500's as well as in the 200's??? I really don't know how these #'s work with regards to dosage...
 
Yes I would drop your dose down to .8 unit even if your PS is high. The last time he was doing well your dose was between .8u and 1 unit. We need to get him out of those black numbers.

Unless of course if his PS is very low.
 
Ok, here are his #'s so far:

AMPS - "Hi"
+5 - 262
+10 - 207

Will post his +11 and PMPS to see if the # is rising or falling still. Attitude-wise he is looking good.

Does anyone know if clinical signs appear if he is getting too much insulin??? I noticed a little increase in water consumption and urination today as compared to yesterday. I know these are signs of diabetes and when a cat comes out of remission, but does it also happen when a cat receives too much insulin???
 
At the 0.8u dose a little over a week ago you were still getting swings from blues to reds for preshots. At this 1.2u dose, not every HI or 500 reading was after shooting a blue preshot. Honestly looking at your spreadsheet I see the best preshots and overall numbers at the 1.5u dose, but that dose resulted in some unshootable preshots, which is why I think you should stay at the 1.2u dose. Ultimately, you need to do what your gut tells you to do though. The 0.8u dose is really close to this 1.2u dose, so it won't take too long to move back up if needed.

Increased drinking and urination is in correlation to the high glucose readings, not necessarily that he is getting too much or too little insulin. There is no definitive symptom to know if these numbers are from too much or too little. You just have to experiment with dropping the dose or raising the dose to confirm your suspicions.
 
Hi Kelly! Thank you for your input. I also see he's got some great #'s at 1.5U but also some scary #'s on both 0.8 and 1.0 so I'm not able to make sense of his response to the insulin dosages yet. And to be completely honest both my gut and my head is a mess right now with conflicting theories I really don't know what is best for him... :cry:

Update on his +11 is 211 which is comparable to his +10 of 207. Will test again shortly.
 
ok, last update -- his PMPS is at 219, looks like he rising ever so SLOWLY.

Any advise on PM dose??? Please post any thoughts you have based on his #'s and I will try my best to make a decision on what dose to shoot. Thanks!
 
For tonight, to be safe I'd go with either 0.8u or 1u since he really isn't rising much in the past 2 hours. If we had a definitive rising number, then I'd feel more comfortable with 1.2u.
 
Thanks to everyone who responded to my post. I ended up giving 0.8 tonight just to be safe. Also I was thinking that since 1.0 was giving us big swings in PS#'s and 1.2 is getting us into black zones, perhaps it's time to try 0.8 for a few more cycles?

Is this what everyone is doing? Just experimenting with the doses and see which one is giving us the best #'s?
 
I think saying experimenting is too simplistic. We take all the facts that we know, crunch them together.

I knew Beau went low, was newly Dx. and was very sensitive to insulin. You, as his bean, know even more and then there is his SS, look at all the low #'s .... that says caution in giving insulin. That is why we test, why we do data, why we learn as much as we can.

ProZinc can be dosed many ways. There is TR or tight regulation. That has you change your dose on your PS each time, and there is a chart as to dosage if you want to do the proper. My Payne went into rebound and stayed there until we stopped.

Then there is learning what dose seems to work, not go too low, not go too high, hold that dose for 3-5 days and adjust up or down in small amounts, holding each dose 3-5 days, according to the numbers.

Had you not been keeping such good records, it would be hard to know that he goes low. But in knowing that and the fact he uses so little insulin, I felt good in saying go down a little. Had I not known I would have said with the extremely high PS#'s ..... shoot more which would have been wrong. IMHO

You learn your own sugar cat and in time you will be able to take all the facts and put them order and I think you are doing really well.

Nancy and Payne
 
Since Beau is really new to this, that's likely what you'll be doing for a while until you figure out how he responds best. It is not an exact science, unfortunately. A healthy pancreas knows how much insulin is needed at a given moment and produces it, but in this case we're only "producing" insulin twice per day and guessing as to how much is needed based on levels and patterns. The pancreas does vary how much it produces. We could also dose as needed and some do, but it also can confuse the picture because we are guessing somewhat as to how much is needed. If we keep varying dose a lot, it can be hard to tell what worked and what did not since bounces can last a while. You do get a sense after a while as to how your cat reacts to different things, but it takes time. You'll get there!
 
Alicia,
I don't have a spreadsheet, so I can't post mine. However, I really don't think it would help you anyway. The reason is that (as you know) ECID. I find it amazing that you are getting the swings you are getting based on the dosage you use. Same goes for many others.

Apparently, Bob had a different reaction to PZI than many other kitties (ECID). He went from 1 unit BID to 4u BID before he showed any real signs of improvement. That's just how much insulin it took to get his pancreas working again I guess. Once he reached that 8 units a day peak, he came back down just as quickly. But the biggest difference I see with Bob than any other kitty I've "seen" (and granted, that is not many kitties, I've only been around here for a couple months) is the amount of insulin he would tolerate when his BG numbers were what are considered "no shoot" numbers here. I mean, I shot him with 2u with a reading of 150, and his nadir was 80. He never had a hypo, never exhibited any hypo signs.

I guess the point I am trying to make is this - people can look at Beau's SS and try to figure out what is going on, based solely on how they read his reaction to varying doses of insulin. But looking at someone else's SS, while it might help you understand how their sugarcats responded to what they dosed, it won't help you much in figuring out what is going on with Beau. If I had done a spreadsheet, and you saw that I gave Bob 3u on 6/26 with a AMPS of 176 (his +6 was 84, his PMPS was 184), and you even considered doing the same thing to Beau, he'd almost certainly hypo. But that's because every cat is different. Not only do they process insulin differently, they also process food differently, based on whatever else in their body is all wonky besides just their pancreas. The liver is involved, the kidneys are involved, and their whole GI tract is involved. For whatever reasons, Bob's body didn't get the results out of 1u of PZI as Beau's does.
I look at your spreadsheet, and my instinct is that his dose needs to go up to get rid of those high PS readings. But then I look at his low numbers in the middle and I think "How can she up the dose without him crashing?". Beau goes low. But Bob didn't.

My guess is that it is going to take a lot of patience on your part to get Beau where you want to get him. Maybe there are still parts of his body that are trying to heal, and until they heal, he'll keep getting really high "highs" and really low "lows". Perhaps his liver will fight to keep his sugar higher, or his pancreas will sputter for a while or what-have-you. Maybe what is happening now is that Beau's liver is freaking out when he goes so low, and it's dumping sugar to raise it back up and then you end up high 12 hours later?

I think sometimes when I see numbers like you and others are having to deal with, it makes me feel guilty because it was so freaking "easy" for me and Bob. I didn't (for the bulk of his dance anyway) have much of a clue what I was doing, and yet it all worked out. I'm just damn lucky his body healed as fast as it did.

The number that really has me confused is that 196 amps on Sunday. It's like he got 12 hours out of the nighttime dose. Then you shot another 1.2, but ended up having to boost his sugar with 6 feedings all day. I think that's what gave you the high PMPS Sunday night (as opposed to his liver fighting the insulin). It appears to me that you've needed to use supplemental meals in order to avoid a really low nadir for several days when you've increased the dosage to 1.2.
My advice would be to drop the dose back to 1 or even to .8, and let him go low. Try to avoid a hypo of course, but let him go down to 50 if he insists and try not to bump him up with more food between +4 and +6. Just added it up and it looks like he ate 4 cans of FF on Sunday. That's close to 400 calories (depending on what flavor(s). How much does Beau weigh? I'm only asking because 400 calories will keep a 20 pound cat at that fighting weight. If he weighs that much, that's fine, but if not, he's trying to convert those calories to energy (glucose) which might end up giving you high readings as well.

Carl in SC
edited for a typo - probably some others I missed as well.
 
Hi Nancy -- Thank you for putting it altogether to help me understand this whole "sugar dance" thing we are doing with our sugar cats. I am very good at gathering data and measuring Beau's in's and out's, it is putting the data together and interpreting them that I find quite difficult for me. I am so grateful for this board for the combined experiences and support in helping me to learn this process.

Hi Wendy -- Thank you for the encouragement! I know it will take some time to understand how Beau will respond to different doses, I just wish it isn't so nerve-wracking! These days I hold my breathe when I open the door to check on him not knowing if I might him hypo'd and I wake up before the alarm goes off from panicking that I might have overslept and missed his shot times :lol:

Hi Carl -- Thank you for sharing your experience with Bob and really made me see how every cat really is different! I don't think you should feel guilty for having it easy with Bob, I think both you and Bob are BLESSED to have such a quick healing! I was so happy in the beginning of his treatment to see such great response to insulin during the 1st week. Then everything kind of went wacky after that. I get so nervous seeing the reds and blacks as we had such pleasant #'s in the beginning. And what makes it even harder is that with the same PS# and same dose, he would end up at such different #'s in the next PS :shock: so I have no clue what's "good" for him. As far as food is concerned, I know I am feeding him throughout the day and there are quite a few reasons for that: 1) the multiple feedings on Sunday was because he just had a dose increase the night before and I didn't want him to go hypo given his tendency; 2) he has lost quite a bit of weight in a very short time (14.29 --> 14.19 in 1 week, then to 13.3 the 2nd week, then again to 13.15 in 5 more days) so I'm trying to get as much nutrient in him as I can; 3) I actually don't know how much I should feed him...I feed him various flavors of the Fancy Feast Classic and the label says 1 can per 3.5lbs so that comes to about 3.75 cans for his current weight. I didn't think food will give him such high #'s since when I'm at work he only gets to eat before/after AM shot, during +6 checkup, before/after PM shot, then I leave some food out for him when I go to bed. I have read that diabetic cats should eat smaller meals throughout the day to keep their BG more leveled. How are most peopel feeding their cats? Does it vary with the type of insulin given?
 
Alicia,
Please don't take what I said about how much he's eating as criticism. Wasn't intended as such. What I would do though is don't go by what is on the outside of the can to figure out how much to feed. Cat food company's are trying to sell food, and they'll tell you to feed more than required in order to make money. Besides, the same thing is written on all flavors, when some have many more calories than others. Want to fatten up a cat quick, feed it 2 cans of some high fat gravy based stuff every day.
The formula I've gone by since I saw it posted here, because it is so simple is "20 calories per pound of body weight, per day in order to maintain current weight."
There is another formula I have seen posted a half dozen times lately, that is a bit more exact, but it makes my head hurt trying to wrap my brain around it :smile: It works out pretty close to the simple formula though.
I understand you are trying to put some weight back on Beau after he lost a good bit in a short amount of time. I did the same thing with Bob who lost about 5 pounds. The vet told me to put a pound back on him, and I did 1.5 pounds, so I put him on a 250 cal diet for a couple weeks and took the 1/2 pound back off. Because his potassium is sort of low (low end of normal scale), and potassium levels are crucial to muscle and heart function, she didn't want him putting on too much weight and straining his little heart. I can tell just by looking at him that he is much better off at the 14 lb limit than he's been in years.
So figure out what he weighs, and if you're trying to fatten him a little, just add 30-50 calories above the optimum for a couple weeks and he should put the weight back on.

What I was trying to help you avoid was giving him food in order to temporarily boost his sugar when you fear he's going "too low". If you have to do that, then that indicates (to me) that his dose is too high by a bit.

Carl in SC
 
Hi Carl -- oh no, I did not take anything you said as a criticism. I apologize if my response came out differently than what was intended. I welcome all input from this board and appreciate how you have been responding to my posts with so much helpful info especially during the times when few people are on the board to give advise. I was listing out the reasons on feeding to see if it makes sense to others of the way I have been feeding him. As a matter of fact, both vets I saw mentioned that Beau is actually a bit overweight (really?!) and they want him to loose a bit of weight but not due to his dieases, and that we will need to deal with his weight issue once we get him more regulated.

Thank you for the helpful tip on how much to feed. Based on his current weight he will need about 265 calories a day to maintain (wow, that seems so little!) and with the classic flavors used close to 3 cans. Just wondering if he already ate the daily calories and is seeking food, do I feed him more?
 
I would let him eat as much LC as he wants - they need the extra calories, being diabetic they burn them up faster so to speak (that is not the scientific reason!). Unless you are struggling with an issue of your cat being overweight, feed, feed, feed (LC).

As for clinical signs of too much insulin, I don't think the slightly higher doses for him are an issue so much of too much insulin per se, it's that sometimes he is getting steep drops that can cause them to rebound and give you the super-high PSs. Lowering the dose can help prevent that from happening, and then you get much better PSs like today.

It's a balancing act for many cats - lowering the dose can give you better PSs, but sometimes then the mid-cycle numbers are blah and it's really not enough insulin. But then for some cats if you raise the dose you get good nadirs, but steep drops and high PSs. I think it's too soon to tell for him, so there is a certain amount of experimenting and data collection to see if you can squeeze perfect numbers out of it. If not, then there are other options to look at, but I think it's too soon with him to know yet.
 
Just to add to that, I am a fan of free-feeding, makes life SO much easier in so many ways! A lot of people do 4 small meals - one at shot time, and one maybe 3 or 4 hours or so later, which kind of balances the insulin cycle somewhat.

I noticed some comments about rebound in your SS. Just to clarify a couple things:

- flat numbers in and of themselves are not a sign of rebound. High flat numbers (like at least pinks, and often reds) can be a sign of chronic rebound (which we almost never see, it come after a length of time of repeated episodes of acute rebound). After an acute rebound cycle, you often will see high flat numbers in the cycle after that.

- a dip followed by a sharp rise *can* be rebound, but not necessarily. It can also be just lack of duration when the dose is too low. With Bix I remember one cycle when I reduced his dose way too much and he got a perfect nadir at +4 and then shot up into the blacks after that. I thought "oh rebound!!!" but it wasn't that at all. It just wasn't enough insulin to hold him any longer than +4.

One measure is if they drop back down later in the cycle. Something like a nice green +6, a black or red +9, and then a +12 that is back down in the pinks or so is a classic rebound pattern. Of course it isn't usually that easy to detect! But a lot of times if they spike up and just keep rising to +12, it is lack of duration rather than rebound. But sometimes it's rebound, lol, it is just really hard to be sure.

So for instance if you look at Tuesday's yellow cycle, that's not rebound. You have a big drop from the PSs and no spike at the end. So you actually got a good response on that cycle, it just looks like it wasn't enough insulin to get him any lower than yellow cycles. Not criticizing, I wouldn't want to see a steeper drop that than anyway, so that is a good cycle I think off of that PS.

Beau is kind of a puzzle b/c you can't detect one clear pattern. Some cycles he has a nice PS at the end of the cycle with no big zoom, so then why the black PSs on other cycles? It doesn't look like liver training, b/c then you would see the high PSs after every blue or green cycle, and you aren't seeing that.

On some cycles the high PSs could be rebound from a steep drop, but then cycles like last night, there was no steep drop, but then you have a black PS at the end of it. So that looks like lack of duration, but you got a good nadir, so I'm kind of on the fence on the dose.

When you are trying to detect rebound, I think you have to look for the cause as much as for the pattern in the numbers. The causes are:

- low number
- steep drop
- numbers they aren't used to so they get scared

When you look at last night's cycle I don't see either of the 1st two, and for the third, it could be possible, only when you look back at earlier cycles he didn't always react like he is in liver training, so it doesn't seem like it's probably that.

I'm not sure that's any help, lol, but just wanted to comment some on it. From someone who looked endlessly at the numbers for my cat and saw rebound everywhere, when he actually didn't have rebound. ohmygod_smile
 
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