question about tid- Cody 3-23

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Nancy and Cody

Nancy and Cody

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I decided I want to try shooting 3x/day for awhile (we're on PZIR- prozinc) and I know I need to watch for rising numbers. My biggest question is whether I should decrease the dose when I go to more frequent shooting. In other words he's been getting 22u/day. Should I keep that in mind and give him, for example 8u every 8 hours = 24u/day, assuming numbers are rising and not below some threshold (which for us would probably still be 200)

He has been getting about 11u on a 12/12 , (sometimes a 10/14 depending on the numbers) for quite a while.

Today- 3-23-10
AMPS 323, 309 shot a fat 11u at 9AM
+2.25 321
+5 204
+6.5 242
+8.5 264 shot 8u

+2 296, fed light dinner
+3.5 310 (9pm EST)
+5 322 this isn't what i was hoping for! maybe 8u may not do it.
+6 327
+7.5 354 fed lightly and shot 8u @1AM
 
I wish I knew the answer to your question, but I have no clue. I just wanted you to know that someone read your post and wanted to help. However, you need the people that have actually done this...maybe Carolynn, Carolyn, Patti?
 
If it never goes down, how am I going to know its going up again? +8 is 1:30AM and I'm already tired...(11PM ) maybe this is a bad idea
 
Nancy, it's not a bad idea. Are you looking for a fixed dose tid, or a sliding scale? When I used PZI, I used a scale. Yes, I shot lower than most and sometimes I shot 4x a day. Here's Fletcher's last scale:


Scale as of 1/27/07:
Blood Glucose ---------- Units of Insulin to Give
120-129 --------------------------------- 9.0

130-139 --------------------------------- 9.5

140-150 --------------------------------- 10.0

151-170 --------------------------------- 10.5

171-185 --------------------------------- 11.0

186-200 --------------------------------- 11.5

201-220 --------------------------------- 12.0

221-250 --------------------------------- 12.5

251-290 --------------------------------- 13.0

291-350 --------------------------------- 13.5

351-410 --------------------------------- 14.0

411-450 --------------------------------- 14.5

451-480---------------------------------- 15.0

481-500 --------------------------------- 15.5

501-520 --------------------------------- 16.0

521-540 --------------------------------- 16.5

541-580 --------------------------------- 17.0

>580 --------------------------------- 18.0


This was one of his first scales:

********* SLIDING SCALE AS OF 11/28/06**********

Blood Glucose ---------- Units of Insulin to Give
151-170 --------------------------------- 6.5

171-185 --------------------------------- 7.5

186-200 --------------------------------- 8.0

201-220 --------------------------------- 10.5

221-250 --------------------------------- 11.0

251-290 --------------------------------- 11.5

291-350 --------------------------------- 12.0

351-410 --------------------------------- 12.5

411-450 --------------------------------- 13.0

451-480---------------------------------- 13.5

481-500 --------------------------------- 14

501-520 --------------------------------- 14.5

521-540 --------------------------------- 15.0

541-580 --------------------------------- 15.5

>580 ------------------------------------ 16.5


Scroll down this post, and you can see how/what I did http://catacromegaly.com/acmb/viewtopic.php?f=9&t=474 Also look at what Patti did with her Merlin and Steph's scale for Phoebe. If you check out the Blood Glucose and Health Log forum on catacro.com there's lots of info.

Have to get ready for work, but will try to check in later.

(((hugs)))
 
wow, 9u for BG 120 is brave even for me! I don't know if I could do that.... maybe.....

I hadn't really thought it out (sliding or fixed) , but I guess I would rather do a simple sliding scale, TID and attempt to get it close to every 7-8 hrs during the day, and 8-9 hrs overnight. I'm not trying to keep him below 100. According to the vet his kidney values are good, and he's gaining not losing weight, so I really just want to try to get less fluctuation and get below the renal clearence level.

He also just started a long course of antirobe, because a urine culture showed he has baytril resistant enterococcus UTI. This scares me and I want to get the sugar out of his urine, so I've got to get those numbers down ASAP.

I shot a fat 8 again today, and I probably should have done more, but I wanted 1 day of data first to understand the overlap, and it becomes a 2u increase/24 hrs over what I was giving on the 12/ 12 schedule (22u vs 24u/day)

Heres the latest:

AMPS 323 SHOT >11u at 9AM 3-23-10
+2.25 321
+5 204 good nadir for him
+6.5 242
+8.5 264 SHOT 8u @5:30PM 3-23-10

+2 296
+3.5 310 (9pm EST)
+5 322
+6 327
+7.5 354 SHOT 8u @1AM 3-24-10 LOUSY cycle- what happened?

+5 344
+8 288 SHOT fat 8u @ 9:15AM 3-24-10

+1. 307
+2.5 268 aspirin yesterday helping?
+4 240
+5 237
+8 257 SHOT 8u at 5PM 3-24-10

+3 293
+4.5 340
+7.5 334
+8 361 SHOT 8
 
When we switched Norton to TID, we did cut the dose -- he was getting 16 units per day (8u BID) -- we started him at 5 units 3x per day (total = 15 u per day) -- but using a sliding scale

We did use a sliding scale that Patti proposed and made adjustments to the scale based on Norton's BG response.

So... in effect, we might give 4.5u in the morning (based on BG / Scale), 4u in the afternoon and 6u in the evening. so the total was nearly the same as his previous BID dosing.
 
Phoebe and Carolynn,
Thanks, that what I figured. So you actually usually give/gave less than when on a bid schedule?
- was he getting good numbers on bid?
-did you see improvement on tid? Folks on PZI seem to say it helps but is difficult long term
-were you able to keep it up long term?
-did you ever go back to bid for a day here or there because of your schedule? If so do you increase dose a bit?
-how close to 8/8/8 did you shoot? or did it vary day to day? I figure I can be a little flexible with PZI, especially at our high numbers
-how do folks put this into the ss? I'm guessing a new line each 8 hr cycle would be easiest

I keep updating the post above to add new data, so I dont keep re copying it. It's looking better today than last evening. could be the aspirin I gave last night finally disolving. I've increased that a bit to every 3 days, instead of 2x / week. He seems happy today.
 
So you actually usually give/gave less than when on a bid schedule?
not necessarily - it depends on sliding scale / BG at shot time & activity level/food etc
- was he getting good numbers on bid?
not necessarily - we went from Humulin N BID to PZI TID -- so the usual N rollercoaster of Highs
-did you see improvement on tid? Folks on PZI seem to say it helps but is difficult long term
absolutely yes - We were able to keep Norton in comfortable numbers most of the time
-were you able to keep it up long term?
We did this for about 2 months - Norton developed inoperable cancer and was PTS
-did you ever go back to bid for a day here or there because of your schedule? If so do you increase dose a bit?
Norton had an interesting response - kind of syncopated - about every other day, he was too low to shoot. The sliding scale can take care of such increases when it is customized especially to your Cody. If we went 12 hours or more between shots, we added 1 unit to the scale number
-how close to 8/8/8 did you shoot? or did it vary day to day? I figure I can be a little flexible with PZI, especially at our high numbers
Let me get a link to our old profile - BG numbers there (pre-spreadsheet) http://www.felinediabetes.com/phorum5/p ... php?9,5529 The timing did vary day to day
-how do folks put this into the ss? I'm guessing a new line each 8 hr cycle would be easiest
With Norton, I recorded it just in my profile. I did create a spreadsheet with a line for each dose, and am using it for Tiggy -- It has 12 hours per line, but you could delete columns as desired. Link here: http://spreadsheets.google.com/ccc?key= ... DS3c&hl=en
 
very helpful, THANKS

I keep updating the TID numbers in the entry above, so what does anybody think? I think I'm going to keep it here a day or two for more info. How do you decide on the scale?

Last nights numbers were really strange- they kept going up and up. That almost never happens. was that from the 11u followed by 8u at 8 hours? too much?

I have a TON of 12/12 data if anybody wants to check my ss

Thanks
 
Patti made the first scale for Norton. He was at 15-16 units per day at the time, so it might be OK for you to start using this and adjust upward as needed.
(Carolynn's scale for Fletcher is TOO HIGH for Cody)

If you use this scale, it would be a good idea to test for ketones.

This was our scale:
Starting BCP PZI U40 on 4/5/08
BG_(u.s.).........BG_(cad/uk)....Dose A...Dose B (give dose A if less than 12 hours since last shot)
<150 no shot! from 4/18 if +12 add +1u
151-170…….......8.3-9.4……....... 2....... 3
171-185…….......9.5-10.2……...... 2.6..... 3.6
186-200……......10.3-11.1……...... 3 ...... 4
201-220……......11.2-12.2……...... 3.6 .... 4.6
221-250……......12.3-13.8……...... 4 ...... 5
251-290……......13.9-16.1……...... 4.6 .... 5.6
291-350……......16.2-19.4……...... 5 ...... 6
351-410……......19.5-22.7……...... 5.6 .... 6.6
411-450……......22.8-25.0……...... 6 ...... 7
451-500……......25.1-27.8……...... 6.6 .... 7.6
501+++ special for 4/26............. 7 ...... 8
 
Well so far this is a bust... I think he did better on 12/12, but I'm going to try again tomorrow.

Maybe I'm giving too much ? I thought Cody would be somewhere between Norton and Fletcher's scale

I entered it into my ss now so it may be easier to follow. Opinions?
 
Today I tried 7.5u. instead of 8u,
AMPS was 316, at +1.5 its 363 where's my overlap?

The vet had us start fortiflora after being on antirobe for a week to keep him from getting diarhea from the antibiotic. His tummy kept getting bigger, and i couldn't tell if he was getting constipated again or about to blow with diarhea.
All I can say is I'm glad it was in the 60's last night at 1AM because after an enema, and blow out poo, I had every door open! What we do......

As for these scales- Cody rarely leaves his little 250 -- 350 range, so these detailed scales are hard for me to grasp,

I feel like at this point I need a scale with about 5 levels- maybe something like:
180-220 6.5u
220-250 7u
250-300 7.5u
300-350 8u
>350 8.5u

except today I already didn't use it because I shot 7.5 on a 313 because I've been wondering if these non curves and 300's are from too much insulin. Thoughts?

If you see the good numbers last week, they occurred the days after he started antirobe.

Its so frustrating, I just cant him into blues- even at nadir, what am I doing wrong?
 
Ok - looks like you did get some overlap today -- 361 to 316 to 273

BTW, it is OK to shoot every 6 hours if the BGs are rising -- the jump in blood sugar between +4 and +5 shows that you could give a shot at +6

With the scale, when you are shooting a lower BG, you are giving a smaller dose. There is some fine tuning required to get the scale just right. Patti is great at it - I hope she is back soon.

Mind you - I've used BCP PZI, but never ProZinc -- it may be different.
 
I miss Patti too, I'm sure she's really sad and is gonna need time. I think with a little help, I can figure this out...when she comes back, maybe we'll make her proud :-D

So do some cats get worse/ higher numbers when they have too much insulin?

I've been studying my ss and I always ignored the area where I started seeing more purple, because I blamed it on the new meter, which consistently tested higher (aver ~30 points) compared to the one I used when it was all yellow. Some other stuff happened then - new vials, replaced vials, dog food accident which made everything murky, but I'm beginning to wonder if I need to go back to 5.5u.
Maybe I missed a good dose or just didn't let it settle long enough. Im feeling like PZIR does take a while to see what it is really going to do. Maybe with TID I can break into the blue eventually.

This evening on a decrease to 6.5u I actually had a downward cycle in the evening, more like what I'm used to. The last two evenings have been really weird- the numbers climbed steadily after the 5PM shots. -maybe that just has to be too much insulin... ?

Ketones neg tonight -thankfully as always. The boys are cuddling and TF is grooming Cody, who seems content.

If I take the last scale I suggested and subtract 1.5- 2 unit, maybe that would work better.
180-220 5u
220-250 5.5u
250-300 6u
300-350 6.5u
>350 7u

Thanks guys! Any help is appreciated :smile:
 
Looks great!
If Cody is not prone to ketones, it is ok to drop the dose and check his response.

If Cody IS prone to ketones, make sure to check for ketones when you make a dose-crease.
 
Nancy and Cody said:
Well so far this is a bust... I think he did better on 12/12, but I'm going to try again tomorrow.

Maybe I'm giving too much ? I thought Cody would be somewhere between Norton and Fletcher's scale

I entered it into my ss now so it may be easier to follow. Opinions?
Click to expand...


Hi Nancy, I'd have to go back and look at Cody's SS. I don't know... I can totally be wrong, but it looked like you were giving too much at one time? Maybe his numbers are all over b/c of tummy problems? I know one thing that I've noticed while doing the tight regulation with Pru... is that even 15 mins can change everything. You may want to try and check bg at +6 and +7. Seems by the time he's at +8 he's back into the pink. I've had to shoot at +7 just to keep Pru in the yellow than she finally got into the blues. If you're shooting 7.5 first tid and he's in the mid to high pinks at second tid... I'd shoot 7 and see what the numbers look like. Then go to 6 units for thrid tid. On 3/19 you were shooting 21 total units for the day an that seemed to work. If you can catch Cody around +7 for the yellows... I'd shoot. Even if you have to bg every 15 minutes. I hope this can help :YMSIGH: I know all of our furbabies are different, but I just want to help if I can. Sending good vibes & numbers your way :YMHUG:

Hang in there... you're doing great!
 
Oh this is so so slow! just got a 256 at +5 but the yellows are so brief lately. Dang tumor...
His reaction to 256 is to climb the steps (unusual) looking for me to feed him ("OMG I"M GONNA STARVE") :?

No ketones today, but the sugar part of the strip maxed out at 1000, which is worse than other recent strips--not good because i'm tryig to get the gluc out his urine to help fight the enterococus UTI were treating now.

Actually the only time I've ever seen ketones was a day he had a vet enema followed by a 3 hr car trip. It was brief because I was able to give fluids LRS SQ immediately.

This morning I did shoot at +7, (drooler woke me up, and number was high, and I need to get on a earlier schedule, 1:30 Am is a tough time to shoot) I'm gonna try to shoot earlier again this afternoon, maybe +7, then I can shoot before midnight. Do you guys actually wake up in the middle of the night to shoot again? :?:

Now that I'm rereading I see what you're both saying about shooting much earlier- at +6 if its rising. I knew that, its just hard to LIVE that.... and all this "flexible shooting" is challenging our "meal routine" and my sleep routine! Good thing DH is traveling again, he thinks I'm obsessed as it was. I dont know what he's talking about :lol: :lol:
 
I never got up in the middle of the night to give a shot--

however, Charlie (DH) and I were on different work schedules -

he would test-feed-shoot at 5 a.m.

I would do a spot check at ~8 a.m. if Charlie could not shoot at 5 a.m.

Dh would get home at +10 and test - maybe shoot

Then I would test-feed-shoot at bedtime ~11p.m.

so our schedule was not 8-8-8, but more like 6-10-8 or similar ---- and about every other or every third day, Norton would be too low to shoot at the +6 time, so it would be +10 +14
 
Well I was going to try to shoot at +6 or +7 (3pm) but the numbers went back down ( probably the normal variance shot to shot) so I had to wait until +8 (4:30pm). At +8 it was still a pretty yellow number (282), so I shot 6u, instead of 6.5u like this morning (325).

Well at least I can shoot at midnight, instead of waiting up until 1:30 am ahhhhhh.

heres hoping-

send yellow vibes my way :-D
 
Good call! The forty point increase is definitely "rising"

To be considered "Rising", we like to see at least 20 point increase in BG -- and that is a bit borderline considering normal meter variance.
 
Believe it or not, things WILL come together. Sliding scales can be awesome-- it just takes time to figure them out!

I didn't get up to shoot Fletcher, but sometimes did stay up later than normal. I also did some crazy shots and shot really, really low (there was a 64 once... don't think now I'd even shoot that on Lev/Lantus! Well... maybe!), and it was tiring, and frustrating... but once things evened out and I just "knew" if an increase or decrease was needed, it was better. Even with the scales, I think you're better off easing the bgs down instead of trying to hammer them into submission, so be aim for yellows, then low yellows, then blues, etc. Blues are great for an acrocat... and you're getting there!

(((hugs)))
 
Even with the scales, I think you're better off easing the bgs down instead of trying to hammer them into submission, so be aim for yellows, then low yellows, then blues, etc. Blues are great for an acrocat... and you're getting there!
Click to expand...


I agree with Carolynn. I do set my alarm to check bg's and shoot if need be. Yes, DH thinks I am crazy, haha You're doing great Nancy :smile:
 
I swear there is no rhyme or reason to this - another bad evening with no response to insulin. Was 6u too little?

344 at +7.5hrs, shot skinny 7u; BG stayed at ~330 ALL evening

His breath smelled weird so I checked ketones at 11pm - negetive, but sugar is max.
Had aspirin late tonight- wonder if tomorrow will be better.

I need some sleep-
 
Nancy and Cody said:
I swear there is no rhyme or reason to this - another bad evening with no response to insulin. Was 6u too little?

344 at +7.5hrs, shot skinny 7u; BG stayed at ~330 ALL evening

His breath smelled weird so I checked ketones at 11pm - negetive, but sugar is max.
Had aspirin late tonight- wonder if tomorrow will be better.

I need some sleep-
Click to expand...


Oh Nancy, you're doing the best you can right now... BIG HUGS to you cause I know how frustrating this can get. Just know that you're not alone, OK! :YMHUG:

What food are you feeding Cody?
Are you free feeding him?

It does look like you're shooting to low. I keep looking at the 19th when you were doing 10.5 12/12 I am feeling that 7.0/7.0/7.0 would be a good number. Just try to keep it consistent cause that's really the key with tid. Get some rest and I will check on you guys tomorrow.
 
Thanks Michelle,
frequently I ask myself WTH am I doing this for? Cody is not even an affectionate cat. And the answer is: he belongs to my dearest sweetest daughter whom I would do anything for. Two+ years ago, a few months after Cody was diagnosed with FD, my baby angel went off to college and 3 months into her freshman year had her first seizure. Come to find out she has epilepsy.

So now, I live, waiting to lose my 89/88 yr old parents whom I oversee, my acromegaly FD cat who I can't fix no matter what I try, my daughter away at school to some fluke occurrence (seizure while driving, smother in her sleep). Add to that a DH who travels constantly oversees, a son who loves his beer and drives hours daily in Atlanta traffic, and a sweet sweet lover civie who keeps losing weight. I'm sorry to go off like this. DH has been gone 3weeks and and I guess I needed to vent somewhere.

And to top it off, Cody outsmarted me last night and got into TF's food, which included a bit of dry kibble/FF mix. His BG this morning tested 338 and 427, take your pick... I tend to go with the 427 because he's drinking water.
Oh Nancy, you're doing the best you can right now... BIG HUGS to you cause I know how frustrating this can get. Just know that you're not alone, OK!
Click to expand...
Thank you... I needed that
 
and for the cat info/feeding etc, take a look at our profile-its pretty complete, he gets a bunch of meds, fluids, and canned DM which is 5% carb. I've tried wellness, but the carrots & sweet potatoes seem to cause a larger than normal food spike ( they have a high glycemic index, so they turn to sugar faster than protein or fat) He eats a measured amount every couple hours around the clock, but I never leave food down- I can't, he'd eat until he exploded.

Now that he's getting shots 3x/day, I haven't figured out the best way to space out the 2 cans of food/day (and other meds,) which I suppose could be part of the problem.

AM ketones - negetive
 
For you Nancy:

I pray for you all the time
but my wish is invisible

My heart is crying to see your pain
but my tears are invisible

I give you all my support
but my hands are invisible

I get happy to see you smile
but my pleasure is invisible

I do care for your life
but my concern is invisible

I think I am your friend
but my association is invisible

Maybe you won’t see them any day, my dear friend
but my love for you is invisible.

Hang in there :YMHUG:

Things that might make your situation easier...
Get rid of the kibble :o this way Cody can't get into it. What is DM? do you mean MD? haha, I don't know what DM is... You'll figure out how to space out the 2 cans of food/day and other meds. It will just take a couple more days I bet! ;-) Great news is that Ketones are negative!!!! I am not sure how meds play a roll with bg's, so I hope someone will chime in about that for you. Just know that I am sending extra angels to guide you through this process. I'll check back in soon!!!!
 
Michelle,

That was super sweet- thanks, very very thoughtful. I really do appreciate my 'cyber friends"

Today we had a sunny spring day digging in the garden and that helped too. I skyped with the dh tonight and when I showed him Cody, he said "wow he looks good" which made me step back and realize the numbers aren't everything.Gotta look at the whole cat.
 
Hi Nancy,

Did you read about Dr. Lunn's new study? It might be perfect for Cody...I know he's older so you're not wanting the SRS. I think the new study is only 6 months. I don't have ANY details, but if you are interested, you could contact Dr. Lunn.

Also, you might want to consider switching to one of the longer-acting insulins. Most of the acros use Lev...some of the older folks (meaning, been around longer) have used both PZI and the Lantus/Levs and could provide you with some input on which they liked better and why.
 
Funny thing is, PZIR was pretty long acting for us back in January. I am wondering if that may be part of the trouble I'm having with this TID. I'm wondering if this is chronic rebound. I've never seem his numbers rise 2-3 hours after a shot, and thats what has happened like 3 nights in a row since I've tried tid.

I've been studying Cody's spreadsheet lately and in early January, at 5u BID, Cody had a really good run of low yellows. This was before I knew he had acro, so I was pushing to achieve blue or better, so I upped the dose. and if you notice the higher I went, the worse things got. I'd be thrilled with low 200's the rest of his life.

In fact, if you go back to when we first switched to PZI, it seemed to last about 18 hrs.

I think I'm going back to 12/12 and I am dropping the dose. Am I crazy?
 
I can't answer that with PZI; hopefully some of the other acromoms will comment. With Lantus and Lev, you would see lower numbers if he was overdosed (take a peek at Gayle & Shadoe...she's having major decreases right now). The problem with acro is that once the tumor kicks in, you have to "catch up" with the tumor by being aggressive and raising the dose. Again though, I can't comment on PZI since I haven't used it.
 
I got into a middle of the night +9 shot time and couldn't deal with it. I woke up and managed to test, but I couldn't focus enough to decide whether or not to shoot, or how much, so I didn't.

This morning I decided to go back to 10.5u because we had nice curves on that, and it was +13 (minimal overlap). So far it looks very good.
PS 345 fed 3 tsp with meds (+13Hrs)
+1 365
+2 307
+3 259 fed 2 teaspoons
+4 216
+5 223

I guess I'll shoot when I see it clearly rising near/after +8 ; not sure yet. Patti, where are you ?
 
I did a week ago to send condolences- it's still in my outbox- never retrieved. I'm sure she's dealing with her mom's affairs. This can wait. I do appreciate your support- thanks :smile:
 
Hi Nancy, Not sure if you're going back to BID today, but if you shoot at that 287 right now... I think you'll be in good shape. Doing the 10.5 was key to start with, so it's up to you if you want to stay TID or go back to BID. If you decide to stay TID, I'd probably shoot 8.0 and see what the numbers look like. I know this can get crazy cause you have to figure out how to keep Cody in about 21.units for a 24 cycle. Here's a link where I posted how it worked out for Prudence http://felinediabetes.com/FDMB/viewtopic.php?f=24&t=10377

Sorry to hear that you had a rough night :sad:
 
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