Questions about dosage ketones at 1.6

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occhi

occhi

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Hello Friends,

I have updated Dude's spreadsheet with every test we ever ran and now I have some questions about the dose of ProZinc we are giving him. Not long ago he seemed to be so sensitive to the insulin that if we gave him 2 units in the morning 12 hours later he was under 50. Now we can't seem to get him any lower than 256 (10/21). I talked to the Vet on saturday and we decided to raise his insulin to 2.5 to see what happens and if it does not get better in 7 days to raise him to 3. We are on day 3 of 2.5 units and I see no difference. His ketones are also testing at between 1.6 and 1.9 (1.6 being the most recent so they seem to be going down). I worry if we bump him too high he's going to have a hypo due to the weird low numbers previously but clearly he cannot stay this high and feel good at all. He acts like he is starving though his appetite has gone down the last couple of days. He is still eating, just not enough, and not alot of variety for my taste. He is also drinking alot of water and peeing alot.

I would like your thoughts on what dosage we should be giving him.

FYI he weighs 11.7 pounds but he is a giant cat, weighing 17 when he felt good.

thanks!

Temujin
 
Re: Questions about dosage

Are you sure your insulin is still good? How old is it? What does it look like?

Are the ketones measured on a meter?

Agree numbers are too high and even a trace of ketones is not good. Normally on 10/1, you would have reduced the dose after getting the low nadir and long surf. I am wondering if he is in constant rebound and getting too much insulin. http://petdiabetes.wikia.com/wiki/Somogyi_rebound But if he has any trace of ketones, I would not suggest reducing the dose for a trial period.

Let's see what others say. Please add "Ketones" to your subject line. We have several people who have dealt with them often.
 
Re: Questions about dosage

Hi Sue,

We were actually wondering about rebounds ourselves. The insulin has not expired yet but we have also wondered about it being no good. Other than buying a new bottle I dont know how to find that out. We can do that this weekend when I get paid. We do test the ketones on a meter though we did just buy the kind of strips you dip in urine. Haven't had a chance to use them yet.

Thanks for your help!

tmjn
 
Rock, hard place....you..
so I am going with rebound, but if ketones are in the picture
I agree with Sue. can you please do another test with the stick and see what that says
hopefully in a little while some people wil be on that have ketone experience, as I dont have any experience with that.
If ketones were not in the picture I would also say reduce to 1 unit and start over...
raising only after a few days and at .25 increments

please keep us posted on what is going on
THanks

Denise and Shakes
 
hehehe

Hi Denise and Shakes,

I so love rocks and hard places :\ :P

We will do a regular ketone strip test tonight and let you know what we find.

Thanks!

tmjn
 
I haven't been following along so far, but in general terms I would suggest raising the dose in smaller increments but more often. IMO you can raise the dose every 3rd or 4th day, and I would move in 0.2 or 0.25 increments. If you give each dose a solid 4 cycles and do not get a breakthrough, then I would raise another 0.2. When I was doing that with my cat, I would try to get a nadir test on the 3rd and 4th cycles of a new dose (every cycle if I could, but that usually was not practical). That way if you do get a breakthrough you can catch it and minimize any hypo risk. You do want to be sure to get a nadir test before you decide on the next dose increase.

I would definitely not wait 7 days though to raise the dose. PZI does not build up a lot of overlap, so whatever you are seeing by cycle 3 or 4 is generally going to be about all you will get out of that dose. Yes, some cats may respond better with a little more time adjusting to the dose, but I don't think you have the luxury of waiting to see with ketones in the picture. If it were me, I would be aggressive with the dose (not big increases at a time, but increasing every 3rd day), and do a lot of testing to be sure it is safe. Of course if you can't test during the day that is a challenge, so I'm not sure what to suggest in that case...

Caveat is my experience is with PZI Vet rather than ProZinc. In theory the approach should be similar.
 
and agreed if ketones were not an issue I'd say there is some rebound possibly going on, but with ketones I wouldn't try a dose reduction... it's dicey, what a pain! I would say too that he's a TID candidate, but that is hard to manage schedule-wise.
 
Hi Temujin,
I remember you and Dude from the DKA and almost hypo .... I hate to go against the consensus but it doesn't seem like rebound to me. Although we do know he can go low. Have we talked about can you try t.i.d.? 3 shots a day to see if he is having a duration problem? I know it is hard to do, but with the ketones and recent DKA, reducing his dose at this time is iffy.

Now that you have the urine strips, you should try and use them daily and if they show more than trace bring out the meter, strips are expensive! The meter is reading trace .... but he should not have ketones. Are you home on the weekend? maybe try 3 shots then to see if we can get his numbers down. If we raise his dose any higher, that encourages rebound, since he can go low and we face that, his going low with too much insulin.

I would love to see what his numbers would be on 3x a day, he needs to come down, sometimes high BG #'s
encourage ketones. I also have a complex kitty and I totally sympathize ....
Nancy and Payne
 
Good Morning everyone,

I will answer questions and advice in order, hopefully.

@Joanna and Bix, we don't have needles that show that small an increment. Any ideas where I can get some? Today would be day 4 after the bump to 2.5 and this morning his BG tested at 377 which is much better than it has been. We work literally 2 minutes from my house so we can test in the middle of the day and shoot if necessary.

What is TID?

@Nancy and Payne, I see you answered my question above actually, three shots a day? how much at a time? We are home all weekend usually so we can do that too.

FYI, Dude clearly did not feel well a couple of days ago, but last night he was playing with his brothers again and he looks a whole lot better than he did. Whatever was going on I think it might be done. That doesn't mean I don't want to try things to get his BG down though. I know its way too high.

Thanks!

tmjn and Dude
 
For needles, an option is to use U-100 3/10 cc, short needle syringes with half unit markings (Walmart may have them) and do the math to get the correct dose using a U-40 insulin (U-100 mark * 0.4 = dose of U-40 insulin)

You should use a conversion chart, unless you are really good at math in your head!

And here is a partial table: U-40 insulin is 40% of the actual units marked on a U-100 syringe, thus
the 1.0 unit on a U-100 syringe would dose 0.4 units of ProZinc
the 2.0 unit on a U-100 syringe would dose 0.8 units of ProZinc
the 3.0 unit on a U-100 syringe would dose 1.2 units of ProZinc
the 4.0 unit on a U-100 syringe would dose 1.6 units of ProZinc
the 5.0 unit on a U-100 syringe would dose 2.0 units of ProZinc
the 6.0 unit on a U-100 syringe would dose 2.4 units of ProZinc
the 6.5 unit on a U-100 syringe would dose 2.6 units of ProZinc
the 7.0 unit on a U-100 syringe would dose 2.8 units of ProZinc

to get to 2.5 units, you would be between the 6 and 6.5 mark on a U-100 syringe - you'd have to 'eyeball' it as there is no mark there.
 
I used to order the syringes from Hocks. You have to double check they have the half-unit markings (at Walmart they might tell you they do when they don't, so look closely at the picture on the box, or open it & check if they will let you!). There is a link to the conversion chart in the sticky.

With TID, you shoot every 8 hours, and for starters you take the amount of insulin you are giving in 24 hours and then divide by 3 rather than 2 to get your dose. You want to be sure you shoot on a rising number with each shot, which means either one mid-cycle test each 8 hour cycle, or a rising # test at shot time - one test and then another 10 minutes or so later to be sure their BG is on its way up.

Several here have used TID with a lot of success, hopefully they can give you some more tips (I only did it briefly).
 
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