RX or dose Help needed!

Mesacakes

Mesacakes

Member Since 2020
So I stopped my ProZinc last night to see how Tom does without it. So far same as with it. (He still was best before insulin.)
So I never Really went over 1.8 units because his preshot numbers & curve numbers just got high every time I increased his dose. He seems to never get below 300 except for a few rare fleeting times. It’s been six months now.
So do I stick with ProZinc and push through the high numbers to see if he responds?
Or do I switch to a different insulin. I can get a new prescription today.
https://docs.google.com/spreadsheets/d/16P71NNxYznGKjz_f_nBJ-6PmsLC9DvZGXBze-VG_eAg/edit
 
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Honestly, you got your best response when he was on 2 units of insulin. That's the only time your sugar cat dropped to blue range numbers. Then you had a little bounce and lowered the dose instead of holding it steady. I honestly don't know why you have been lowering the dose when protocol suggests keeping it the same unless the numbers drop enough to warrant it.

My advice, start slowly increasing the insulin back to 2 units twice a day, no more than a .25 change at a time. Hold for 7 days ( I originally said 3 12-hour cycles, which was incorrect.) then raise again. Don't reduce unless he has a reading under 90. Don't reduce because of high/bounce pre-shot tests. It's the lowest reading of the day that determines when to change dose. This is the SLGS (Start Low Go Slow) method, which I am more conversant with. But it's not your only choice.

Please read the sticky posts here in the Prozinc forum to learn about dosing protocols. Changing type of insulin isn't going to do much if the cat isn't getting the right amount of insulin.

Please consider making a signature that gives members the information they need at a glance when they want to assist you. Take a look at my signature as an example.
 
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Juls and Billy said:
Hold for 2-3 cycles then raise again. Don't reduce unless he has a reading under 90.
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You're combining two dosing methods here - MPM has you adjusting the dose every 3 days but reductions are earned below 50, not 90. SLGS has you adjusting the dose after 7 days and reductions are earned at 90.

I agree with Juuls - you are heading backwards for no reason. Look over the protocols on the Prozinc board stickies, pick one and follow it. He needs his insulin so start working your way back up in .25 increments.

If you want to switch to Lantus there's nothing wrong with that either.
 
Thank you, Panic. I did get them confused. I am more conversant with the SLGS method. So I should have said 7 days, not 3 cycles. (which should have been 3 days!)

I'm out of practice. I'll re-read the dosing protocols myself. I obviously need a refresher course.
 
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Ok. Well since I have plenty of ProZinc the cheapest option is to push him higher. I understand to go by the nadir but when all his numbers get highwe it is strange.
I was given advice, back in January, when he was on 1.8 that I should restart at 0.5. So that’s what I did then I held him there because I had a trip out of town in February. Then I started trying to find a good dose for him so tried higher and lower. Then in April I started getting all the 400 readings while I was titrations up again which freaked me out. So I lowered the dose again to try to stay below the 400s. I have tried to get help. The vets say to go higher and that his numbers shouldn’t go higher too. So I have been floundering around and thought I would try him with no insulin since he has hardly been on any.
Oddly, the 277 reading was after my idiot petsitter let him gorge on regular cat food for 24 hours. I have no idea what Exactly she did with his insulin while I was gone, as she clearly couldn’t follow directions, but that was his best mid-cycle test he has had lately.
 
Was it your vet or someone here that recommended dropping from 1.8 to 0.5? I'm assuming your vet since you weren't here in January. I don't think that was appropriate advice but it's in the past now. BG levels can go higher both with too much or too little insulin, so I know it's frustrating!

Let's start again. I'm going to ping @Deb & Wink and @JanetNJ who are both very good at suggesting starting doses. Let's see if one of them has time to peek and give you an opinion on where to start again. They may say 0.5 or 1u, I am not sure.

There are many people here who make dosing threads (or you can just use this one!) and ask for help day by day. Please do so and we can help watch Tom and offer dosing advice. :)
They will ask for you to set up your signature like Juls did, it's easy peasy compared to the spreadsheet. Here is a walkthrough on how to set it up.
 
I'm so confused why you kept lowering the dose. Your dosing strategy makes no sense to me. The amount he was on was not enough, so you lowered it even further.

Now you have been shooting too low for a very long time, and I suspect you will be finding there is some insulin resistance as he's gotten used to being in these high numbers.

I might suggest starting at 1.5 for a few days and seeing what happens. If it is not enough we will suggest raising it again. Let me tag a few for more opinions. @Kris & Teasel

@Chris & China (GA) , @sharon4, @Bron and Sheba (GA) , @Deb & Wink
 
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I'm also confused by your unit amounts. Are you shooting with U100 needles? If so are you using a conversion chart?

Can you please post the spreadsheet link directly in your signature? To do that, click on your name on the top right, go to signature, paste the link in it, then save. That way we don't have to keep scrolling to the top post.
 
Panic said:
Was it your vet or someone here that recommended dropping from 1.8 to 0.5? I'm assuming your vet since you weren't here in January. I don't think that was appropriate advice but it's in the past now. BG levels can go higher both with too much or too little insulin, so I know it's frustrating!

Let's start again. I'm going to ping @Deb & Wink and @JanetNJ who are both very good at suggesting starting doses. Let's see if one of them has time to peek and give you an opinion on where to start again. They may say 0.5 or 1u, I am not sure.

There are many people here who make dosing threads (or you can just use this one!) and ask for help day by day. Please do so and we can help watch Tom and offer dosing advice. :)
They will ask for you to set up your signature like Juls did, it's easy peasy compared to the spreadsheet. Here is a walkthrough on how to set it up.
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I was in the other group In January thru April. FDSG. They said I may have started too high so to go lower.
 
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JanetNJ said:
I'm also confused by your unit amounts. Are you shooting with U100 needles? If so are you using a conversion chart?

Can you please post the spreadsheet link directly in your signature? To do that, click on your name on the top right, go to signature, paste the link in it, then save. That way we don't have to keep scrolling to the top post.
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Yes u-100 needles and conversion.
 
I went lower for these reasons:
1. “Too much insulin can look like too little“
2. His numbers got worse every time I titrated him up
3. Nobody told me to ignore the high numbers and keep going up in dose anyway
 
Great job on the signature, thank you!

Mesacakes said:
I was in the other group In January. They said I may have started too high so to go lower.
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Gotcha, okay. Starting at 1 unit is pretty standard (0.25 - 1 u is normal) so I don't know why they told you that, especially when he was previously hospitalized for ketones and was just starting to show blues. Caregivers with ketone-prone kitties need to be extra cautious when skipping/dropping the dose. I'm not telling you this to scold you/the other group or anything, but so you understand the logic behind the information.

Mesacakes said:
2. His numbers got worse every time I titrated him up
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I don't really see them getting worse, just not budging. Perhaps an indication of glucose toxicity (someone else is free to chime in if they disagree), which would indicate that he needs to keep going up until he "breaks" that wall, then the numbers start going back down.

Unless someone objects, Janet has suggested starting again at 1.5u (or as close as you can get since you're converting). Which protocol would you like to do? Tight Regulation has you evaluating the dose every 3 days, it requires more testing and tends to keep them in better numbers. Start Low, Go Slow has you evaluating every 7 days. I don't know what your work/home schedule is but if you can let's get you on a testing schedule. Always try to get a +2, both morning and night, that will help us to get an indication of what the cycle is going to be like. You can alternate - say +4, +6 one day and +3, +5, +7 the next as an example. Some later cycle tests would be great here and there as well. That way we can fill in the gaps on your spreadsheet. And at night a +2 if possible and/or a before bed test. Do you think this is a good course of action?
 
Mesacakes, believe me, we all get confused when we start helping our sugar cats. When I started with my Billy, I was blindly following my vet's advice and we almost lost him on day five. Luckily by then I was in here, reading all the sticky posts and getting good advice.

Speaking of advice, I like Janet's advice a lot. Starting at 1.5 for a few days would be a good way to start this adventure over. This time, watch the low numbers and pay less attention to the high pre-shot readings. Going to lower doses has not been working. I think Tom will need more before we see some progress in his readings. And while you do this, get a good pair of patience pants to put on, as member Deb and Wink likes to advise. Changes to dosing need to be made slowly as you go along. You need time to see how the new dose effects Tom. It takes time for a cat's body to adjust to a new dose.
 
Tom has not had ketones. If you are looking into my old posts, that was Frank, who was diabetic for one month. Sadly he had cancer and died 5 months later.
Ok so for Tom, yes I can do +2 and others as I’m still mostly working from home. I will be gone a chunk of the day tomorrow but can get a +2 before I leave and check him when I get back, around +9 probably. I will start with 1.5 (eeck!) and go from there. Either method works for me, I just want what will work for him.
I kind of feel like I should have just listened to the vets from the beginning! But they are both young and I trust experience over education... but I wouldn’t have been jacking around with all this for 6 months. Ugh.
Oh and I gave plenty of U-40 syringes so will go back to those so conversion isn’t an issue.
Thanks for helping!
 
Oh I'm so sorry to hear about Frank. :( Yes I assumed that was Tom. It may help to have a divider between the two kitties' info, unless Marje recommends setting up a newer spreadsheet.

And you just never know about vets! Experience is always good but the young ones have up-to-date knowledge that older ones may not, you never know!
I'm curious to see how he does tonight on 1.5u! :) Definitely get a +2 to see where he's heading, and tomorrow if he's lower than you're comfortable with and you have to leave be sure to leave out some higher carb wet food.

I find cats do well on both protocols but TR is better for cats that need a lower reduction number - sometimes reducing at 90 results in a lot of failed reductions (solely depends on the cat, mine was so I switched to TR and got much better numbers) but whichever you chose I would put the protocol in your signature because we'll have different advice depending on which one you use.
 
How old is your bottle of Prozinc? How long has it been open?

A cat needs as much insulin as a cat needs to get their BG levels below the renal threshold (180-200). After that, they need as much insulin as they need in order to get them regulated and possibly diet controlled.

You DO NOT want to start the dose over at 0.5U or 1.0U. Agree with @JanetNJ on the 1.5U dose of Prozinc for now. But we may want to "fast track" the dose increases a bit more often than every 7 days, which the SLGS protocol would have you doing.

You mentioned that your "idiot pet sitter" give him regular cat food. Specifically, what food was that? Which Weruva? Some of them are fine for diabetic cats.

Even if Tom has not had KETONES, skipping the insulin or him not getting enough insulin and poor appetite can quickly lead to them. Please be sure to test Tom for ketones. With either a blood ketone meter or there are urine ketone test strips.

Mesacakes said:
I went lower for these reasons:
1. “Too much insulin can look like too little“
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They're still trotting out that old wives tale of outdated information and internet rumor in the FDSG? There are some moderators over there they don't know what they are talking about. Sorry it took you so long to find our group.

You have not found an appropriate dose for Tom yet. We change doses in 0.25U increments, giving time to see how a dose change is working before deciding to increase or decrease the dose.

That version of the spreadsheet may be corrupted. Plus, since you used the exact same tab for Tom and Frank, it's impossible for us to see which BG readings and information belong to which cat. I believe you will need to create a new spreadsheet, in our format. @Marje and Gracie may be able to help you with that.
 
In my google sheets app the spreadsheets are separate. I just saved Franks for sentimental reasons.
It is old and from the other group. Not sure I can retype six months of numbers in my phone in a new sheet though. That would take hours and kill my eyes...

Idiot pet sitter gave him Fromm Wild GameBird for 24 hours.

where are the protocols listed? I was planning a 5 day like I used to do.
ProZinc is a new bottle. I had plenty in the old bottle but thought maybe I had a bad bottle so got a new one 3-4 weeks ago. No difference.
Tom eats well. He is always hungry and only in the last month has refused to eat some beef and salmon canned foods but otherwise eats everything he can find.
 
Mesacakes said:
PS 351
+2 348
+4 292 which is exciting!
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Well done, Mesacakes! I agree with Janet that the dose will likely need to increase, but to hold it for now to let Tom's body adjust. That dip under 300 gives me big hopes this will work out well for Tom. I feel like we wouldn't be seeing such a good response if he'd become terribly insulin resistant. It's more likely he just needs his dose adjusted properly, which you are working on. You rock!
 
@Mesacakes , did you see @Marje and Gracie offer to get the new spreadsheet setup for you? She'll transfer your data for you, so you don't have to retype it.

Go back to post #20 in this thread, click on the Avatar to the left and that will open a new dialog box, where you can send her a private message (PM). It's called "Start a Conversation" now, but it's the same thing.
Mesacakes said:
where are the protocols listed? I was planning a 5 day like I used to do.
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The protocols are found at the top of the forum. There are a number of pinned or "Sticky" posts that are always at the top of each forum. Look at the ones here, in the Prozinc /PZI ISG, and you will see one that talks about Prozinc Dosing Methods. Those are the protocols.

A 5 day what? Not sure what you are talking about here.
Mesacakes said:
Idiot pet sitter gave him Fromm Wild GameBird for 24 hours.
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Not sure your "idiot" pet sitter did something bad, since Tom had good BG numbers on that food.

Yellows are good! At least better than the pinks and reds and blacks you have been seeing.
Baby steps, we'll help you get Tom better little by little, one small step at a time.
 
Panic - I don’t understand why it has to be a certain protocol of 3 days or 7 day changes. That seems silly.
I can’t imagine how his body would react different if it was 4 days...
 
Mesacakes said:
Panic - I don’t understand why it has to be a certain protocol of 3 days or 7 day changes. That seems silly.
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It doesn't sound like you've taken any time to read the protocols. The protocols are there for a reason - more than just how many days you count for insulin changes. Cats need time for their bodies to adjust to insulin changes, for one. Some cats do well on SLGS because they need 7 days to adjust. Some cats do better tightly regulated on MPM because 7 days is too long for their body to stay on one dose. SLGS has you reducing doses at 90. MPM has you reducing doses at 50. These protocols have been used successfully in cats for years and help caregivers have a guideline to determine when to make changes. If you're not following a protocol, we have no way to give you safe advice in the future.

I also think Janet was referring to you to change the dose to 2u tomorrow, not increase by 2u. And the reason being for that is you haven't been following a protocol, have been reducing down to nothing, and now we have to fast-track to keep him from developing ketones. Pick a protocol or don't, but some people may not be willing to help if you're just winging it.
 
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Mesacakes said:
I thought that is too much to increase at once. Only 0.25 or “maybe“ 0.5 increases.
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You have a long way to go and the last raise on 0.25 didn't make much difference. I'm trying to FastTrack you to better numbers. If you feel more comfortable raising just 0.25 then that's what you should do. Going to 2 is a 0.5 increase.
 
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Obviously I got bad advice so I am still trying to figure out who to trust and what is actually best. I’m sure you have plenty of people that need your help but jumping on someone is going to drive them away.
I did read the dosing protocols also the paragraph about them being “guidelines” not hard rules. Also Holding the dose for the 3-5 days when starting. Plus nobody stated I needed to decide yesterday on a protocol. I thought we were fine holding for a few days to see how things went on the new higher dose.
I just need to titrate up so I guess I’ll do the TR/MPM but I can’t be home to test tomorrow so I’m only comfortable in increasing 0.25. I increased it tonight so I can test him more tonight.
I did understand the increase up to 2 units correctly. I don’t need any snarky comments. I need to be comfortable with the dose changes and timing. I can’t be home 24/7 to test this cat constantly.
I appreciate your help, patience and understanding.
Thank you.
 
The dosing protocols are guidelines, not hard and fast rules, because ECID. Every Cat is Different. You need to find out how YOUR cat reacts to the insulin, when the onset is, how low a particular dose brings down the BG numbers at nadir, how long the duration is for a particular dose, what reaction your cat has to the different food options (LC, MC, HC).

Tom was diagnosed back in November 2019, so the "holding the dose for 3-5 days when starting" does not apply. You started Tom on insulin months ago, so the protocol sections that apply are the ones that talk about adjusting based on the nadirs.

The dosing recommendations are different, depending on which protocol you are using. We need to know which protocol you have chosen, so we can help you to the best of our abilities. When to skip, when to stall, when to hold the dose, when to increase or decrease the dose are all dependent on the dosing protocol you are using. Those protocols were developed from hundreds and hundreds of cats, by many experienced members of the message board, after following many cats in their diabetic journeys over the last 3 decades, and reading hundreds of spreadsheets, and they were updated in February 2020.

Why does it make a difference between 3 and 7 days you ask? Well, if you cat has ever had ketones or DKA, they are more prone to that condition occurring again. Holding the dose for 7 days with a cat in that situation could be too long. A cat that drops really low, very quickly and early in the cycle, then changing the dpse every 3 days may be too soon. They need time to adjust to the dose changes. ECID Every Cat is Different, Every Caregiver is Different, Every Cycle is Different.

"Know Thy Cat."

You can also change the dosing protocol you are using. You are not "locked in" to a single protocol. MPM is a more aggressive dosing method, since it let's the nadirs drop to 50 before doing a dose reduction. Since Tom is eating only low carb canned food, you are able to choose either SLGS or MPM. If there was still dry food in the picture, then only the SLGS protocol could be used. That is because dry food takes too long to have an effect on the BG levels, if they drop really low (<50 mg/dL)

Yes, you are fine holding the dose for a few days, to see how things go on the new higher dose. But the MPM protocol under the section "Increasing the Dose" is looking at a nadir of >200 and saying a 0.5U increase is warranted.

I tell folks that they know their cat better than we ever will. They also know their schedules and life responsibilities better than we ever will.

You hold the syringe, the final decisions are always yours.
 
At this point I’m not interested in getting him to 50. I will be happy with anything below 200 so his kidneys are healthier.
If I can get him to 100 that would be great too. I don’t need to risk a hypo. I have given up on getting him into remission so just living a relatively healthy life that is also manageable for petsitters while I travel out of town is fine.
 
Mesacakes said:
At this point I’m not interested in getting him to 50. I will be happy with anything below 200 so his kidneys are healthier.
If I can get him to 100 that would be great too. I don’t need to risk a hypo. I have given up on getting him into remission so just living a relatively healthy life that is also manageable for petsitters while I travel out of town is fine.
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Don't totally give up on the idea of remission. It is most certainly possible.
 
Not only healthier numbers, below renal threshold so Tom's kidneys don't have to work so hard to filter out the excess glucose. But also making the signs and symptoms of diabetes better.

With the 5 P's, and appetite, stopping any rapid weight loss and having Tom gain a bit of weight if he needs to. All those in combination gives you a pretty good idea of how Tom is doing.
So, how is Tom doing?


p.s. 5 P's are purring, preening, playing, peeing, pooping.
 
Deb & Wink said:
Not only healthier numbers, below renal threshold so Tom's kidneys don't have to work so hard to filter out the excess glucose. But also making the signs and symptoms of diabetes better.

With the 5 P's, and appetite, stopping any rapid weight loss and having Tom gain a bit of weight if he needs to. All those in combination gives you a pretty good idea of how Tom is doing.
So, how is Tom doing?


p.s. 5 P's are purring, preening, playing, peeing, pooping.
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He has been doing all these things and is very happy. He needs to lose more weight but not muscle. He eats a lot, drink a lot and pees a lot and his poop is better depending on his food. The Tiki chicken luau seems to be good for low poo stink and solid poo. I think the Proplan UTI food also does well for him as he eats a combination of both currently. Other foods make his poo more stinky and sometimes gives him diarrhea.
 
Mesacakes said:
So I will be gone all day Wednesday. Should I do his next dose increase tomorrow/Tuesday or Thursday?
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I'd recommend waiting until Thursday, when you will be around more, to test him. An increase in dose can sometimes take a cycle or 2 to see the full effect, so if you increase on Tuesday, then he may drop low on Wednesday when you are gone all day.

Mesacakes said:
He needs to lose more weight but not muscle.
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The Tiki Cat cat food is lower in calories per ounce, so that helps to lose weight if your Tom needs to. But the Tiki Cat also has lots more protein which helps to build muscle. So that is a winner for Tom I think, a good food to use for him.


Mesacakes said:
He has been doing all these things and is very happy.
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Remember to look at those 5 P's and the appetite and don't focus solely on the BG levels. We tend to do that, focus on the numbers, but a cat is so much more than his numbers. Anytime you get discouraged, remember that he is FEELING better, despite the higher BG numbers and he is telling you that.

HAPPY. Happy is very important too.
 
He has never felt bad. He moved from an old horse barn to a nice home with his old barn-cat guy friend and two lovely lady cats so he is loving life.
I knew when he was peeing a bunch that he was diabetic because that’s what happened with Frank. He plays every day with Sparkly puff balls instead of rocks and frozen horse poop. He loves life except the constant ear pokes! He jumps in my lap purring for them but does flinch and recoil when it’s poke time. He doesn’t mind the injections at all though. Of course he really only has one “good” ear to use so it is a little overused probably.
 

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Looks like Tom was in his share of "cat scrambles" with those ragged ears.

Have you thought about paw pad testing for Tom? You might take some time to get him used to having his paws handled, before you try that.

Sparkly puff balls are loads of fun for cats! Hope Tom gets a whole pile of them.
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Tom is due for a dose increase, on that fast track method to get his BG numbers into a better range. Please try 2U at the next cycle, when you are around to monitor. We need to see some blue (100-199 mg/dL) and greens (<99 mg/dL) for Tom.
 

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Yes I can bump him tomorrow night. I would do tomorrow morning but I will be gone 3 hours away from home for a meeting so would miss all the +3-+11 measures. I can increase him tomorrow night and get a +2 & +4 before bed. Or wait until Thursday morning.
I actually did not expect him to survive when he appeared at the barn with a very bloody ear/face and he was skin & bones. I’m afraid he has already been through many of his “lives” as I thought he would be dead in a week. He lived though and eventually he trusted me to grab him and get him fixed and a steroid injection in his ear. A year later he had a bad UTI and the X-ray showed a BB in his back leg. He still limps on his front end though, maybe someday we will X-ray that. But he cane to me because the barn was closing g and nobody wanted a UTI barn cat. I almost put him down but he is a really good boy that has had a hard life so far.
 
Mesacakes said:
Yes I can bump him tomorrow night. I would do tomorrow morning but I will be gone 3 hours away from home for a meeting so would miss all the +3-+11 measures. I can increase him tomorrow night and get a +2 & +4 before bed. Or wait until Thursday morning.
I actually did not expect him to survive when he appeared at the barn with a very bloody ear/face and he was skin & bones. I’m afraid he has already been through many of his “lives” as I thought he would be dead in a week. He lived though and eventually he trusted me to grab him and get him fixed and a steroid injection in his ear. A year later he had a bad UTI and the X-ray showed a BB in his back leg. He still limps on his front end though, maybe someday we will X-ray that. But he cane to me because the barn was closing g and nobody wanted a UTI barn cat. I almost put him down but he is a really good boy that has had a hard life so far.
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I'd go ahead and bump him either tomorrow morning or night. Honestly I don't see you getting where he needs to be until you are at at 3 units.

Edit to clarify that I'm not suggesting you jump to 3 directly from 2.
 
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Ok... PMPS I just got 175 and 165. :woot:
So I did have less food available all day...
I didn’t feed the Tiki Luau because he has had diarrhea This week. I gave him 2 cans of chicken Fancy Feast this morning, he didn’t eat it all but most. And the “other cats” I gave 1/2 can Proplan. (Tom usually eats the leftovers It’s low carb.) I did give them 1 or 3/4 can the last week But they left food in the bowl so I cut it back again. (Previously to that I only did 1/2 can.) so the food is Exactly what I did probably a month ago. Just not most recently.
He is eating Tiki After Dark now (that is what he ate last week but I found big cans of Luau so bought a bunch of those, but it gave him diarrhea for some reason) and I won’t give him a shot until it goes up but how much do I give? Should I hold him at 2 longer or is this just because he didnt get to eat extra today?
 
Ok 45 minutes later he is 147!!
So I gave him some of the ProPlan ( 4 carbs) and about 25 pieces of Fromm kibble. So will see in another 45 what happens.
I’m confused as to why this is happening. He did eat today. But this is kind of what happened when I gave him 2 units the very first time. He went low then high and I freaked out. So holding on the shot for now.
 
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And now he is 138! What??? Still dropping?
I mean that’s fantastic but he ate Tiki an hour & a half ago, then Proplan & kibble about an hour ago. He just ate some freeze dried ckn and 2 greeny chicken treats. His shot was due at 6pm and it is now after 7pm.
PS - no more diarrhea tonight. Good poop.
 
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