Samson does not seem to be responding to PZI

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SamsonsMom

SamsonsMom

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Hi all, my cat has been on PZI for nearly two months now but his BG numbers are not looking very good. I started him at 1 unit, increased to 1.5, and finally this past week increased to 2 but he still rarely drops into yellow numbers. In his appearance and behavior, he seems somewhat better: his oily, dandruffy fur is back to normal, and some hair loss that occurred on his hind legs (which is what led me to bring him to the vet and get the diabetes diagnosis in the first place) is growing back in, and he seems more playful and active than he had been pre-insulin. Still, I don't understand why his BG hasn't dropped more. He eats pure protein (either raw meat or limited-ingredient wet cat food, duck flavor) so it's not his diet. Can someone talk a look at his chart and help?? Thanks :D
 
I know this is all feels like a lot sometimes, but if you want him to make progress, it requires regular testing, consistent shot times, and dose adjustments. Along with the great things you're already doing with food choices and monitoring other health factors.

If you'd like to see him make some progress, I'm sure we'd all be happy to help you! But we need a bit more data. Most of the time you get pre-shot tests, which is great. However, the dose is determined by knowing the mid-cycle numbers as well, and there aren't a lot of those to work off of.

Do you work outside the home? If so, what is your shot time AM/PM, when do you leave for work, and when do you go to bed? We can help you structure a bit more testing, and then hopefully figure out how to help Samson make some progress.
 
SamsonsMom said:
Hi all, my cat has been on PZI for nearly two months now but his BG numbers are not looking very good. I started him at 1 unit, increased to 1.5, and finally this past week increased to 2 but he still rarely drops into yellow numbers. In his appearance and behavior, he seems somewhat better: his oily, dandruffy fur is back to normal, and some hair loss that occurred on his hind legs (which is what led me to bring him to the vet and get the diabetes diagnosis in the first place) is growing back in, and he seems more playful and active than he had been pre-insulin. Still, I don't understand why his BG hasn't dropped more. He eats pure protein (either raw meat or limited-ingredient wet cat food, duck flavor) so it's not his diet. Can someone talk a look at his chart and help?? Thanks :D
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The short answer is that you haven't found his "good dose range" yet. He's given you the odd blue and one green. That's typical of a kitty who isn't regulated yet: their responses can be a little erratic. I agree with what Djamila has said about the need for more data. We all know how demanding this is but it's the best way to move Samson forward. We can help! :)
 
Hi guys, thanks for your responses! I work at home, so I can try to be more diligent about getting a mid-cycle test. Is that the most important piece of data that's missing?

As for other q's: I dose on a regular schedule, typically 9 am/9 pm.
 
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SamsonsMom said:
Hi guys, thanks for your responses! I work at home, so I can try to be more diligent about getting a mid-cycle shot. Is that the most important piece of data that's missing?

As for other q's: I dose on a regular schedule, typically 9 am/9 pm.
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If you can make a point of grabbing two tests between +3 and +8 in the daytime and one before bed test for, say, a week, that would really help to build the picture. It'll also get you into a good testing groove that becomes part of your regular routine. You can start this while you're giving 2 u. My guess is that after about 3 days or so of doing this we'll know whether the 2 u dose is high enough. We might also get an idea of how bouncy he is - or not. That's the value in more data. :)
 
Dosing for Prozinc is based on the difference between the pre-shot number and the lowest point in the cycle (nadir). So both of those numbers are important in order to know what to do. The problem is that they can vary from day to day, so multiple days of data are taken into consideration in order to decide what to do.
 
It's great that you work at home so you can get some more tests in! That makes life a little easier. As Kris said, grabbing some tests between +3 and +8 will help...and if you try getting them at different times of day for the next few days, it'll help build a really good picture of what's going on.
 
Hi SamsonsMom and Samson!
Just checking in on some members who haven't posted recently. Looks like the 2.5U is too high now, are you thinking of trying 2.0U for a while or even 1.75U? Update when you can :)
 
Bumping this post looking for advice :) I have been doing my best with home testing but haven't been perfect. Samson's numbers still don't seem great after 3 mos. of PZI treatment. I am moving out of the country Sept. 1 and entrusting his care for one year to a friend who is subletting my place, so I need to find the correct dose for him before then - though I would have long ago :( Can you guys take a look at his numbers and let me know how I should proceed with the dose? THANK YOU!
 
@Yong , I never saw this post, I am so sorry. Why does 2.5 seem too high to you? Yes, of course I would consider the 2 unit dose if it is better. Thanks!
 
Back when I posted that you were having much lower PMPS numbers which can sometimes indicate a dose is too high :). I'd say try the 1.75U as best you can. But try to get the PS numbers since 2.0U has gotten him to a lime green. What syringes are you using? Do they have half unit markings? It makes those 0.25 increments easier ;)
 
Thanks @Yong! Can you give me an idea of what kinds of numbers I should be expecting in the AM, nadir and PM? I have no idea, which is why I keep messing with his dose. Or at least what kind of pattern they should be following? I kept increasing his insulin because his numbers still seemed high and he is still drinking and urinating with abandon. Can you explain why a higher dose is not necc. a good idea in this case? THANKS! PS. Yes, I have the syringes with half-unit markings!
 
No specific numbers per se but we aim to try to get similar AMPS and PMPS numbers without dropping them too much for nadir. This can cause somogyi effect or what we call here "bouncing", which can make some kitties feel icky. Are you testing him for ketones? Weekly testing is recommended if he is not prone to developing or post-DKA. How many hours after PM shot do you go to bed? Getting some before bed tests could help see where he's going overnight as most kitties naturally run lower cycles at night for an idiopathic reason :cat:. Also, for higher dosings, sometimes too much insulin can look like too little. So try your best to get those AMPS and PMPS readings and if you can, try for some test during his PM cycle :). Since you're up to 2.5U, back down to 2.0U again for a few days and we'll re-evaluate ;)
 
Hi guys, I'm back from vacation and trying to test Samson like WHOA. But he's been on 1.75 the entire time I've been away and his numbers are NOT where I want them to be. I'm very very concerned because he was DX'd like 3 mos ago and hasn't shown a lot of improvement on ProZinc. I am moving out of the country in 3 weeks and NEED to figure out his correct dose before then. Should I switch insulins??

BTW, I found this chart for Lantus users re: what a cycle looks like and it's VERY HELPFUL. Does one exist for PZI users? Tx!

Example of an ACTIVE, but NOT necessarily typical Lantus cycle:
NOTE: Until kitty is pretty well regulated, the description below is NOT not what you'd consider a "typical" Lantus cycle. It takes time and patience for kitty to achieve a "typical" cycle! The example below is what you're working towards (a nice shallow curve). A relatively flat cycle is the ultimate goal.

+0 - PreShot number.
+1 - Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number. Onset begins around +2 for most cats. You'll probably see an active cycle if the +2 is the same/similar OR lower than the preshot number. Continue testing!
+3 - Often lower than the PreShot number.
+4 - Lower.
+5 - Lower.
+6 - Nadir/Peak (the lowest number of cycle. NOTE: ECID. Not every cat has a mid-cycle nadir. Adjust the hours on this example to fit your cat.)
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (one of the quirks of Lantus/Levemir: some cat's blood glucose numbers dip around +10 or +11... not to be confused with nadir).
+12 - PreShot number.

EDITED TO ADD: Samson's fur is still of poor quality (thin, dandruffy) and he's still drinking too much water and urinating too much. I am freaking out.
 
More or less the "ideal" by the book curve should end up about the same as the one described for Lantus, minus some lingo ;) like surfing. A quick glance at your SS suggests to me, his dose may be a teeny bit higher and it might be time to revisit the 1.5U. Try to get the AMPS and PMPS consistently next few days and squeeze in some before bed tests so we can see where he's going at night. Most kitties tend to run lower at night for some idiopathic reason :). Just to be safe, when was your last ketone test on Samson?

Once his numbers get under better control (doesn't mean regulated) his coat should start looking better again and symptoms settle down some :bighug:. But we do rely on the data to tell us what's going on with him as well as how he's feeling :bighug:.
 
Hi @Yong, thanks for your reply! OK, I can switch back to 1.5, but it looks like I was doing that dose throughout June with too little effect? Although I wasn't very good about getting PMPS numbers then - I can be better now. Should I switch to that dose tonight? @Kris & Teasel - do you want to weigh in, too? Thanks! :D
 
SamsonsMom said:
Hi @Yong, thanks for your reply! OK, I can switch back to 1.5, but it looks like I was doing that dose throughout June with too little effect? Although I wasn't very good about getting PMPS numbers then - I can be better now. Should I switch to that dose tonight? @Kris & Teasel - do you want to weigh in, too? Thanks! :D
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I'll be different: that 1.5 u dose got some good numbers but it was quite a while ago now. I'd stay with 1.75 u for a few more cycles to see what happens - maybe a full curve on the weekend?
 
@Kris & Teasel thanks, he's been on this dose for many cycles now, though: as I noted in his chart, I was away the past 9 days ( so haven't been testing) but his caretaker gave him 1.75 the whole time. So he's been on that since 7/31.
 
This is why I'm confused... It seems like Yong is saying the dose is too high and you are saying the dose is too low :( He was on 2 units from 7/15 to 7/24 and that didn't seem to work too well either.
 
SamsonsMom said:
This is why I'm confused... It seems like Yong is saying the dose is too high and you are saying the dose is too low :( He was on 2 units from 7/15 to 7/24 and that didn't seem to work too well either.
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We all weigh in with our opinions and they will diverge occasionally. Yong is at work now I think. You could post on the main health forum with a question mark icon added to your title.
 
Oh yes! I definitely appreciate any and all feedback, just feeling really lost right now because I've tried many doses and none seem right!
 
Ugh. This is a tough one. I'm inclined to go with Kris and suggest 2u, but there is some hint that today might be a high flat from a low, which I'm guessing is why Yong said to go with the lower dose. The reason you got two different opinions is because of the gaps in the data. We end up having to just make our best guess. If you can get a test around +4 tonight (after the PM dose), that would really help. If you shoot and then go to bed, maybe set an alarm, or get a +7 as soon as you wake up? We could really use a hint about what's happening overnight.

One thing I want to point out though is that there is no such thing as a perfect dose. Even if you figure out a good dose for right now, that will change over the weeks and months while you're gone. Your caregiver should really be on the forum and willing to do some testing in order to take care of Samson while you're gone. Or is there any chance you can take him with you?

Oh, and here is a graph that shows a Prozinc curve:

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That is from a kitty who was still getting AMPS/PMPS numbers that were too high, but it shows the general shape of the curve. A regulated kitty should be around 200 at AM/PM pre-shot, and a bit below 100 at nadir. If the drop between the pre-shot and nadir is around 50%, it's a good cycle. More than that and you'll often end up with bouncing. Less than that and the dose is probably too low. HOWEVER, you'll usually get flat cycles after a big drop, so your cycle today might mean that there was a big drop last night. Or it might mean that there isn't enough insulin. That's why those mid-cycle tests matter so much.
 
Hey @Djamila, WOW! Thanks so much for your expansive response. I can get a +4 test tonight - if I'm understanding correctly, you're saying that will help a lot in determining if Samson should go to 1.5u or 2u from where he is now? Do I need additional +4 shots or would the one from tonight be enough?

also, should I give him 1.5 or 1.75 or 2u insulin tonight? THANKS!
 
Definitely not a +4 shot. Just a test. I'm so glad you asked for clarification on that! Sometimes communicating over the internet can get tricky!

We want to see how low he's getting after his normal PM shot. So you would test, give the normal PM shot, and then four hours later, do another test.

And yes, it will help figure out if his numbers today were because he's dropping lower during the night or not. And that will help us figure out if the dose should go up, down, or stay the same.

For tonight's dose, why don't you stick with the 1.75u, and then after we see what numbers he gets, we can hopefully have a clearer picture of the next step.
 
Yes, I definitely meant a +4 test! Oops, looks like I wrote "test" but later "shots"! OK - tonight I'll do 1.75u, and a +4 check on his blood. Will we need more of these +4 tests, or should tonight's suffice? Thanks, I appreciate the feedback so much!
 
As often as you can get them, they can be helpful, but sleep is important, too. If you look at my spreadsheet, you can see that I get the AM/PM pre-shots every day, and then most days get a +3 (Sam hits nadir early, so a +3 is usually his nadir). So his shot time is at 4:30am/pm, that way I can get a +3 before I leave for work at 7:30am, and then in the evening the PMPS and somewhere between a +3 and +5. Having mid-cycle tests during both the morning and evening cycles is really important since some cats respond differently at night, and also because one cycle impacts the next cycle, so if you know what just happened, you can better predict what will happen next.

If getting a +4 tonight means you'll be staying up late, or setting an alarm to wake up, you don't need to do it every night, but an occasional one can be helpful. Someone around here shoots and then goes to bed, and then they grab somewhere between a +6 to +8 when they are waking up in the morning. That's another way to make it work so you can get tests during both cycles.
 
Thanks! Yeah, it means I'll be staying up late tonight on a work night, but in the future I can grab some over the weekend when I tend to stay up late, anyway. Thanks!
 
In case anyone sees this tonight, how should I base tomorrow's shot on tonight's +4 result? His PMPS was 322, so if he goes down what does that mean for his dose of 1.75u and what about if he goes up? Thanks! @Djamila
 
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He should be going down by +4. How much he goes down by +4 is what will help determine which dose looks like it will work best.
With the 322 preshot he has room to drop more than 50% but fast drops can cause a bounce too. It really does depend on the numbers you get.
 
Sorry for the confusion! It was a mild suspicion that, I should have added :facepalm:, needed more data to confirm if 1.5U was too much but he's probably OK to do the increases since you are testing :). Consistent AMPS, PMPS, and some before bed tests will help us see what he's doing overnight ;)
 
Guessing if he has a typical nadir of between +5 and +7, he'll be around the same AMPS of 300's. If this holds true, you can probably try the 2.0U unless you have to go to work. If you won't be around, stick with 1.75U. You can wait until the weekend, assuming you're off, to try the 2.0U.

Given that he's already dropping >50% of his PMPS, and he's probably clearing his bounce, you'll probably have a similar or slightly higher AMPS.:)
 
Wow! That is a great response to the insulin. I agree with Yong that if you're going to be around to monitor today, you could try the little increase to 2u. However, it was a 50% drop and you might not have been at nadir yet, so if you are not going to be home to monitor, I would stick with 1.75 again.

Great job getting that test last night. That was a really helpful piece of data!
 
You guys are really the best and so supportive, I'm feeling less stressed. Is there a reason, though, if he's responding to the insulin, that he's basically never had a good curve the entire time he's been on it?

He's at 337 this AM - not bad - I'm not home to monitor today, so I'll do 1.75 and try a bump to 2 over the weekend. THANK YOU!
 
I'm not sure what you mean by he's never had a good curve. There are quite a few cycles that look like, if all of the data was there, they would have been good curves.

Do you mean that he isn't in that 200 pre-shot/under 100 nadir? That just takes time, monitoring, and careful dose adjustments. You're only on month three, and there are a number of cycles where the monitoring wasn't happening enough to really know what changes to make. I don't say that as a judgment. This is hard, and it takes a lot on the part of the caregiver. Work and life interfere a lot and make this difficult. We can't always get the data we wish we could get, just because there are other demands and obligations.

Also, it looks like he's been on a healthy diet for a long time, which means that his FD isn't related to poor diet, which means that it may be harder to get him regulated - there isn't an easy fix in this case like there is when it's just that the kitty has been eating crap for years, and a diet change fixes it pretty quickly. Although now that I think about it....which raw food has he been eating? Are you making it, or is it one of the commercial ones? I ask because Sam was on a raw food diet that ended up being 23% carbs and was the cause of his diabetes.
 
Thanks for the encouragement @Djamila ! I guess I thought I'd have a better idea of Samson's treatment by now, but I guess it's a longer (ie, life-long) project :/ I'll keep up with the testing! So just to confirm, you support trying him out at 2u while I'm home to monitor him?

I need to update my signature. Samson WAS on a raw diet for years (it was just raw ground meat from the butcher, either chicken or beef, which they sold frozen as dog food) but as I've been dealing with his diabetes I've just been feeding him canned food: first Wellness then I switched to Natural Balance LID thinking maybe his symptoms were an allergy to chicken or beef (they weren't). In my anxiety yesterday I switched my cats (I have one other healthy one) to Fancy Feast which I saw is MUCH higher in protein than either of the other two foods I've been feeding him. I hope it helps, they both love the taste and the food is cheap!
 
Hmmmm....so you just switched food yesterday? And you're feeding Fancy Feast Classics, or one of the other ones? Fancy Feast Classics run between 0-3% carbs, while Natural Balance LID runs 10-12% carbs. That might not make any difference, but it may make a difference if Samson is carb sensitive. Were you able to get any mid-cycle tests today?
 
Hi @Djamila, yes I switched last night (to Classics, yes) - I had no idea the LID was so high in carbs, so I'm hoping this helps. I couldn't get any tests today, I normally work from home but a couple of days a week work in an office! I can get some tomorrow!
 
Djamila said:
Are you home both days this weekend to test? I'm torn between waiting another day to see if the food makes any difference, or go ahead with the increase. @Yong, @Rachel, @Kris & Teasel @StephG, any thoughts on this?
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I'd suggest giving 1.75 u again tonight and then increase to 2 u either Saturday or Sunday. Waiting until Sunday would give one more day's data with the food change but his numbers are high enough that you could increase tomorrow.
 
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