STILL trying to find the right dose... HELP!

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JenM

JenM

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Tink lost remission over a month ago and I'm STILL not finding the right dosage. He's on ProZinc. We started very low as it didn't take much to get him into remission when he first came home after diagnosis (in full blown DKA & hepatic lipidosis). However, we're now up to 1.4u BID and STILL seeing high numbers - with a few lower ones thrown in sporadically.

I know many cats get more than 1.4u and I'm fine with trying another dose increase... but the sporadic quick drops scare me when thinking about upping the dosage. Most of his cycles are rather flat, dipping only into the 200s - making me think I need a higher dose. However, once in awhile, we see a really significant and early drop (ex: 7/6 PM +3).

I can't find a way to indicate meals on the SS that anyone but me can see (I can see it if I add comments, but ya'll can't see it). Sometimes if I take a test 2hrs after feeding, it's lower than it was before feeding - other times it's 100+ higher. I just can't find a pattern! Sometimes his +10 or 11 is in the mid 200s, but then his PMPS is 70-100pts higher. Other times, it's only a few points higher. Generally speaking, he eats at AMPS, +5, PMPS & +4 (+5 if I'm up late).

On the weekends, I can monitor him closely, but during the week, I am gone after AMPS until +10. He gets a meal via timed feeder at +5, but if he were to go hypo before that, it wouldn't be good.

Can you guys see anything I can't see? I'm going to take him in for bloodwork and to discuss his SS with the vet next week after I get paid. We ruled out urinary infection and dental issues when he first started looking like he was losing remission - so it's not that. He's acting fine except has a crazy appetite and increased thirst drive. He's lost some weight, but it's been slow enough that I'm not THAT worried about it (I want him at 12lb and he's still over that - I just worry he's losing it due to the high #'s). He has tested negative for ketones thus far.

Appreciate any insights here. Should I try 2u this weekend, or is that too much of a jump? I just worry that he's been mostly in the 200-300s for over a month now. I NEED to see some green on his SS!
 
Also... it seems I'm seeing way better numbers at night than I am during the day, despite feedings being at pretty much the same time in each cycle. Does anyone give a different AM dose than the PM dose?? Thinking he might need more in the morning than at night - WHY I dont know... but just what I'm seeing when I look at the numbers.
 
Do not fret over the possibility he needs a higher dose. It didn't take much the first time he was on insulin but you did shoot 2u at times. If you choose to try 2u or more, do it on a day you can monitor the cycle (weekend?).

It isn't uncommon for the numbers to run lower during the PM cycle than the AM cycle. If the routine is the same, food-wise, then it can just be because that's how his metabolism works. He could be more, or less, active during one cycle or the other.

Yes, people have dosed differently AM and PM. One nice thing about Prozinc/pzi is that you can adjust the dose according to patterns and data you have collected. When Bob was on pzi, I adjusted the dose just about every cycle.

One thing that might be affecting his numbers is "glucose toxicity". The more time a kitty spends over the "renal threshold", the harder it might be to get to a "breakthrough dose". You're right. You want to see more greens and low blues in between shots. The unknown is what size dose it will take to make that happen. Try not to think in terms of "how did it work in the past". Because he isn't the same kitty today that he was the first time he was on insulin.

Oh, one suggestion. When you see the vet, ask him if there might be some pancreatitis going on.

Carl
 
Thanks. Unless I start seeing better numbers over the next day or so, I'll up his dose again starting with Friday night. Not sure if I want to go straight to 2u or not... maybe 1.8? I've dealt with "chasing the number" before on ProZinc... but I just can't seem to CATCH UP with the number this time. :/ Its frustrating when I shoot the same dose on the same preshot and wind up with a TOTALLY different +3, +6, whatever. I just want it to be at least semi-predictable! But perhaps I need to be a little less worried about hypo and a little more worried about getting him more consistently below 200 before we cause any long-term damage.

Will definitely be doing a full blood panel when we see the vet. I feel like SOMETHING had to cause his previously beautiful numbers to go out of whack. But then again, it was fairly gradual - he started hanging out in the lower blues long before he went back on the juice... so maybe it's just the nature of the beast.
 
JenM said:
I can't find a way to indicate meals on the SS that anyone but me can see (I can see it if I add comments, but ya'll can't see it).
Click to expand...
Enter in a "M" in the +time box.
It almost looks like there would be a AM dose and a lower PM dose. I've no idea if you can do this but I might try with mine.
 
Entering an M is difficult because two of the meals are in the same box as his shots - I mean, I guess I could, I'd just have to manually color the box. I wish Google docs would let you just do a bold border on the box or something. :YMSIGH:

I am thinking once I find the right dose, it might be lower at night. Seems like his AM cycle runs quite a bit higher than his PM one. Which is odd... since his preshot is usually lower, since his evening cycle runs lower... go figure. I guess if it was easy, it wouldn't be FELINE diabetes. :lol:
 
Add a blank line underneath and code it there. If using the World spreadsheet, be sure to add lines in the same spot on both pages.
 
Hi Jen,

i am sorry you and Tink are having a hard time getting good numbers. It does seem that some kitties who go into remission and then drop out have a harder time going OTJ the second time.

What did the 1.8 do? If not enough after 3 cycles, I'd go up to 2 - on a day when you can monitor. Sometimes it's as though there is a celing they need to break through before things improve (see the thread on glucose toxicity on the ProZinc pages)
 
The 1.8 is helping some - but we still aren't there yet. I'm going to play with 2u this weekend. I have started giving his PM shot an hour or two early. It seems to help him stay lower if I can prevent his PS# from going over 320ish. I'd like it to be even lower. I need to get better at updating the spreadsheet. My paper copy at home is current... but Google Docs gives me a REALLY hard time usually, so I procrastinate about updating it.

Anyway, giving the PM shot early seems to be helping prevent the big spikes. Since he surfs lower on his PM dose, it doesn't SEEM like it's changing his AMPS much - even though it's resulting in the PM cycle being more like 13-14hrs. It may also be that if the AM dose can go to 2u, we might not have to shoot so early... but I can't do daytime testing except on the weekend, so haven't tried that yet. We've still not seen ANY green in forever, so definitely not quite there yet. We DID get a 109 at one point - but that caused him to bounce. @-) I really think it's just a conspiracy to drive me batty at this point. nailbite_smile

OH... and BJM... I tried adding an extra line to document meal times, but that made Google work even WORSE for me (it just sits there and ignores anything I type in)... I dont know what the deal is. It's the same way on my XP machine at work or my Windows7 machine at home - and I can't even DREAM of altering the doc on my Android. Does everyone have issues with Google docs being INCREDIBLY slow and glitchy or am I just lucky??
 
Adapting the dose is one of the nicest things about ProZinc. I like the idea of shooting early and late and am glad it is helping. I'd stick with that a few cycles and then maybe increase the dose on the higher preshot by .25 and see what happens.
 
Google does provide some help documentation for the Drive products, if you care to read up on it.

Otherwise, just list the times as +# over in the notes section.
 
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