The Switch to Prozinc, Part 3

Status
Not open for further replies.
Susan and Timmy

Susan and Timmy

Member Since 2017
I'm kind of thinking out loud with this post, but I need some guidance. Timmy was 417 this morning. I gave a skinny 2.0 units. This isn't enough when he is in the 400's. I need to be consistent with the dosing so he doesn't bounce, but still give him enough so he comes down into the blues and greens. :banghead: So if he is in the mid to lower 200's, I could give either a very skinny 2.0 or a fat 1.75. I'm trying to figure out a safe, but effective dose range. When I was on the other insulin, @JanetNJ would make a range list for me and that helped tremendously. With that hypo the other day I'm just apprehensive right now. I ordered the U-100 syringes yesterday so they should be here by early next week, which will help. Guidance, thoughts...help.
 
Susan and Timmy said:
I'm kind of thinking out loud with this post, but I need some guidance. Timmy was 417 this morning. I gave a skinny 2.0 units. This isn't enough when he is in the 400's. I need to be consistent with the dosing so he doesn't bounce, but still give him enough so he comes down into the blues and greens. :banghead: So if he is in the mid to lower 200's, I could give either a very skinny 2.0 or a fat 1.75. I'm trying to figure out a safe, but effective dose range. When I was on the other insulin, @JanetNJ would make a range list for me and that helped tremendously. With that hypo the other day I'm just apprehensive right now. I ordered the U-100 syringes yesterday so they should be here by early next week, which will help. Guidance, thoughts...help.
Click to expand...
Timmy might be a kitty who does well with sliding scale dosing. I have no experience setting one up but Janet has done many. I see that you tagged her and I'm sure she'd be willing to help. Those U100 syringes will be a godsend to you!
 
Have a look at Teasel's SS where you can compare his numbers on ProZinc and Lantus. They're still all over the map but there's more blue and green in the Lantus section - and I'm using a pet meter! You've only recently switched to ProZinc so there's no need to consider a switch. Teasel and Timmy are similar in their extreme reactions so a comparison might be interesting to you.
 
Kris & Teasel said:
Timmy might be a kitty who does well with sliding scale dosing. I have no experience setting one up but Janet has done many. I see that you tagged her and I'm sure she'd be willing to help. Those U100 syringes will be a godsend to you!
Click to expand...
I have lost my confidence to go to 2.0, but he needed more today. He is going to keep me on my toes though. When he goes too low it is hard on him, and really hard on my confidence in dosing him.
 
Susan and Timmy said:
I have lost my confidence to go to 2.0, but he needed more today. He is going to keep me on my toes though. When he goes too low it is hard on him, and really hard on my confidence in dosing him.
Click to expand...
I truly understand this. We want to do what's best in what can be a very difficult situation. I know that Teasel doesn't feel well when he drops too low. He seems happiest when his BG is around 120 to 150, maybe not ideal by the criteria of well regulated but good for him. Now, getting him there and keeping him there is a whole other issue ... :confused:
 
Kris & Teasel said:
I truly understand this. We want to do what's best in what can be a very difficult situation. I know that Teasel doesn't feel well when he drops too low. He seems happiest when his BG is around 120 to 150, maybe not ideal by the criteria of well regulated but good for him. Now, getting him there and keeping him there is a whole other issue ... :confused:
Click to expand...
Looking at Teasel's spreadsheet, I could be looking at Timmy's if I didn't know better. He does have more blues and greens since you switched though. You have nerves of steel dosing the greens, I know it is an entirely different insulin, but still! Comparing the two spreadsheets makes me feel like I'm not totally off track with Timmy. Thanks. :)
 
Susan and Timmy said:
Looking at Teasel's spreadsheet, I could be looking at Timmy's if I didn't know better. He does have more blues and greens since you switched though. You have nerves of steel dosing the greens, I know it is an entirely different insulin, but still! Comparing the two spreadsheets makes me feel like I'm not totally off track with Timmy. Thanks. :)
Click to expand...
I'm glad that Teasel's chaotic SS makes you feel better, Susan. :smuggrin: Dosing on green the first time or two was a bit stressful but it's manageable.
 
PMPS was 341. Gave a skinny 2 units. He probably could have been given at least 2 units to get his down farther, but 2.0 units hasn't been kind to us lately. :confused:
 
I do not love sliding scales on prozinc. (pretty sure everyone is tired of hearing me say that by now). What I see on spreadsheets with sliding scales is just utterly chaotic bouncing. Timmy actually doesn't seem that bouncy to me, but he is less predictable than you might want. For the most part though, he doesn't run sky high after a low. He just goes back into his "normal" range and hangs out there for awhile. Maybe a very very broad sliding scale. Something like Under 300 = 1.8, over 300 = 2.0.

Lantus has a dosing rule for some kitties that they have to have three hypos at a dose before they get a reduction. It's the rule for reactive kitties that sometimes will just throw a lime green for no good reason (ahem...Timmy!). Kris, can you shed any more light on when a kitty gets into that category? I've only skimmed over in Lantus-Land, not studied. I wonder if something like that might work better - waiting a bit before reducing since right after a lime, he seems to run high for a number of cycles.

I do respect though, that you were just saying this is all pretty stressful for you. Please please please know that hypos don't mean you did something wrong. And high numbers don't mean you did something wrong. This whole thing is a long process of gathering data, looking at the data, and making your next move. You can only know anything in hindsight. So whatever is happening in the present is just new information. You are doing a really really great job. And beyond all the numbers, just paying attention to how you are doing and how Timmy is doing and staying focused on that.
 
Also, remember that you KNOW what to do if he hits those lime greens. You can handle it, and there's usually someone around here on Health if not on here to help talk you through it if you feel like you aren't sure what to do or just want some company when it happens! Basically, Susan, you can take care of him if something happens and that should give you a bit of confidence. I totally get how stressful this is! You're doing a fabulous job with Timmy and he's super lucky to have you!
 
Djamila said:
Lantus has a dosing rule for some kitties that they have to have three hypos at a dose before they get a reduction. It's the rule for reactive kitties that sometimes will just throw a lime green for no good reason (ahem...Timmy!). Kris, can you shed any more light on when a kitty gets into that category? I've only skimmed over in Lantus-Land, not studied. I wonder if something like that might work better - waiting a bit before reducing since right after a lime, he seems to run high for a number of cycles.
Click to expand...
This guideline is part of the Tight Regulation (TR) protocol for Lantus users. Strictly speaking, you have to get three BGs under 50 or one under 40 on a human meter before you reduce the dose. The idea behind it is to make sure that a dose reduction is truly earned instead of being given because of a single lime green. It's in recognition of the fact that these can happen a little randomly. It's important to know that if you follow TR you're doing quite a lot of testing so you can catch an impending crash and intervene.
 
Thank you all for your insight. What I am understanding is that the sliding scale, at this point, will only make things more chaotic. So Ill shelve that option for now. Timmy's numbers this morning show that he really needs 2 units now. I like the broad scale of 1.8 if he is below 300, and a skinny 2.0 to 2.0 units for over 300. Those new syringes are on their way. They can't get here soon enough for me. I need him to have a dose where I don't have to guide with food or test every single hour. If I do keep steering for a little while, will he start to come down to lower numbers, in theory?
 
Theoretically, yes. His pancreas isn't getting time to rest and heal when he's over about 200 (there's some debate about what is really a "healing" level of BG). So he needs to be in lower numbers in order to recover more function and therefore need less insulin. For Timmy, it looks like he's either too high...or diving. At least for now. So it seems like in order to get him into better numbers more often, you're going to be running the risk of those occasional limes. I wish there was some way to make this all easier for you!!!
 
Yep, unfortunately, Timmy is one of those tricky kitties...with luck in time he will settle down some. While I know the bouncing is trying and upsetting, it's something a lot of kitties have to deal with unfortunately. We had a kitty on ProZinc a few years back who bounced for 2 years...until one day he bounced right into remission! It does happen...and you're doing a wonderful job with Timmy!
 
Your knowledge and guidance helps so much. Thank you! To get him down, I'll have to push the envelope a bit, but if that will get him down, that's what I'll do. So correct me if I'm wrong, but for now, I will use the very broad scale of 1.8 for under 300 and 2.0ish for over 300. I will monitor like crazy and keep my fingers crossed that I can get him into better numbers. :)
 
Rachel said:
Yep, unfortunately, Timmy is one of those tricky kitties...with luck in time he will settle down some. While I know the bouncing is trying and upsetting, it's something a lot of kitties have to deal with unfortunately. We had a kitty on ProZinc a few years back who bounced for 2 years...until one day he bounced right into remission! It does happen...and you're doing a wonderful job with Timmy!
Click to expand...
That gives me hope. Bouncing right into remission, however long it takes, sounds wonderful to me. Thank you.
 
Djamila said:
Well, he at least got sort of near a blue :cool:. Hang in there!
Click to expand...
Well, maybe he'll want to feel "blue" tomorrow. Those u-100 syringes are scheduled to arrive tomorrow. So after I figure out how to use them, hopefully my dosing will be more accurate and we'll start to make some progress.
 
Timmy's Amps was 396. I gave 2 units. I would like to give 2 units am and pm for a few days for consistency, providing he isn't too low. If his numbers don't move after a few days, should we increase the dose? I can't believe I am even thinking this, but I don't know what else to do. I received the u-100 syringes this morning. If I am understanding the conversion, 1.8 units will be 4.5 and 2 units will be 5. It's going to take me mental minute to be okay with these syringes and the conversion that 2 is 5 :nailbiting:, but I'll get the hang of it. I usually order the syringes with black writing on the outside and a red stopper inside to make it really clear. The syringes that I ordered this time aren't like that. They are black writing and a black stopper on the inside. I'm not sure it is called a stopper, but that's what I'm calling it. :)

His numbers just seem kind of stuck right now. We're just stuck. What do you think?​
 
Susan and Timmy said:
Timmy's Amps was 396. I gave 2 units. I would like to give 2 units am and pm for a few days for consistency, providing he isn't too low. If his numbers don't move after a few days, should we increase the dose? I can't believe I am even thinking this, but I don't know what else to do. I received the u-100 syringes this morning. If I am understanding the conversion, 1.8 units will be 4.5 and 2 units will be 5. It's going to take me mental minute to be okay with these syringes and the conversion that 2 is 5 :nailbiting:, but I'll get the hang of it. I usually order the syringes with black writing on the outside and a red stopper inside to make it really clear. The syringes that I ordered this time aren't like that. They are black writing and a black stopper on the inside. I'm not sure it is called a stopper, but that's what I'm calling it. :)

His numbers just seem kind of stuck right now. We're just stuck. What do you think?​
Click to expand...
You'll get used to the black plunger, Susan. Print out the conversion chart and then store the U40s somewhere completely separate.

Yes, give 2 u for three cycles max if he doesn't shift. Then up it to 2.2 u with a U100 syringe. The longer he sits high the harder it is to bring him down. Teasel is very much the same. I know this is a scary mental hurdle for you but you'll get used to it and you know how to steer him if needed. :smuggrin:
 
Yes to everything Kris said.

I printed out a few copies of the conversion chart and highlighted the u100 dose that I was supposed to give. Then did a new one when the dose would change. It helped me make sure I wasn't going to mess up when I first started with them. And definitely put the u40's far far away. That is not a mistake you want to make early in the morning!
 
Kris & Teasel said:
You'll get used to the black plunger, Susan. Print out the conversion chart and then store the U40s somewhere completely separate.

Yes, give 2 u for three cycles max if he doesn't shift. Then up it to 2.2 u with a U100 syringe. The longer he sits high the harder it is to bring him down. Teasel is very much the same. I know this is a scary mental hurdle for you but you'll get used to it and you know how to steer him if needed. :smuggrin:
Click to expand...
Okay. I had another though/question. Do you think that I should start the 2.2 units with the tomorrow morning dose, or stick with the three cycles at 2 units am and pm? I don't want to move too quickly, but I want to get him moving.
 
Djamila said:
Yes to everything Kris said.

I printed out a few copies of the conversion chart and highlighted the u100 dose that I was supposed to give. Then did a new one when the dose would change. It helped me make sure I wasn't going to mess up when I first started with them. And definitely put the u40's far far away. That is not a mistake you want to make early in the morning!
Click to expand...
Oh, that's a great idea! I just printed out some copies and will highlight the dose. I moved the U-40s to another closet altogether.
 
Up to 2.4 u tomorrow AM if you don't get any good action on 2.2 u today, Susan. As scary as it is, you have to press on to get him to a dose where he responds better. We're here to help! :)
 
Last edited:
We've got action. We have a blue! It is at +4 though. My thoughts are that I am going to wait 30 minutes, test him, and then steer with a little LC food before he goes too low. I know that I am pushing the envelope to try to get him moving, so I'm thinking that if I start to steer before he gets too low, he wouldn't hit the limes. Thoughts?
 
Kris & Teasel said:
Timmy might be a kitty who does well with sliding scale dosing. I have no experience setting one up but Janet has done many. I see that you tagged her and I'm sure she'd be willing to help. Those U100 syringes will be a godsend to you!
Click to expand...
Why are you using U-100 syringes?
are you doing the conversions for your SS? It's so much simpler to use U-40 syringes.
 
Ugh! That was stressful. He just drops so darn fast. Nothing, and than Wham!! Dosing for tonight? Can I reduce a bit depending on numbers?
 
You could reduce a bit...maybe 2 or 2.1 if you can eyeball that? I wouldn't go too far down, though, because quite honestly...you haven't been getting great numbers on lower doses and you monitor well.

How does that feel to you? It's a bit aggressive but I hate to see you lose momentum...it's a catch 22.
 
Rachel said:
You could reduce a bit...maybe 2 or 2.1 if you can eyeball that? I wouldn't go too far down, though, because quite honestly...you haven't been getting great numbers on lower doses and you monitor well.

How does that feel to you? It's a bit aggressive but I hate to see you lose momentum...it's a catch 22.
Click to expand...
It feels scary. Lol. I gave 2 units. Eek. I have to get him down though. Hopefully this will be a short, nerve wracking time to get him down. Thank you.
 
Last edited:
Status
Not open for further replies.
Back
Top