Time for an increase

J

Jess092

Member
Hi there!

We started Buddy on a half unit 2x a day on Sunday morning, so she has had 5 shots so far. We are starting to think we may need to up the dosage. We would probably up it to 1 unit, because I fear it would be hard to consistently measure 0.75 units with the syringes.

We would welcome advice, if anyone wants to take a look at our spreadsheet. Should we be patient and wait, or up the dosage now? Should we up to 1 unit, or just to 0.75?

Thanks so much everyone!!!
 
Remember, you only started the insulin a few days ago. Even 5 cycles is not much time for a cats body to adjust to getting insulin. You should try to hold the initial dose for a week.

Patience please. A jump in dose from 0.5U to 0.75u or even up to 1U may be a bit much right now for Buddy. I'd suggest giving it the full 14 cycles before you increase. To give Buddy's body time to adjust to getting insulin. 9 more cycles to go.

If Buddy's BG levels were higher, in the pink, red or black ranges more consistently, then a dose increase would be warranted now. But he isn't. He is mostly in the yellow ranges, and only a couple of higher numbers so far.

His BG levels are dropping down a bit in the middle of the cycle. Which is good, that is what you want to see happening.

Consistency is important when raising the dose. Simply do the best you can to try and measure a 0.75U dose with those U40 syringes. You could even make a reference syringe, with some colored water in it, to gauge the 0.75U dose.

This picture shows the plunger placement for the smaller doses. The picture shows U100 ,syringes, but the plunger placement is the same for the U40 syringes. The concept of the plunger placement is the same. I also copied the descriptions of what the fine doses should look like. Simply scale it up for more units.
  • Fine dose gradations:
    • 0.5U = exactly half a unit
    • 0.4U = skinny 0.5 touching the line
    • 0.3U = skinny 0.5 with daylight under the line
    • 0.2U = fat zero with daylight over the line
    • 0.1U = fat zero barely touching the line
someinsulin-1.jpg
01unit-1.jpg

025unit-1.jpg


Does that help you at all?
 
Deb & Wink said:
Remember, you only started the insulin a few days ago. Even 5 cycles is not much time for a cats body to adjust to getting insulin. You should try to hold the initial dose for a week.

Patience please. A jump in dose from 0.5U to 0.75u or even up to 1U may be a bit much right now for Buddy. I'd suggest giving it the full 14 cycles before you increase. To give Buddy's body time to adjust to getting insulin. 9 more cycles to go.

If Buddy's BG levels were higher, in the pink, red or black ranges more consistently, then a dose increase would be warranted now. But he isn't. He is mostly in the yellow ranges, and only a couple of higher numbers so far.

His BG levels are dropping down a bit in the middle of the cycle. Which is good, that is what you want to see happening.

Consistency is important when raising the dose. Simply do the best you can to try and measure a 0.75U dose with those U40 syringes. You could even make a reference syringe, with some colored water in it, to gauge the 0.75U dose.

This picture shows the plunger placement for the smaller doses. The picture shows U100 ,syringes, but the plunger placement is the same for the U40 syringes. The concept of the plunger placement is the same. I also copied the descriptions of what the fine doses should look like. Simply scale it up for more units.
  • Fine dose gradations:
    • 0.5U = exactly half a unit
    • 0.4U = skinny 0.5 touching the line
    • 0.3U = skinny 0.5 with daylight under the line
    • 0.2U = fat zero with daylight over the line
    • 0.1U = fat zero barely touching the line
someinsulin-1.jpg
01unit-1.jpg

025unit-1.jpg


Does that help you at all?
Click to expand...

Thank you so much Deb, this is so helpful. We really appreciate your advice and taking the time to look at her spreadsheet!! We are going to take your advice and wait the full week before we raise the dosage at all. We make ask for advice after the full 14 cycles to see if the change is warranted at that time, because we are brand new to this, and you guys are so wonderful and helpful!!

That is such a good tip about the reference syringe filled with coloured water- that is genius! I will definitely try that ☺️

We have been so nervous about all this, but today we took the advice and just tested her blood at +3, +6 and +9. Tomorrow we will try to do the same, but it will be the first day we are leaving her alone during the day. For the last three days, one of us has been home with her. Tomorrow we will leave her, though we may check in on her at lunch if possible.

Thanks for sharing those images as well! I am going to print them off so I have them for reference!

Thank you again
 
Hi Jess! Just dropped in to say that you are doing great so far with Buddy. Nice blue number today. I agree with Deb to hold steady with that dose for now. Deb really knows what she's talking about when it comes to sugar cats.

Checking on Buddy at lunch when you can manage it is a great idea. And it will let you get a quick mid-cycle BGL test in, which is always helpful. Make sure you leave some food out for Buddy while you are away from the house, or feed him when you stop in at lunch. He'll have an easier time keeping his BGL regulated if he isn't going too long with no food.
 
Juls and Billy said:
Hi Jess! Just dropped in to say that you are doing great so far with Buddy. Nice blue number today. I agree with Deb to hold steady with that dose for now. Deb really knows what she's talking about when it comes to sugar cats.

Checking on Buddy at lunch when you can manage it is a great idea. And it will let you get a quick mid-cycle BGL test in, which is always helpful. Make sure you leave some food out for Buddy while you are away from the house, or feed him when you stop in at lunch. He'll have an easier time keeping his BGL regulated if he isn't going too long with no food.
Click to expand...

Hi Juls! Thanks so much! You are right, and I feel a lot better when we check in on her at lunch!
 
Hello again!!

Looking for some insight/opinions from those of you that have more experience than we do! We have been giving Buddy insulin for 6 days now and we are wondering if we should be using the dose this weekend, or holding steady and being patience! If anyone is willing to look at her chart and give their thoughts that would be awesome!

Thanks so much
 
Hey Jess! Glad to see you over here from the FB group!

I think you could go up to .75 for Buddy and try that for another 10-14 cycles. She's gotten some better blues but we want her to get down to low blues or dark greens for nadir's

  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases. If you decide to change another factor (e.g., diet or other medications), don't increase the insulin dose until the other change is complete (but decrease the dose if your cat's glucose numbers consistently fall below 90 mg/dl (5.0 mmol/L) as a result of the change).
 
Yup, time for an increase.

And maybe a curve this weekend, if you have a chance.
Testing every 2 hours, from one pre-shot to the next pre-shot.
 
Jess092 said:
Yes I am! Sorry if we are confusing things by both posting. Should we merge our accounts?
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Well, it seemed like too much of a coincidence to have a cat the same age, sex, same name, same city, same dose. same............................

If you could pick one FDMB user id, and use that one on an ongoing basis, it would make things easier.

Don't mind if both of you ask for advice and suggestions. But it would be less confusing for us here if you used a single account. There is no way for us to know there are 2 different people posting about the same cat. Unless we notice so many similarities. Which was sheer happenstance.

You could have one account and then simply let us know who is writing the responses. Member @JOJI and Kit and her partner JW do that.
 
Hi! It’s D’Arcey we are both going to be using Jess’ account from now on.

We gave Buddy a 1U shot at 6pm with 1/2 can of FF pate and she started at 19ish mmol. When I checked her again at 9pm she dropped to about 9 mmol. Is this a normal drop? The SS has been updated with her most recent readings. We are excited about the numbers but a little nervous at the drop in levels.
 
Hi D'Arcey. That is a nice drop so far for Buddy. It's nice to see some blues for her mid-cycle. those are nice safe numbers. but she could drop even more and still be safe. Down into the high green numbers would be fine.

Were one of you available to test at +6 tonight?
 
Beautiful surfing in the blues. That is what you want to see.
It would have been ok for Buddy to have gotten down into the higher greens too.
Using the SLGS protocol for Prozinc, you want to try and keep her nadir above 90.

Hopefully, she'll do well on this 1U dose.

Good job Jess and D'Arcey.
 
It’s is time for buddy’s evening shot, and she is current at 153. I am going to postpone food and insulin for half an hour and text again then.

Would you still give her insulin at 153? Are there any hard and fast rules on how low is too low to shoot for prozinc? We will be around to monitor and test her but of course we do not ever want to put her in danger!

Thanks so much
Jess
 
You shot a 9.3 mmol/L (165) a couple of days ago. So this 9.2 (165) is pretty close to that.

That 8.5 was 1 hour before shot time, so you were able to see that the PS (pre-shot) was a rising number.

I'd go ahead and shoot.

With the Prozinc SLGS protocol, anything > 8.3 mmol (150 ) is shootable.
Jess092 said:
Are there any hard and fast rules on how low is too low to shoot for prozinc? We will be around to monitor and test her but of course we do not ever want to put her in danger!
Click to expand...
As long as you can test and monitor, and feed some food to bring up the BG levels as needed, you can learn to shoot lower than that 8.3 (150 mg/dL).

You get a very good amount of test data, so it's more for your own comfort with BG numbers below 8.3 (150) as to weather you give Buddy insulin or not.

To get her into diet controlled remission, you will have to learn to shoot the lower numbers.

I think Buddy may be in a very slight bounce, from the green numbers on 22/03/20 AM.
 
There is even a tiny bit of wiggle room, where a fat 1U dose may help Buddy to drop a bit lower.
That suggestion is a bit of a judgement call. A bit iffy if you'd want to try that with her.
Not sure if she would drop into the neon green BG numbers if you did that tiny increase.
If she did, you'd need to feed some food to bring the BG numbers back up into the tree green numbers.
1 teaspoon of low carb food to start, then go to medium carb food if you need to.

Up to you if you want to try that. I'd definitely suggest monitoring if you decide to increase a tiny bit.
I think a full 0.25u dose increase would be a bit too much for Buddy right now.

Those pre-shot and mid-cycle blues are better than you have been getting. But you want to see her in the tree green number range a bit more at mid-cycle. It's a fine line in dosing. To try for that smidge more in the dose in the insulin syringe, and be consistent from one shot to the next.

Sometimes, a smidge more insulin, for even 1 cycle, can "kick start" some action with the pancreas and get the BG levels to drop a bit lower.
 
Deb & Wink said:
There is even a tiny bit of wiggle room, where a fat 1U dose may help Buddy to drop a bit lower.
That suggestion is a bit of a judgement call. A bit iffy if you'd want to try that with her.
Not sure if she would drop into the neon green BG numbers if you did that tiny increase.
If she did, you'd need to feed some food to bring the BG numbers back up into the tree green numbers.
1 teaspoon of low carb food to start, then go to medium carb food if you need to.

Up to you if you want to try that. I'd definitely suggest monitoring if you decide to increase a tiny bit.
I think a full 0.25u dose increase would be a bit too much for Buddy right now.

Those pre-shot and mid-cycle blues are better than you have been getting. But you want to see her in the tree green number range a bit more at mid-cycle. It's a fine line in dosing. To try for that smidge more in the dose in the insulin syringe, and be consistent from one shot to the next.

Sometimes, a smidge more insulin, for even 1 cycle, can "kick start" some action with the pancreas and get the BG levels to drop a bit lower.
Click to expand...


Thanks so much Deb! I will talk to D‘Arcey about trying a smidge more insulin!

We would definitely love to see a diet controlled remission. Does that mean we would shoot insulin for any number that is above the healthy range of about 100? I have been reading the dosing protocols but find it a little bit confusing to know when to decrease the dose and when not to shoot, when following the tightly regulated protocol.
 
The Prozinc protocol "Sticky" doesn't call it a "Tight Regulation" protocol, but the MPM (Modified Prozinc Method) is basically the same thing. More frequent monitoring, supporting low numbers with food to stop steep drops and high bounces, a good amount of test data before trying the MPM protocol, taking mainly the nadir BG as a factor for dosing but also taking into consideration the pre-shots and how steep the drops are.

You need to be available to test more, and to support the low numbers with some food when needed.
 
So we gave Buddy her shot this evening and she had a PMPS of 151, we gave her full dose because we are her to watch her. We tested her at +2 and she is a 58. When do you think it would be wise to get her to have some higher carb food? Or how should we proceed? This is her lowest she has ever been and although we know it’s a normal range, she is still set to drop for another hour or two.

D’Arcey
 
Always try a teaspoon or two of her regular low carb food....test again in 20-30 minutes

We want to encourage her to surf and sometimes just a little low carb food is enough.

You can always pull out the big guns if she drops below 50
 
Chris & China (GA) said:
Always try a teaspoon or two of her regular low carb food....test again in 20-30 minutes

We want to encourage her to surf and sometimes just a little low carb food is enough.

You can always pull out the big guns if she drops below 50
Click to expand...

We tested her about 20minutes after her reading of 58 and she was a 56. We decided to give her a bit of high carb wet food just to be safe. We will testing again 30minutes after that.

D’Arcey
 
Hi again! @Deb & Wink @Chris & China (GA)

At +12, we took Buddy’s blood and she was at 133 (7.4). We stalled without feeding for a half hour, and at +12.5 she was 126 (7). Her numbers are going down, not up, at the moment.

At this point do we just continue to stall without food and test every half hour, and then give the full dose as soon as we see the numbers going up?

Jess
 
Those 2 numbers are basically the same. If you keep stalling, what does that do to your shot schedule?
Stalling is suggested for no more than 1 hour.
If the BG numbers are not up far enough for you to shoot the full dose, you may either skip the dose or give a greatly reduced dose. Such as half the normal insulin dose or less.
 
Deb & Wink said:
Those 2 numbers are basically the same. If you keep stalling, what does that do to your shot schedule?
Stalling is suggested for no more than 1 hour.
If the BG numbers are not up far enough for you to shoot the full dose, you may either skip the dose or give a greatly reduced dose. Such as half the normal insulin dose or less.
Click to expand...
Stalling doesn’t upset our schedule anymore because we are home all the time these days.

We are at +13 now, as we’ve stalled for an hour, and she’s still going down- she is at 119 now.
 
I'd either skip, or give a greatly reduced dose. Especially with that BG number still trending down slightly.
If you give the full 1U dose, I'm concerned that you would have to stay up and "feed the curve" so that Buddy's BG numbers would stay > 2.7 mmol/L (50 mg/dL).

You might have to do that, even if you give Buddy the greatly reduced dose. Stay up to monitor that is.
Do you have plenty of test strips?

I can not stay up with you. It's already almost my normal bedtime. Our convention here, is that if someone tells you to go ahead and shoot a dose on low numbers, they are committing to staying up with you. I simply can not do that.

So, the choice is yours.
 
Deb & Wink said:
I'd either skip, or give a greatly reduced dose. Especially with that BG number still trending down slightly.
If you give the full 1U dose, I'm concerned that you would have to stay up and "feed the curve" so that Buddy's BG numbers would stay > 2.7 mmol/L (50 mg/dL).

You might have to do that, even if you give Buddy the greatly reduced dose. Stay up to monitor that is.
Do you have plenty of test strips?

I can not stay up with you. It's already almost my normal bedtime. Our convention here, is that if someone tells you to go ahead and shoot a dose on low numbers, they are committing to staying up with you. I simply can not do that.

So, the choice is yours.
Click to expand...

Deb & Wink said:
I'd either skip, or give a greatly reduced dose. Especially with that BG number still trending down slightly.
If you give the full 1U dose, I'm concerned that you would have to stay up and "feed the curve" so that Buddy's BG numbers would stay > 2.7 mmol/L (50 mg/dL).

You might have to do that, even if you give Buddy the greatly reduced dose. Stay up to monitor that is.
Do you have plenty of test strips?

I can not stay up with you. It's already almost my normal bedtime. Our convention here, is that if someone tells you to go ahead and shoot a dose on low numbers, they are committing to staying up with you. I simply can not do that.

So, the choice is yours.
Click to expand...

Thank you so much Deb! We really really appreciate the help and advice. We definitely do not expect you to stay up with us

I think we are going to skip tonight’s dose and see how she does! We’ve never seen her numbers go down like this so we will play it safe tonight.

Thank you as always for the quick support. It means the world to us
 
Get a good nights sleep, and pick it back up in the morning.

p.s. If you are still up a bit later, do a test or 2 before you head off to bed. To see if Buddy's BG levels head up and how far up. There will be a food spike for sure.
 
Good morning!

Just a little update. So Buddy has a couple more pre shot readings that have been lower than we are used to. She has been in the 130s. With these lower numbers we chose to skip the shot because we can generally expect her to drop about 90-100 points after a 1U shot. For now I think we have decided that we will continue to shoot the full dose for a PS of 150 or more (provided Nadirs aren’t dropping below 50, in which case we would lower), but that anything below 150 is a no shoot number for us for now, this early on in our journey.

Does skipping the dose when below 150 make sense, or would it be preferable to give a token dose?

D’Arcey
 
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Jess092 said:
Does skipping the dose when below 150 make sense, or would it be preferable to give a token dose?
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Yes, it's preferable to give a token dose instead of skipping the dose entirely.

If Buddy is dropping too far, so that you feel she is in danger from a hypo, I think it's time to lower the dose.
You want to be able to give the insulin twice a day. Buddy needs the insulin, so she can process her food. Not enough insulin, also increases the possibility of ketones forming.

If you skip, please do a ketone test, either with urine ketone test strips, or there are special blood testing meters that can test for blood glucose, but also for blood ketones with a special test strip.

How about a 0.75U dose? See how she does on that for a few days?
 
D"Arcey and Jess, I'm starting to feel sick, running a fever. Not sure how long I can help out here.

Please post in Feline Health if you don't get replies here.

Thanks.
 
Deb & Wink said:
D"Arcey and Jess, I'm starting to feel sick, running a fever. Not sure how long I can help out here.

Please post in Feline Health if you don't get replies here.

Thanks.
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Hi Deb,

I’m so so sorry to hear that you are getting sick. If we can support or help you in any way please please let us know. I will be thinking of you, and hope you get well soon.

Jess
 
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