to shoot or not to shoot, that is the question

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Alexi

Alexi

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So today is Cappuccino's fourth day on prozinc she is supposed to be on 1 unit twice daily but last night I had to reduce to 0.75 as I was not comfortable giving 1 unit with her reading. I did grab some mid cycle tests the first two days and she seems to have food spikes with a late nadir around 7-8 hours. Tonight she has given me a blue number and I am thinking maybe a 0.25 or 0.5 tonight with a reduction in the morning, she is fine and has been all day. @Rachel @Sue and Oliver (GA) @Ruby&Baco your thoughts would be appreciated as I have to shoot in the next hour. I am used to her giving me odd numbers but my vet is keen I don't change her dose too much in the first week until I can do a full curve. I have u40 syringes with half unit markings.
 
Hi! Well with this PMPS 160 I would not give a shot. For newbies we allways say 200 is the no shot limit. I know you've given other insulin but in this case you just started with prozinc. I would give it at least a week or two to gathee more data so that, in cases like this, you can give maybe a drop or 2 and monitor.
But for now, today I would skip this PM cycle. :)
Great number btw!
 
Oh and btw, I would defenitely give a reduction as off tomorrow when the pre shot number is shootable. Dear Cappuccino is all over the place, and I think it's because the dose 1U was too high. So start off with 0.50U as soon as you get a shootable number (hopefully tomorrow morning) it's best to get 2 shootable number instead of 1, like tonight.
 
Very nice. He is responding well to the insulin. Is it too late to think about stalling? ( wait 20 minutes without feeding and retest to see if he is nearer 200). If that works, then a reduced dose.
 
Wishing you both all the luck in the world! :) Looks good so far! ( well to me anyway)
 
So sorry! I was at work..and it's been a week s checking in has been hard.

I'm guessing you are too far away from shot time to stall. Next time, you might try that. Wait 20 minutes without food and retest to see if she comes up. I hate to see you skip if you don't have to since she's been so high for awhile.
 
So far so good - she has had shootable numbers the past few days so I have gone with my instincts on when to reduce the dose from 1 unit. I have to try for a curve the next few days but I really want to do this on a 1 unit dose so I will try to steer her numbers a bit to get a number that is ok for 1 unit on the APMS, hopefully her numbers will co-operate! She is absolutely fine and happy and bouncy (in a good way). Last night she was overheated - it has been very hot and humid here so she had a tepid bath. She did have an episode of heat exhaustion a few years ago, she is susceptible as she is so fluffy, and I had to syringe water into her and give her a good soak to get her out of it, so she knew the bath would help!
 
I got more readings today - she wasn't very active today and apart from when she was demanding food spent most of the day snoozing. Seeing as she doesn't drop very far and her pre shot numbers are on a gentle slide I'd like to hold the dose for a few more days and try again for a curve on a more normal day when she is doing a bit more. She might need a dose increase but I'd rather get more data first.
 
It looks fairly flat, but I think your idea of holding the dose a few cycles and collecting some more data is fine. You may need to increase the one unit by a little bit on those mid 300s, but time will tell.
 
Another blue pre shot number but this time I'm going to try a 0.25 unit dose and check a +3 as she doesn't seem to drop very far and does get a food spike, I've been getting some good numbers the past few days and would like to keep it that way.
 
Another blue PMPS so I'm going to try a 0.5 unit dose with a +3. Hopefully curve day tomorrow!
 
Curve would be great data.

You might look at an 11/13 schedule if the pattern continues. You can shoot the amps an hour earlier than usual - as long as it is high enough to shoot- and wait an hour in the pm if the pmps is lower than you can shoot.
 
The +3 was a little lower than expected so I am going to check again in another hour, hopefully she is not going to drop too fast.
 
So today she got off the trampoline pretty fast and got on her surfboard, I only planned a few tests to check if she really does have a +8 nadir but she stayed in the yellow and even dropped a bit at PMPS. This is the cat that hasn't read the manual, but I'll try again tomorrow for a curve.
 
Cappuccino is doing better on prozinc I find viewing the spreadsheet! How is she feeling and acting?
 
Curve wasn't - not really sure why, so I am going to try to stick with 1 unit for a few cycles and see what she does.
 
That didn't last long - another yellow pre shot number so I'll try to grab some more mid cycle tests today. Maybe as she wasn't very active yesterday that affected her numbers.
 
Yes, I am much happier with the Prozinc as this is what I was hoping for. Shall I hold her at 0.75 for the yellows or is it worth trying a bigger dose? I am on holiday at the moment so able to monitor. She doesn't seem to drop very far over a cycle. On Monday she has to be starved for a test which may throw things out a bit.
 
I like your dosing. She seems to have a little higher flatter cycle after a lower number - a bit of a delayed reaction. I'd be nervous about pushing when you get a yellow preshot, for example. One unit has brought a red pre shot down 300+ points, so I would be wary about giving much more than .75 on your yellow Pre shots.

She may be a kitty who gradually goes down, without the big swings from low nadirs. This is not a bad pattern to have - it means fewer scary cycles with low nadirs to steer with food. We don't know for sure what happened with those blue pmps numbers, but I'd assume that it was a long cycle - not moving back up from a low nadir.....
 
Wow I can see a huge difference from the prozinc! It definitely seems to agree with her that's for sure. I bet you are a happy bunny! :) keeping fingers and toes crossed here!
 
Both of us are happy, hopefully my vet will be too - I just emailed her an update with the link to the spreadsheet. I think Cappuccino may be the only cat they have changed over to Prozinc so far and she is very interested to know of my experiences with it.
 
Alexi said:
Both of us are happy, hopefully my vet will be too - I just emailed her an update with the link to the spreadsheet. I think Cappuccino may be the only cat they have changed over to Prozinc so far and she is very interested to know of my experiences with it.
Click to expand...

Maybe she will consider switching others if Cappuccino keeps this up :)
 
Two blue pre-shots in a row today - she bounced up a bit after the green but still looking good!
 
Alexi, I would be cautious shooting such low preshots. It gives you the potential for a dangerously low nadir and sets up the possibilities for bouncing. MHO. I would not shoot under 180 and then would shoot a token dose. (maybe .5)
 
Thanks for the concern. I have been given a protocol to use for how to handle low pre-shots as part of the clinical trial so don't shoot until after the +1 number is known. Tomorrow is curve day so I will get a better idea of how she is handling the doses then.
 
Curious...can you tell us more about the clinical trial? I may have missed it (I missed a lot the last few days) but I don't think I really know what it is. :) This is just for my curiosity, though.
 
Cappuccino has been entered into a clinical trial in the diabetes remission clinic at the RVC, the protocol uses Prozinc, Purina DM canned (both of which she was having anyway) and long acting exenatide vs placebo (double blinded). Exenatide is a beta cell stimulant with a good track record in treating human type 2 diabetics. She will have a monthly injection for six months. Not sure if it is the increase in her dose causing the lower numbers or whether she has ended up in the treatment group but either way they think she has a good chance of remission.
 
Curve day today - so she decided to snooze most of the day away :banghead: Her numbers seem to be affected by her activity levels. She was getting stressed by PMPS with all the testing and interruption of her snoozing, and asking for food for 2 hours :cat:

She is getting a shallow curve, it seems, as todays numbers were consistent with previous attempts and confirms a late nadir.
 
Well this is looking interesting - it seems Mr P has come out to play, no insulin this morning as she did not get much of a rise from food (therefore no shot according to her individualised protocol) and in the blues before food for the past few days. She couldn't care less and is happily snoozing on the bed.
 
wow, hello Mr.P! How is he enjoying his visit? I think he's liking it because he's been around a couple off hours! Hopefully he's staying a little longer ;)
 
Well you know, it's weekend, Mr.P has his own plans so he needs to leave now and then but I guess he will be back soon ;)
 
Mr P is still popping in from time to time, and the specialist is pleased with her progress. As she gets pretty flat curves her dose is going up as of tomorrow as the Prozinc seems to last longer than 12 hours. Next week she gets her second injection as part of the clinical trial so I'm hoping to see more progress. Cappuccino couldn't care less but she is very attentive and happy at the moment. :cat:
 
Mr P has popped in again today and we are on a roller coaster ride this week! First no shot for a couple of weeks, even allowing for the scary dosing regime, the increase in dose is helping. Fingers crossed. :D:cat:
 
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