unintentional skipped dose, ideal numbers, feeding, and dosing

[mistymisty]

So I’m pretty new to this. Still reading and re-reading in order to learn and hopefully actually retain as much info as possible. Forgive me If I’m asking things that have probably been rehashed to death or are easy to find and I’ve totally overlooked. I used the search function quite a bit before making this post so not to be too much of a bother, and I’ve read the stickied posts in the ProZinc forum.

Background info:

Misty is 18 - or at least that’s how long my mom has had her - about to celebrate her 19th year with us very soon. She was diagnosed this month on the 17th and was started on 1.5u of ProZinc 2x daily. My partner and I are taking care of Misty now, as my mom is unable to. We started feeding her the DM food at the vet’s suggestion, but after reading this forum are now feeding the Tiki Cat luau and after dark lines. We tried Fancy Feast, but Misty has a very sensitive stomach and, unfortunately for our wallets, seems to get really bad diarrhea and bloating with it like she does with many other foods she’s been given in the past. She also needs a low sodium diet due to high blood pressure which resulted in the start of HCM, but fortunately the cardiologist said that it is mild and hopefully will not progress further as long as her blood pressure stays under control, so we are trying very hard to not fret over that for now.

So now onto our totally newbish questions:

Feeding:

Because of this board, we just yesterday started withholding food two hours prior to taking preshoot numbers to get a more true value because all the vet had told us was to just have food available at all times. I’ve read about people on here feeding every 4 hours, so I think we will try that. Before we’ve been pretty much just offering food constantly and seeing if she wants it or not because we don’t want to just leave it out and have the other animals devour it and then think she ate when she didn’t. Are there any other feeding schedules anyone might suggests? Unfortunately I hadn’t thought to chart when she eats in relation to her BG numbers until today, though.

ETA: After reading a bit more about food switches - I see a lot of cautions to go slow, especially when on insulin, but I was wondering just how slow. Misty is primarily on Tiki Cat with some of the Purina DM mixed in at times, but now I’m wondering if we dropped the amount of carbs she’s getting too quickly. The Tiki Cat is 0 carb, and the DM is 6% carb. Should the switch take days? Weeks?

Ideal numbers:

I’m still confused as to what numbers I’m shooting for. I’ve read a few varying accounts online, and the vet offered almost no education on FD and didn’t even suggest we could take BG readings on our own.

When calling in numbers to our vet, he was concerned in the beginning that Misty was going too low because of a 79 BG (on a human monitor) at +7, but from reading the forums, I’m not getting the impression this is a concerning number? Unless it was because of the discrepancy between this and where she started in the cycle or something else I’m not understanding? Because of this he had reduced the dose to 1.25u only to bring it back up again to 1.5u a couple days later and I’ve became very paranoid when I see things going in that range.

From posts on here, I see that under 50 is the Take Action number for hypo on a human meter, but other than that, can someone direct me to a reference regarding numbers? What is the idea range? Misty has been starting her cycles pretty high.

Dosing:

I understand that we only have a weeks worth of information and that might not be enough, but are any experienced members willing to have a look at Misty’s spreadsheet and see if they have any advice to give? Is this a good start? Is it even too soon to tell?

Also I accidentally skipped this morning’s dose due to illness - do I start her night dose today continuing at 1.5u? EDIT: PM insulin time came up and we continued the 1.5 at 7pm.

Thanks everyone for putting up with my questions! I know that was a lot to read.

 

[Lisa and little]

Well hello there. First off don’t worry about too many questions.... no such thing! We’ve all learned by asking questions and you’ve come to the right place. 79 is a great number on a human meter and still a safe number on a pet meter. My advice is when you see her at that kind of number get another test an hour later to see if she is rising or going up. With respect to food I feel you on the expense of TIKI cat but it is what it is if FF is not good for her. Still better than the vet food. I have a multi cat house and there is no such thing as leaving food out as it would be eaten immediately so I feed at shot time. Routine is every 12hrs - test -feed- shoot (numbers permitting) I know the 12 hr food cycle is not optimal but I have no choice if I want to know who’s eating what and when. I cannot advise on dosing and you have just started so I would wait and see what time / more data brings but you seem to getting blues and greens at 1.5. Which is great especially from her high PS numbers. I’m sure soemeone else will chime in. There are some really great experienced people here so ask away as we all learn from everyone else. I personally would stick at 1.5 for now assuming PS numbers make sense and see where it goes. I know this can be stressful but we are here for you!

 

[Kris & Teasel]

Welcome! It's wonderful to meet a new member who has done so much homework already. You're to be congratulated for that! I'll address your questions as succinctly as I can:

we’ve been pretty much just offering food constantly and seeing if she wants it or no

Diabetic kitties generally do better when given multiple small meals a day or being allowed to free feed. That can be hard with other pets in your home and your FD kitty needs a special diet. If you're around to offer food to her you can do that. The two hours before a pre shot BG test is when you want to keep food away from her. Some people (finances permitting) use one of those expensive microchipped feeders that open only for the kitty wearing a special collar.

I’m still confused as to what numbers I’m shooting for.

The BG numbers will be up and down quite a bit at the beginning as Misty's body is adapting to exogenous insulin. Your vet started you on 1.5 u (usual starting dose is 1 u twice a day) and so far she's coping although her drops from pre shot to nadir are large. You're monitoring closely enough to leave her there for now.

Here are some guidelines for numbers:

• about a 50% drop from PS to nadir (Misty's are much bigger quite often so I wonder a little about the dose being a smidge too high)
• expect a "smile shaped" BG curve from ProZinc
• once better regulated, PSs in the low to mid 200s and nadirs in the high 90s to low 100s.

Because of this he had reduced the dose to 1.25u only to bring it back up again to 1.5u a couple days later and I’ve became very paranoid when I see things going in that range.

Kudos to your vet for recognizing that a 0.25 u dose fraction is something to try! We can help you with dose tweaking. It's best done carefully, in 0.25 u fractions and not too frequently. If a dose is obviously too low we'd recommend increasing after 3 to 4 cycles. If she drops too low, ie., lime green, we'd recommend an immediate reduction.

From posts on here, I see that under 50 is the Take Action number for hypo on a human meter, but other than that, can someone direct me to a reference regarding numbers? What is the idea range? Misty has been starting her cycles pretty high.

Yes, it's 50 on a human meter and 68 on a pet meter because those read higher. Don't worry - we all understand human meters here. Her cycles are likely starting high because of her big drop from PS to nadir. It's a rebound phenomenon. That sometimes lessens over time. If 1.5 u proves to be a bit too much a very slight reduction might reduce the ups and downs. Let's see what happens at 1.5 u first though. Here's something I wrote about rebound or "bouncing" as we call it:

1. BG goes low OR lower than usual OR drops too quickly.
2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.

Should the switch take days? Weeks?

You should be able to accomplish the switch in a week. Go by Misty's responses if she's a particularly sensitive kitty. There are members who make their own kitty food using single ingredient meat source with a complete nutritional supplement added.

I understand that we only have a weeks worth of information and that might not be enough, but are any experienced members willing to have a look at Misty’s spreadsheet and see if they have any advice to give? Is this a good start? Is it even too soon to tell?

You've got a lot of great data so far and I've based my comments on that. You've made an excellent start!

Also I accidentally skipped this morning’s dose due to illness - do I start her night dose today continuing at 1.5u? EDIT: PM insulin time came up and we continued the 1.5 at 7pm.

That's fine. If you could add the time zone you're in to your signature text it would be helpful. We're all over the globe here on FDMB.

 

[Djamila]

Hi there, Misty's mom/dad! Kris and Lisa have already given you some good advice, so I'll just say welcome, and echo the "good job!" for all of the learning and work you have done already. Please don't hesitate to ask as many questions as you have. It's never a bother. We have all been in the early phases of this journey at some point too and understand how overwhelming all of the new information can be.

And also, while there is an absolute ton of amazing information around here, there is also an expression we use a lot: Every Cat Is Different (ECID). So a lot of the learning here is figuring out how the advice you read fits with your cat, and sometimes it can really help to have folks chime in with their thoughts when a new situation arises.

I agree with Kris about keeping the 1.5u dose for now. The drop is pretty dramatic, but I don't see any reason right now to lower it. I think giving Misty a little more time to settle into it will help.

 

[Rachel]

Hello! You've gotten wonderful information already so I just wanted to drop in and say welcome! Please do ask all the questions you have...we've all been there and no matter how much homework you've done, it feels scary and you feel very alone. We're here for you and we'll be glad to help!

 

[mistymisty]

Well hello there. First off don’t worry about too many questions.... no such thing! We’ve all learned by asking questions and you’ve come to the right place. 79 is a great number on a human meter and still a safe number on a pet meter. My advice is when you see her at that kind of number get another test an hour later to see if she is rising or going up. With respect to food I feel you on the expense of TIKI cat but it is what it is if FF is not good for her. Still better than the vet food. I have a multi cat house and there is no such thing as leaving food out as it would be eaten immediately so I feed at shot time. Routine is every 12hrs - test -feed- shoot (numbers permitting) I know the 12 hr food cycle is not optimal but I have no choice if I want to know who’s eating what and when. I cannot advise on dosing and you have just started so I would wait and see what time / more data brings but you seem to getting blues and greens at 1.5. Which is great especially from her high PS numbers. I’m sure soemeone else will chime in. There are some really great experienced people here so ask away as we all learn from everyone else. I personally would stick at 1.5 for now assuming PS numbers make sense and see where it goes. I know this can be stressful but we are here for you!

Thanks for the insight in everything!

And I feel you on the multiple cats! We also have a 12 lb tabby that is an absolute goblin when it comes to any food being left out. We once caught her on the counter top eating oatmeal that had been left there for only a couple minutes to cool. You can’t leave anything unattended with her!

 

[mistymisty]

Welcome! It's wonderful to meet a new member who has done so much homework already. You're to be congratulated for that! I'll address your questions as succinctly as I can:


Diabetic kitties generally do better when given multiple small meals a day or being allowed to free feed. That can be hard with other pets in your home and your FD kitty needs a special diet. If you're around to offer food to her you can do that. The two hours before a pre shot BG test is when you want to keep food away from her. Some people (finances permitting) use one of those expensive microchipped feeders that open only for the kitty wearing a special collar.


The BG numbers will be up and down quite a bit at the beginning as Misty's body is adapting to exogenous insulin. Your vet started you on 1.5 u (usual starting dose is 1 u twice a day) and so far she's coping although her drops from pre shot to nadir are large. You're monitoring closely enough to leave her there for now.

Here are some guidelines for numbers:

• about a 50% drop from PS to nadir (Misty's are much bigger quite often so I wonder a little about the dose being a smidge too high)
• expect a "smile shaped" BG curve from ProZinc
• once better regulated, PSs in the low to mid 200s and nadirs in the high 90s to low 100s.

Kudos to your vet for recognizing that a 0.25 u dose fraction is something to try! We can help you with dose tweaking. It's best done carefully, in 0.25 u fractions and not too frequently. If a dose is obviously too low we'd recommend increasing after 3 to 4 cycles. If she drops too low, ie., lime green, we'd recommend an immediate reduction.


Yes, it's 50 on a human meter and 68 on a pet meter because those read higher. Don't worry - we all understand human meters here. Her cycles are likely starting high because of her big drop from PS to nadir. It's a rebound phenomenon. That sometimes lessens over time. If 1.5 u proves to be a bit too much a very slight reduction might reduce the ups and downs. Let's see what happens at 1.5 u first though. Here's something I wrote about rebound or "bouncing" as we call it:

1. BG goes low OR lower than usual OR drops too quickly.
2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.

You should be able to accomplish the switch in a week. Go by Misty's responses if she's a particularly sensitive kitty. There are members who make their own kitty food using single ingredient meat source with a complete nutritional supplement added.


You've got a lot of great data so far and I've based my comments on that. You've made an excellent start!


That's fine. If you could add the time zone you're in to your signature text it would be helpful. We're all over the globe here on FDMB.

Thank you so much for the welcome and your time in answering and explaining all of this! I’m so glad to have clarification on the numbers and the guidelines on the dose tweaking! I’m feeling more confident now that I have some clarity regarding these matters, though we had a bit of a setback last night that sort of dampened my confidence. Had my first (to my knowledge at least) furshot, and combined with the missed dose the day before, Misty’s feeling just awful now, so of course I’m feeling terrible also.

It’s great that you mention the food, because my partner just ordered the supplement yesterday!

Oh, and time zone is PST! I will add it now.

 

[mistymisty]

Hi there, Misty's mom/dad! Kris and Lisa have already given you some good advice, so I'll just say welcome, and echo the "good job!" for all of the learning and work you have done already. Please don't hesitate to ask as many questions as you have. It's never a bother. We have all been in the early phases of this journey at some point too and understand how overwhelming all of the new information can be.

And also, while there is an absolute ton of amazing information around here, there is also an expression we use a lot: Every Cat Is Different (ECID). So a lot of the learning here is figuring out how the advice you read fits with your cat, and sometimes it can really help to have folks chime in with their thoughts when a new situation arises.

I agree with Kris about keeping the 1.5u dose for now. The drop is pretty dramatic, but I don't see any reason right now to lower it. I think giving Misty a little more time to settle into it will help.

Thank you so much for the welcome and assurance as well as the reminder that ECID! This place is honestly amazing; I can’t imagine how much more lost I’d feel without having found it.

 

[mistymisty]

Hello! You've gotten wonderful information already so I just wanted to drop in and say welcome! Please do ask all the questions you have...we've all been there and no matter how much homework you've done, it feels scary and you feel very alone. We're here for you and we'll be glad to help!

Thank you so much! I’m so grateful to have found FDMB!