Update on Spy Kitty

Starting a new thread on the progress of Spy Kitty, and request for advise on dosing as his numbers come down.
Yesterday in the AM cycle he had a reading below 50 so I dropped his dose from 1.5U to 0.75U for his PM shot. Tested through +5 in the PM cycle to be sure all was ok.
This morning his AMPS is 175. I am thinking I should stay at 0.75U for now. Does that sound right? @Shelley & Jess

Previous thread :
https://felinediabetes.com/FDMB/threads/update-on-spy-kitty-bg-50-today-what-dose-tonight.249661/

 

Yes, I'd try the 0.75U.
This should be his ‘bounce breaking’ cycle if he keeps the same patterns up.
Let’s see what the lower dose does to help him not drop so hard and fast early in the cycle.

 

Got an 88 today. I double checked it on the opposite ear and got 89. It came at an unusual time in the AM cycle though, @+7. His nadir tends to be at +4 in the AM cycle and that's what it was looking like today until I did the test @+7. Any thoughts on why the drop at +7 might have occurred?

Does the 88 earn another 0.25U drop? @Shelley & Jess

 

How is Spy Kitty doing? He must be feeling good today! No fast, sharp drops and then bouncing back up.

Prozinc onset is usually around +2 for most cats. When we see those fast drops at +2 it’s usually a bounce breaking and the momentum of the break along with the insulin kicking in can give you an earlier nadir.

Today was a ‘textbook’ curve for Prozinc - flat at +2, a nice gentle 50% drop to nadir in the middle of the cycle and a slow rise back up.

Since he barely dropped below 90 I would hold the 0.75U if above 150.

 

I think he is feeling good. He pretty much just sleeps all day, just getting up to move to a new location to sleep (or use the litter box). I try to get him to play with a wand toy but he only will bat at it with his front paws from his lounging position. No getting up for real combat!

Thanks for the analysis of his numbers today. I totally did not see the "textbook" curve.

Just took PMPS. 137

 

Kinda flat, did I catch you in time, can you do a stall, see if he's rising? If not I'd do 0.5U tonight.

 

Yes I can stall. I did not shoot yet since I was hoping you would be able to reply. Another 15 minutes will be 30 min after the 137. I'll test then.

 

It was 150 after stalling 30 min so I gave him 0.75U. Thanks for your help.

 

So everything went well last night and today, but when I went to give PM shot he was having nothing to do with it. I had actually stuck him and he turned and bit my leg (not bad) before I had injected insulin. Tried again but he bared his teeth and I backed off. Waited 15 min but still no luck. Have to leave now. How late in a cycle can a shot be given? Reduced dose? I will probably be home in 2-3 hours. @Shelley & Jess

 

Awww rats! I peeked at your spreadsheet at PMPS and was so darn happy to see he kept the number down at shot time

I'm sorry he gave you a hard time. Jess did that a couple times with me, didn't bite but wanted nothing to do with the shot. It happens.

Prozinc is more forgiving when you have to shoot late - it's not like Lantus or Levemir where you have a depot to worry about. Since you fed you would've had to wait at least the 2 hours and anytime you shoot late (any amount, token or full dose) that makes the next dosing cycle at least 11 hours later with Prozinc and that's only doable if he's high enough to shoot. The later you shoot the longer it will take to get back on schedule. So yes, shooting late can be done with Prozinc if it works with your schedule.

Looking at your spreadsheet he handled those last two no shots so well and the last time you tested for ketones he was negative so skipping was a reasonable option.


ETA: I see you're not the only one who had a hard time shooting last night - there's another thread in Feline Health (Welcome & Main) discussing the same thing.
Hard time giving insulin tonight, took 3 stabs
It seems most U40 syringes are 29 gauge. There's a couple of brands that say they have 31g U40's. I really hated the fact that I was rather limited to what and where I could buy U40's here in Canada so I switched to 31g U100 syringes and used the Conversion Chart. If he gives you any more trouble in the future either/or may be worth looking in to.

 

Glad to hear I am in good company with occasional non-cooperative kitties! I was really stressed about how it was going to go this morning, but all went well.

Thanks for the input on the late shooting.

Numbers did get a bit elevated last night but they are back down. Got an 89 and 73 @ AM +4 and +5 respectively.

Yes my U40 syringes are 29 ga. I will be happy to order 31 ga. Small price to pay for my cat's "comfort". Is it easier to "measure" smaller doses with the U100 syringes? I see your Jessie is only getting 0.1U. How can you even measure that amount? I can order either U40 or U100 in 31 ga. Do you have a recommendation as to which?

 

I preferred the U100's. The doses are easier to measure because for every 0.2U change of U40 insulin in a U100 syringe with 1/2 unit markings there's a line to go by.

When you get down to those teeny tiny doses I strongly recommend using digital calipers. No, maybe I should re-phrase that, I recommend calipers for all dosing. The lines on the syringes can be wonky from one syringe to the next and the calipers keep things as close to consistent as possible.

If you're interested here's the link to the thread:
Info Dosing with calipers updated w/videos

 

For anyone reading, I should add to my last post:

The information provided in the link above using digital calipers is for U100 insulin in a U100 syringe.

I have a tab on my spreadsheet called "My Digital Calipers" for using U40 insulin with the particular U100 syringes I was using.

If ANY of this is confusing or you don't understand how to make these conversions from U40 insulin to U100 syringes using digital calipers I strongly urge you to post first and ask for guidance before attempting.

 

Ordered UltiCare U100's 31 ga. with 1/2 unit markings today. Also went to Harbor Freight and got the Pittsburgh digital caliper. Thanks for the link.

 

What do today's numbers reveal about the no-shoot last night? Did Spy Kitty earn a dose reduction today? +12 is in one hour. @Shelley & Jess

 

The combined no shot with a bit of a bounce from the green led to those yellow numbers last night and he cleared it fast again during todays AM cycle.

I'd drop the dose to 0.5U tonight and if he doesn't hold the reduction we can always increase again.

Looking good Spy Kitty! Go Spy Go!

 

Reduced dose last night and this morning to 0.5U. Just tested at +11.25 and his number is 358. Do I go back to 0.75U or give 0.5U more of a chance?

This morning's first stick was not successful. Waited about 10 minutes and tried again which was successful but he still growled and gently bit on my hand (not breaking skin). Starting to get syringe-shy. @Shelley & Jess

 

I'm going through the syringe shy business too. Ordered the 31g needles with 6 and 8mm needles...now just have to wait until Friday when they are delivered (seems like so far away). Hang in there!!

 

I'd like to see one more cycle at 0.5U.

- He had a pretty good drop at +2 today.
- Today's AM cycle could still have been part of the bounce from yesterdays AM cycle with that drop to 63 - that was a huge drop from AMPS yesterday morning.
- That 358@+11.5 could be what we call the 'high before the break' and if it is you might have an active cycle tonight.

So, yep, would like to hold the 0.5U for tonight and re-visit the dose tomorrow morning if needed. Sound good?

 

Thanks StarburstMom! Yes, I also ordered 31g syringes. They should be here tomorrow. Hope they make a difference with Spy Kitty. He drew blood on me a couple days ago when I was trying to shoot him.

 

Yes that sounds good. Many thanks! Have a good evening!

 

By the way...... So what do you mean by active cycle tonight? What amount of testing should I be doing?

Out of town guests arriving tomorrow for a few days so my testing may be somewhat impacted. But my intention is to make our schedule allow for me to be home for testing at AM +5 and +6 to catch Spy's nadir. Is that the most critical data to get. I will certainly be able to get +2 and then something close to PM shot but I do want to make sure to capture the most critical information with the testing.

 

I'd start with +2 tonight to see what kind of drop, if any he might have starting. If he drops fast and early be prepared to test and steer with food if needed.

Here's an explanation of High Before the Break that I copied from a post by @Marje and Gracie.

“High before the break” is often missed and thought by many to be a sign more insulin is needed. But you have to look at the clues.

He was bouncing

He was due to clear the bounce

His BG was wobbling a bit like it might be clearing but then the numbers shot way up.

BG Starts down. Sometimes it comes down much faster than he is. I’ve seen it go from 500 to 40s in one cycle. Still, the above pattern is classic high before the break. One note: sometimes members will see a high number out of nowhere and might suspect that is the high before the break but you have to have the entire pattern above, not just a high number from seemingly nowhere. That could be less absorption, loss of duration, etc."

The signs are there for you tonight. It looked like he was trying to clear the bounce this morning when he dropped at +2, he was due to clear the bounce, BG wobbled a bit and then shot up.

 

First of all thank you for all of the detailed explanations you give for all of your guidance. It is educating me.

Just tested at PM +2. Got 358 again. Double checked since it was exactly the number I had at AM +11.5. Spy not happy with double check. Got hisses and teeth. 330 second time. Will keep testing.

 

Just a note to add to Shelley’s explanation: not all cats will show a high before the break and even those that do might not do it consistently.

 

Copied, added the paste to my reference and saved!

Thanks Marje

 

Youre

You’re welcome!

 

Thoughts on today's numbers and tonight's dose? @Shelley & Jess

 

Starting to look like he doesn’t want to hold this reduction, or simply put it’s looking like a failed reduction. The numbers are trending up a bit.

SLGS would have you hold the dose for a week.

You asked about Prozinc MPM dosing in your last thread. You’ve been at it a month, test more than enough, have a good amount of data and have removed all dry food and I think we’re most likely at the point where we won’t see any more drastic changes in the BG now from removing the dry. You could follow MPM now and increase to 0.75U.

From Prozinc MPM dosing:
If an attempted reduction fails, go right back up to the last good dose as soon as you see kitty's numbers trending upwards. You don't have to hold the reduced dose for a certain number of cycles before taking the dose right back up. The guidelines listed under the topic "Increasing the dose" do not apply to a failed reduction. Please use common sense in this situation. The "last good dose" is not the dose that just dropped kitty into the 20s or 30s. You want to resume momentum by finding an in-between the dose.

The only thing I personally didn’t like was increasing on a night cycle. It’ll depend on what you’re comfortable with.

Oh, and I meant to ask, can you make a note on your spreadsheet in the Remarks column when you stopped all dry (I think it was July 12th). It’ll be good for others to see and might help others understand what can happen to the BG numbers when all HC dry food is removed. Gosh, only a month ago you were seeing those scary black numbers! You and Spy Kitty are doing great!

 

Yes, I was afraid it was the case of a failed reduction. But as you say Spy Kitty has made tremendous progress in just one month.

And no, I am not up for doing the increase on a night cycle so I will stay with 0.5U tonight and increase to 0.75U in the morning.

Many thanks. (I added a remark about ending dry food. It was on July 12th)

 

I wanted to follow up on high before the break because sometimes, with a newly diagnosed cat, we need to see the pattern of the cycle before we know whether it’s a high before the break.

In this case, on 7/19 and 7/20 pm cycles, those were not the high before the break now that I can see Spy Kitty’s full cycles. What I am seeing on those two nights are loss of duration on the a.m. cycles. There can be many reasons for that including absorption, not high enough dose, change in barometric pressure (I’m not kidding), food, etc. When you see the BG go up quickly, in this case by +9, but then come back down after the next shot, it’s usually loss of duration. Some mistake it for a bounce but it’s not.

 

Thanks for that information/explanation. Upping the dose to 0.75U this morning has resulted in some good readings today at least up to +10 which I just took. It will be interesting to see what PMPS is. I don't think it will be pink!

 

You’re welcome! Go Spy Kitty!

 

I love how you explain things - another one for the file!

 

Not getting off to a good start today. Numbers up.

 

It's okay! Barely pink and have you read about the allowance for meter variance yet? 274 and 317 could be considered the same number, so he's flat. Your meter can have a 20% variance from test to test. (another tidbit from Marje!)

"The 20% variance only applies to tests taken with a single meter. That means if you use Meter A and you take a test and then later take another with Meter A, there is an allowable 20% meter variation. That helps us tell whether the cat is actually flat or going up or down. If the numbers are within 20% of each other, they are, for all intents and purposes, the same number. The 20% meter variation does not even apply to human meters of a different type."

 

Thank you!!! Thank you for helping Martha & Spy Kitty!

 

Thanks for the encouragement. I had read about the 20% variance but it is just sort of hard to put into practice

 

What started out as a day which was discouraging to me (a newbie) got better. I am amazed and impressed at how the senior/experienced members can interpret the swings in BG. The support offered through this website is truly emotionally life saving. @Shelley & Jess @Marje and Gracie

 

A lot of times, it’s not anything to really think about but when you are wondering if the BG is really flat or not, it’s something ti consider.

 

Using a UltiCare VetRX U100 syringe and digital caliper for the first time on PM shot.
From the conversion chart a 0.75U dose of Prozinc would be to the 1.9 mark on a U100 0.3cc syringe. (Actually 1.88)
From Marje's post on Dosing with Calipers that you shared with me (https://www.felinediabetes.com/FDMB/threads/dosing-with-calipers-updated-w-videos.79851/#post-862835), a 1U dose in the UltiCare VetRX U100 syringe would measure 1.25mm on the caliper.
So I calculated (1.88*1.25) = 2.34mm as the measurement on the caliper for the UltiCare syringe. I am pretty sure that is right but can someone check me on that? @Shelley & Jess @Marje and Gracie

 

You got it!

 

Thanks for sharing the chart!

 

You're welcome!

 

Make sure to store/hide/tuck any U40 syringes you have left way far away from your U100 syringes.

 

This morning's PS number was 106. Stalled 20 min. and got 109. Just stalled another 20 min. and got 111. Since the numbers are so flat I went ahead and let him eat.
My thought is to shoot 0.5U rather than 0.75U. Thoughts? @Shelley & Jess I know it is early to be looking fort a reply. I went ahead with the 0.5U one hour after his normal AM shot time.

Just wondering if my prior "eye-balling" 0.75U with the U40 syringe vs measuring 2.34mm on the U100 syringe for the first time last night might be coming into play here.

 

Grab a +1 test.

 

131

 

Is it ok to leave him for a couple of hours now?

 

Good!

Sorry, bit slow on the reply. I was thinking the same thing. +3 sounds good.

 

Awesome!