UPDATED dosage advice

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milosmommy

milosmommy

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Milo went to 3Xs daily on 1/11
He seemed to do well but now he's back to bouncing like crazy the past couple days.
His dosage is the 3 line on 100U syringe.

It is really tough with the 3Xs daily.

Should I continue with 3Xs. If so should dosage remain the same or go down or up.

Should I go back to 2xs daily. If so what should I do for dosage. If I do this how do I transistion back safely.

I will do what is best for him so if I should stay 3Xs daily I will. Issue is I sub and have days coming up so between 1st and 2nd shot I can't get midcycle reading.

His 2xs daily ss is marked Milo SS
his 3Xs daily SS is last link

Thanks
 
I can't access your TID SS. Did you choose "share with anyone with the Link"?

I'd also start a conversation with Bj and Lisa (b00kworm) and see if they'd come take a look
 
To go back to BID (every 12 hours) dosing, just wait another 4 hours for the next shot.

While you add together all 3 doses, then divide by 2, you might back off a bit of the total to avoid going too low.

Its really up to you what you want to do. I think you'll have a duration problem still.

What about trying BCP PZI? Maybe it would work better than ProZinc for you.
 
Thanks
I think I fixed the link
I believe originally 6 years ago before remission Milo was on PZI. I might call vet tomorrow and ask if that is what he was on. I know he'd be willing to switch.
I did read up on the PZI and how it's close to cats.
Does it have longer duration between shots.
Thanks again
 
About every other day, you get some good numbers and yes, then he seems to be bouncy for awhile. I think I might lower the dose for under 300 to .8 and see what you get. This is one of the things that makes TID hard. It's more difficult to see patterns.
 
Again, duration is going to depend somewhat on the cat. One thing which may cause shortened duration is hyperthyroidism. Other things include glucose toxicity, and high dose conditions.
 
I just tested for 1130 shot. I have 20 minutes until shot but he was 526. Highest in a long time. I did email vet asking about switching to pzi. All of Milo's blood was normal a month ago on diagnosis.
If I am being impatient or expecting too much too fast please tell me.
If we continue on 3Xs should I stay with the 3U if above 300 and reduce if lower as suggested to see if that makes difference.
 
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You're doing your best and that is all anyone can ask and expect of you. Because each cat is an individual, you sometimes need to tweak the protocols and guidelines to customize them to your needs.
Another option for duration issues is split dosing, where each of 2 shots is divided in half and each half is given 2 hours (or 3 or some consistent amount of time) apart. So you'd have an AM 1 and 2, and a PM 1 and 2.
Its always a good idea to consider what might happen if you change something, then what, if anything, you might need to do with the consequences. They call this anticipatory planning. So for each of your choices, what do you think might happen? Is that possibility one you can manage? Will it help or harm your cat? And so on. I'm about to pop out to check on the remaining garage cat, so I'll check back when I'm done.
 
Thanks BJM

If I am understanding correctly the way you just described above with 4 shots would be...
5am 1.5U
730am 1.5U
5pm 1.5U
730pm 1.5U

Adjustments could be made depending on readings. If you do the 4 shots do you test mid cycle from the original tome 5am and 5pm. So ideally at 11AM and 11pm to get idea of when nadir is.

I really appreciate your help. I am hoping to hear from vet tomorrow. I know pzi is what we had last time. I guess that would be my first change and start low on 2xs. Then see where he responds and goes from there.
His appetite is good and so is his appearance.
If I messed up anything on that example please let me know. He is happily sleeping by me on couch now.
I will check back in morning. I gave 3U on the 100 syringe since he was so high
I will check when I get up at 5am. So that will he +6.5. He'll eat then. I will test again prior to 730am shot.
Again thanks for your patience with my questions.
 
Exactly what I meant. You'd do pre-shots and aim to keep very stable dose amounts.
To visualize it, if the normal glucose curve looked a bit like a U shape, splitting the dose would be like having double vision, with slightly shallower scoops downward as the insulin would bedivided up. Does that make sense?
 
Thanks BJM
I'm waiting to hear from vet today about possibly changing the insulin. They are really good about workingwith me so I am hopeful they will.

Either way I might try and get full curve today even though Milo won't be thrilled.
If I decide to do the 4xs I would start Friday as that is the first day I will be able to watch for at least 3 days in a row. I would also slowly bring back times to the 5/730 exampke. It would be easier but I know it takes time. Is it safe to assume each shot I can mover back 15 minutes or should I do another wat if I need to change times.

Thanks again
I will update once I hear from vet.
 
If you do it slowly, you have more time to intervene (safety!) if something isn't working well.
 
Just got off the phone with the vet. He said he'd just been to a conference and they discouraged compounded insulin. We talked through why I want to change. He said he had no problem switching milo over. He wants to read up tonight and said he'd call me tomorrow about getting it ordered.
I am fairly certain he will call in.
 
The issue we have seen with BCP PZi is that it does vary from batch to batch sometimes, resulting in a second batch that may be stronger or less strong than the first.

Can you manage with the 12/12 schedule needed for one of the depot insulins and be able to consistently get a nadir to use for dose adjustments? If so, I think I would consider Levemir. It is supposed to be easier for cats on higher doses - stinging less and sometimes lasting longer. I would go with a completely different insulin if I were going to change.
 
I can talk to him about that. Is Levamir the one you want in a single pen so cost is lower. I will do whatever schedule needed to help Milo.
 
Yes, single pen. Also, may be cheaper to get from Canada at someplace like Mark's Marine or 77Canada Pharmacy. You can fax the Rx.
 
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