Urgent dosing advice needed (shooting in 2 hrs)

AliceL

AliceL

Active Member
I discovered today that our bottle of insulin might be out of date. The bottle was sold to me with the label trimmed to hide the expiry date so I can't be sure but I don't see any other reason why the label would be cut other than to hide that it is expired..

We have been doing MPM and are already up to 2.4u with minor effect on her BG levels. I've been feeling a lot of frustration and despair at how sometimes insulin doesn't even seem to be working, she sometimes even has inverted curves or flat nadirs. Kind of all makes sense now if the insulin is not as effective as it should be.

Got a new bottle this afternoon. I'm really worried about shooting her current dose in case it sends her into hypo numbers. Do I reduce dose and start MPM again? Shooting in less than 2 hrs...
 
AliceL said:
I discovered today that our bottle of insulin might be out of date. The bottle was sold to me with the label trimmed to hide the expiry date so I can't be sure but I don't see any other reason why the label would be cut other than to hide that it is expired..

We have been doing MPM and are already up to 2.4u with minor effect on her BG levels. I've been feeling a lot of frustration and despair at how sometimes insulin doesn't even seem to be working, she sometimes even has inverted curves or flat nadirs. Kind of all makes sense now if the insulin is not as effective as it should be.

Got a new bottle this afternoon. I'm really worried about shooting her current dose in case it sends her into hypo numbers. Do I reduce dose and start MPM again? Shooting in less than 2 hrs...
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I do not know what to say about your insulin, however I looked at your SS and it said you were using U100 syringes. Are you using the conversion chart for the U100 syringes, if not you should be using U40 syringes. I bought a bottle of ProZinc from my vet in November and it seemed to be working fine. In a short period of time it seemed as though the numbers were not moving. I bought another vial and in one of my senior moments I put it in the freezer. I went back to the original vial, which had an expiration date of a few years from now. The original vial just did not move his numbers at all. I recently bought another vial which is working well. The expiration date is right in the open, easy seen.
 
Teresa & KitKat said:
I do not know what to say about your insulin, however I looked at your SS and it said you were using U100 syringes. Are you using the conversion chart for the U100 syringes, if not you should be using U40 syringes. I bought a bottle of ProZinc from my vet in November and it seemed to be working fine. In a short period of time it seemed as though the numbers were not moving. I bought another vial and in one of my senior moments I put it in the freezer. I went back to the original vial, which had an expiration date of a few years from now. The original vial just did not move his numbers at all. I recently bought another vial which is working well. The expiration date is right in the open, easy seen.
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@Sienne and Gabby (GA), @Suzanne & Darcy, @Bron and Sheba (GA), @Diane Tyler's Mom GA
 
Diane Tyler's Mom GA said:
I would post this on the Prozinc board
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Isn't this the Prozinc board or am I missing something?

Suzanne & Darcy said:
I see you got a new vial and shot the full dose and she’s having a good cycle but nothing extremely different than last night’s cycle.
I am sorry. I haven’t been able to be on the Board much today at all.
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No worries, I was prepared for low numbers if thats what was going to happen. I do think the new insulin is slightly more potent.

I have also been testing a new single protein food which seems to be working out well for her, think that might be responsible for the couple cycles of low numbers at night lately. She has been trying it slowly as a test (first day 25%, second day 40% etc), I notice a definite improved result in expected BG numbers at each reading when I feed her the new food. One thing I am concerned about is it is slightly higher carb 10% up from the regular food 5%. But definitely seems to be improving her numbers so I think it's better on her system. What do you think about the new carb percentage though? I just bought a couple cans as a test, I must decide if I want to order some more or not.
 
AliceL said:
Isn't this the Prozinc board or am I missing something?


No worries, I was prepared for low numbers if thats what was going to happen. I do think the new insulin is slightly more potent.

I have also been testing a new single protein food which seems to be working out well for her, think that might be responsible for the couple cycles of low numbers at night lately. She has been trying it slowly as a test (first day 25%, second day 40% etc), I notice a definite improved result in expected BG numbers at each reading when I feed her the new food. One thing I am concerned about is it is slightly higher carb 10% up from the regular food 5%. But definitely seems to be improving her numbers so I think it's better on her system. What do you think about the new carb percentage though? I just bought a couple cans as a test, I must decide if I want to order some more or not.
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I agree it may be slightly more potent. I don’t think we can necessarily expect for her journey this time to be the same as last time because her health situation is different than last time. For most cats, I would not recommend 10 percent carbs as a normal part of their diet, but every cat is different and you will see how it goes. Feeding is always trial and error. It should become clear whether her numbers are actually lower on that food or not. Many cats have lower numbers at night already, but still there could be a difference in addition to that. It’s a possibility I won’t dismiss.
 
I have been feeding her the new food all day today (after slowly introducing it the last two days). She has just given us her first green number. And first low day time cycle number. I’m definitely seeing this as cause and effect from the food. Even her runny eye has cleared up quite nicely.

We just double checked the carb count on the new food and it’s actually 8.28% ME Carb (food website stated something different to the actual can). I assume still ok to carry on with this food in light of this new information?
 
Look, thinking about it, it's a little hard to pin down the reasons for these better numbers. She does have a new bottle of insulin too. But I definitely noticed some lower than expected BG results when I first fed the new food before she started the new vial of insulin. The better numbers could be a combination of both changes.

Just also need to report that I held dose this morning instead of going up after 6 cycles as per MPM guidelines. I just wanted to see what this new vial would do first.
 
AliceL said:
Just also need to report that I held dose this morning instead of going up after 6 cycles as per MPM guidelines. I just wanted to see what this new vial would do first.
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Good, because you have just changed two variables— the food and the insulin vials — and since you have the green nadirs we would hold the dose anyway. Hopefully Evie’s dose will start to go the other way!
 
@Suzanne & Darcy Help! Extra low preshot number at 173. We are currently stalling and will test again soon. I see the four options for low PS on MPM and I want to shoot but it's really scary. Last night she was 215 PS and went down to 114. Can I reduce dose a bit?
 
It would be good to have the retest results. She clearly has been on an upward trajectory since nadir and then the blue then higher blue.
 
Conditionally (depending upon your retest) I would not shoot less than 2 units as long as you and your husband have her evening tests covered as you usually do. What do you think? I want you to be comfortable. I also know that you are experienced at handling lower numbers and are familiar with the testing routine involved if she drops below 50.
 
@Suzanne & Darcy After stalling for 20 mins I tested again and got 274. Completely stumped at that one (100 points in 20 mins?) except Evie clearly felt stress at waiting for food. She is quite used to her routine of getting up from an afternoon nap, test and feed. She was howling. I shot her regular dose based off this test result. I will be around to manage the lows, thankfully I had a great nap myself this afternoon :smuggrin: Sorry for not waiting for an answer, I panicked a little and made decisions quickly. I maybe need to pre plan what to do in future with low pre shots.
 
Suzanne & Darcy said:
I also know that you are experienced at handling lower numbers and are familiar with the testing routine involved if she drops below 50.
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I do feel comfortable enough to manage lows. And I've shot low numbers before but never at these doses. It's really a scary thought for me, shooting 2.4u on a low PS number. I feel like I need more data shooting low PS to feel more comfortable about it.

In future if she is under 200 but over 150 could I reduce to 2u and see how that works out?
 
AliceL said:
In future if she is under 200 but over 150 could I reduce to 2u and see how that works out?
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Well yes I would say so — but that answer is really only a valid answer for Evie on her current dose of 2.4. If she were at a lower dose (we can hope) you could adjust the dose down accordingly. You know that already, of course.
 
I can’t believe what a dumb thing I’ve just done. In my 5am stupor I went and shot from the old bottle of insulin. And we had such a good preshot number. This mistake will probably set her back for the day :arghh:
 
Wow, you are being way too hard on yourself! Just put that old vial away somewhere where you can’t reach it …. Or throw it away since you thought it was old. Where did you buy that one from anyway?

I haven’t looked at her spreadsheet yet. I am hoping you will be happily surprised. And if she is running a little higher today then that will confirm for us that you should throw out that old vial.
 
Looking at her spreadsheet, I can only see as far as +3, but she’s almost exactly where she was yesterday.

It’s strange how the ProZinc is taking so long to onset. Her +3 is so high — almost the same as AMPS.
 
Suzanne & Darcy said:
Where did you buy that one from anyway?
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Direct from the vet!

Suzanne & Darcy said:
And if she is running a little higher today then that will confirm for us that you should throw out that old vial.
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She had a nice little dip at +5.5 but not as good as yesterday's nadir. I'm sure with that low preshot number she would have earned a reduction today if I had shot the new insulin. Clearly the old insulin has some effect but I still don't think it's as potent as the new vial.

Suzanne & Darcy said:
It’s strange how the ProZinc is taking so long to onset. Her +3 is so high — almost the same as AMPS.
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That happened in 2023 as well (on her night curves) and I recall you commented on it back then too :smuggrin:
Evie just seems to get quite a big glucose bump from food early in the cycle. Back then I fed her 100g at insulin time, this time around she gets 40g yet it still happens. Maybe it's all to do with her sensitive stomach. Actually, that's how I have been noticing the new food seems better for her - when she eats it she seems to have smaller food bumps in the proceeding BG test...
 
I must tell you, Evie was feeling so good this morning she actually took a running jump up into our huge bay tree at the end of our garden. My sweet little cuddly lap cat is not a very catlike cat if you know what I mean...she can catch butterflies but not much else and she certainly can't climb - I don't think she has ever been able to heft her big bum up easily :smuggrin: but she has lost some weight now so I guess she went for it. It was amazing that she managed to get up there at all but once up she couldn't get down by herself and needed saving.
So there Charlie and I were climbing up the ladder in our dressing gowns at 8am while the farmers in the neighbouring fields looked on with mild amusement. Once rescued I saw she had torn one of her nails in the misadventure, I must watch that it doesn't get infected...Never a dull moment!
 
AliceL said:
I must tell you, Evie was feeling so good this morning she actually took a running jump up into our huge bay tree at the end of our garden. My sweet little cuddly lap cat is not a very catlike cat if you know what I mean...she can catch butterflies but not much else and she certainly can't climb - I don't think she has ever been able to heft her big bum up easily :smuggrin: but she has lost some weight now so I guess she went for it. It was amazing that she managed to get up there at all but once up she couldn't get down by herself and needed saving.
So there Charlie and I were climbing up the ladder in our dressing gowns at 8am while the farmers in the neighbouring fields looked on with mild amusement. Once rescued I saw she had torn one of her nails in the misadventure, I must watch that it doesn't get infected...Never a dull moment!
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This really has me smiling and laughing! Thank you for sharing this little story!
 
She did come close to a reduction tonight at +5.5, but she’s not there yet. With her feeling so well and getting better numbers now, I feel optimistic that she will soon earn a reduction. It is great to hear that the new food is suiting her so well.
 
181 at PMPS today so I've reduced the dose to 2u as previously discussed.
Last night she was 241 and had a nadir of 63 on 2.4u so I don't want to risk it.
If nothing else it will be good to get data on a reduced dose.
 
You’re not going to go with the MPM reduction point of below 50? It’s okay, but add “reductions at ## (whatever your chosen reduction point is) to your signature. Or is this a temporary reduction based on the lower PMPS?
 
Suzanne & Darcy said:
Or is this a temporary reduction based on the lower PMPS?
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Yes, I thought thats what we decided a few days ago, see below.
Suzanne & Darcy said:
Well yes I would say so — but that answer is really only a valid answer for Evie on her current dose of 2.4. If she were at a lower dose (we can hope) you could adjust the dose down accordingly. You know that already, of course.
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It is a little confusing for me as a first time MPM'r...I know on MPM we just carry on shooting the dose until under 50. But what happens if the PS is lower than usual? Surely we don't shoot full dose knowing hypo is likely...?
 
Suzanne & Darcy said:
You’re not going to go with the MPM reduction point of below 50? It’s okay, but add “reductions at ## (whatever your chosen reduction point is) to your signature.
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I'm still happy to continue with reductions at 50. Just a bit uncertain how to proceed with lower preshot numbers, especially if I see the previous evening's cycle sent her quite low on a higher preshot number...
 
AliceL said:
I'm still happy to continue with reductions at 50. Just a bit uncertain how to proceed with lower preshot numbers, especially if I see the previous evening's cycle sent her quite low on a higher preshot number...
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Yes. We don’t have much in the way of blue preshot numbers for Evie this go around! It’s all good. Maybe she will show us up tonight.
 
AliceL said:
Yes, I thought thats what we decided a few days ago, see below.


It is a little confusing for me as a first time MPM'r...I know on MPM we just carry on shooting the dose until under 50. But what happens if the PS is lower than usual? Surely we don't shoot full dose knowing hypo is likely...?
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No. You have the right idea. With Modified ProZinc Method we can shoot anything 50 and above but we would have to have data to support that and we are nowhere near that — and that would work for some cats who surf along in greens but would not work for others. Our goal is to be able to shoot lower numbers, but gradually as we gather data. I don’t know if she would go under 50 tonight on the full 2.4 units. Just because she started out lower doesn’t guarantee that she would— but that is what tonight’s reduced dose will help us to see. So we would not just blindly shoot low numbers. We shoot based on previous data or shoot reduced doses and gather data, as you will tonight. I mostly write that for people reading along who don’t post for assistance.
 
Sorry for my confusion about whether you meant this to be a temporary reduction or a permanent one. We are all squared away now, I think.
 
Gosh, this really is confusing now. Based on tonight’s cycle it’s highly likely that 2.4u would have sent her lower than 50 and earned a dose reduction to 2.2u. I know tonight’s dose was a temporary reduction of 2u. But for her AM shot I’m inclined to hold 2u despite what her AMPS is - I have a feeling her AM preshot number will be on the lower side anyway due to this nadir…also I’ll try not to feed her too much more tonight to avoid a slingshot high BG in the morning.

She does run lower during the PM cycle so perhaps 2.2u for AM cycle is ok too. However I feel she may have had a late nadir on today’s morning cycle (that I didn’t catch) and that is why she had low PMPS numbers tonight. I just don’t know what is the right thing to do! It’s all so confusing. I doubt you’ll be available for my AM shot time so fingers crossed you’ll see this post tonight and weigh in before I have to make a decision tomorrow…
 
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AMPS was 218 so I ended up shooting 2.4u because I guess officially she hasn’t earned a reduction yet? But I’m really worried about shooting 2.4u during the evening cycle based on what happened last night on 2u. How do you think I should proceed?
 
@Suzanne & Darcy Really need some guidance on what to do. Our cycles are out of sync. Evie has low PMPS with low nadir at night - I cannot increase her evening dose beyond 2u however the morning cycle is higher preshot with flat higher nadir. I am now alternating her dose morning to evening from 2.4u to 2u because don’t actually know what to do here.
 
I worry we are about to get stuck in a sort of loop here, the higher day dose might be too high resulting in lower PMPS last night and even lower PMPS tonight.
And then the night dose of 2u will probably send her under 50 tonight technically earning her a reduction.
I think I will reduce tomorrow morning's dose if that's ok? I think I must try to stop this strange pattern that is developing because it's not going to help me follow MPM guidelines by myself...
 
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