What point do you start steering?

[Katie & Marcy]

Still new. Raised her dose a week ago, and I’m trying to do a curve today. Just got a 61, what point do I give medium carb food, how often do I test again, and does she need a dose reduction now?

 

[Bandit's Mom]

Sorry no one responded earlier. In future you could tag a few members who have experience with Prozinc:

@JanetNJ
@FrostD
@Hshray

Are you following the SLGS protocol? If yes, any drop below 90 means a dose reduction by 0.25U.

From the sticky on the Prozinc Dosing Methods:

"Hold the dose for at least a week:

• Unless your cat won’t eat or you suspect hypoglycemia
• Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.

• If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
• If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
• If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit"

Link to your previous thread
https://www.felinediabetes.com/FDMB/threads/stalling.251659/

 

[Katie & Marcy]

Question, can I adjust the dose slightly by preshot number? I was going to drop her dose from 1.5 to 1.25 tonight, but the preshot number was higher than usual so I didn’t drop it yet.

 

[Katie & Marcy]

Also for future reference at what number should I give medium carb food. Or do I just wait it out and only use it if it drops further?

 

[Bandit's Mom]

Question, can I adjust the dose slightly by preshot number? I was going to drop her dose from 1.5 to 1.25 tonight, but the preshot number was higher than usual so I didn’t drop it yet.

Dosing is based on nadirs - how low the dose takes the cat and not on preshots.

The high PMPS you are seeing tonight could be her "bouncing". A reaction to the lower numbers she dropped to, today.

Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver".

Also for future reference at what number should I give medium carb food. Or do I just wait it out and only use it if it drops further?

From the data on your SS, it seems like Marcy's onset (the time when the insulin starts working) is around +2.5 (2.5 hours after the shot). Do you feed small meals during the day/night? Some food at +2 and +3 might help prevent those steep drops you see.

And yes, a drop into the 60s, like you saw today would need some MC.

 

[Katie & Marcy]

Okay thank you for all of the info and help, I appreciate it, should I reduce the dose to 1.25 then? I give her small amounts during the day and the 2 main meals before shots. I can make sure that she’s getting them at +2 though

 

[Bandit's Mom]

Okay thank you for all of the info and help, I appreciate it, should I reduce the dose to 1.25 then? I give her small amounts during the day and the 2 main meals before shots. I can make sure that she’s getting them at +2 though

Yes, please reduce her to 1.25U tomorrow morning. A good sized meal with the shot and smaller meals at +2 and +4 could help. In both cycles.

 

[JanetNJ]

Question, can I adjust the dose slightly by preshot number? I was going to drop her dose from 1.5 to 1.25 tonight, but the preshot number was higher than usual so I didn’t drop it yet.

That high number was a bounce from going too low. This morning bring it down to 1.25. Good job steering yesterday. You did good.

 

[FrostD]

I just wanted to clarify something Bhooma said - there are certain instances where yes, you can and perhaps should adjust the dose based on preshot.

Since you are new to testing, we recommend a cutoff of 200. If you get a preshot below 200, especially with her history of DKA, please stall without feeding and post for help on Feline Health (main forum). With the DKA we want to avoid skipping insulin as much as possible, but there's a few factors that come into play when shooting a lower number so it's always best to ask for help.

You have shot low than 200 before BUT we don't know how low she went when you did that. As you get more data, you'll be able to shoot lower and lower preshots. For some reason my tags aren't working, but Hilary and George are a good example of this if you browse the ProZinc forum to find his spreadsheet (I'll link if I get a minute - here is a post, she eventually switched to Lantus to help with bouncing).

Never increase a dose just because you see a higher preshot. Higher preshots are often bounces, and cats often break those hard - meaning they come down lower than they normally would. So that combined with extra insulin is a recipe for trouble.