What should I do for AM shot

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milosmommy

milosmommy

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My SS is attached to signature.
This morning Milo was over 500 so I dI'd the 1.25U like I did previous shot. His +4 and + 6 numbers today were 180 and 172. Then at +8 and +10 he jumped up. Pmps was 431.

I read the attached Prozinc protocol and assume the numbers are bouncing since last night was the first time I increased from 1U to 1.25U.

I understand when he gets low or is low mid shot to watch. I guess the confusion I'm having is in morning if he is 300 or above should I up .25 and do 1.5U or just continue with 1.25U for a couple more shots since we are just starting out.

I plan on doing 2 hr checks until +6 tonight. Tomorrow I can check often also. He is eating well abd has no box issues. Has sneezed today but no runny nose or cough
Played with his toys and was social.

I will keep adding numbers to SS as I check.
 
It is hard to know what to do about bounces until you have enough data to see his patterns. He may be a cat that has the high preshot the cycle after a lower nadir - that's sort of what the last high preshot looks like.

I do think you are dealing with bounces in general. Any time you have a preshot of 500 and he drops to 170 ( more than 50%) he is likely to bounce. If he were mine, I think I would stick with the 1.25 awhile and see if he settles in, getting lower preshots and flatter cycles. I know it is frustrating to see the highs, but he has to have time for his body to starting using the insulin efficiently. And remember, he is spending a good part of the cycle in pretty good numbers.
 
Think tortoise, not hare. It took a while for him to become diabetic; it is going to take some time and patience to get it under control.

As you get test data, it will help you identify his patterns of response which can be used to customize his dosing later.
 
Thanks Sue!!! Sometimes just reassurance is all you need. I will keep on the 1.25U and see where he goes. I honestly appreciate all the help and feel like such a dummy asking all the questions. He's mad at me now. Wants to eat but has +4 poke soon so he has to wait.

Thanks to you too BJM for responding and helping. Think I will try just updating SS AND staying with the 1.25U. Will not post unless 911 abd check in mid week. I reread protocol for prozinc twice so think we are good.

Appreciate everything. ..
 
I honestly appreciate all the help and feel like such a dummy asking all the questions
Click to expand...

The only dumb question is the one you don't ask. :mrgreen: This stuff is HARD! Soon you will get the hang of it and be making the dosing calls on your own, and helping others who are new and scared. Be patient with yourself and with Milo.
 
Let us know if you do need anything. FD has a steep learning curve...I was posting several times a day my first month or so! :mrgreen:
 
If I can put in my 2 cents worth...I am by no means an expert in this stuff although Humphrey was experiencing similar results as Milo occasionally over the last 4 months since he was put on insulin. It seemed like nothing I did (increasing the dose, reducing the dose, changing food, etc) helped at all. My vet was (and I believe still is) clueless as to what was going on with him. I did a ton of research and some cats are very good at metabolizing insulin which is why long lasting insulins like Lantus only last 12 hours (or sometimes less) in cats while they last 24-48 hours in humans. Humphrey seems to be the extreme case where the insulin's effectiveness is only 4-6 hours leaving 6-8 hours of little to no insulin for every 12 hour cycle. Since onset is in hours 2-4, by +10 the insulin was out of his system leaving the last 2 hours of the first cycle plus the first 2-4 hours of the second cycle with almost no bg lowering effects. Obviously this is not the desired result. The solution? Increase the frequency of dosing to TID or QID (if you and your cat don't like sleeping much :)).

It took a few weeks but since switching to TID with Humphrey his numbers are a 180 from where they were about a month ago (see his chart). The total daily dose is about the same as with BID but spread over 3 cycles rather than 2 is more effective for him. The reason is I am getting a good overlap between cycles now. I shoot at +8 consistently which means that at shot time, he still has about 2 hours of insulin effectiveness before it's used up. This works great since the insulin he's on (BCP PZI) has an onset of 2-4 hours. While Humphrey's numbers are still not where I would like them to be, he is close to normal range for a good part of the day and his bounces are much less severe than they were just a few weeks ago. The goal is not to get a roller coaster curve. The pancreas cannot heal if it is bombarded by high bg for 6-8 hours per day and the liver will not know what a normal bg is if it varies by 200+ throughout the day. The goal instead is to get the bg low and keep it there! When the liver starts seeing more consistent numbers it adjusts to the "new normal" over time rather than freaking out over a 150 after being at 300+ for the last 8 hours.

I do not know if this is exactly the case with Humphrey (I'm not a vet) but this is what I have and am currently observing and it kind of just makes sense if you think about it. Shooting TID is not for everyone but I strongly believe that it can offer better results for some cats like Humphrey and maybe Milo. Oh and a side note, feeding times don't seem to matter much any more either. I feed at pre-shot and also at +4 in the afternoon (around 5pm). Feeding smaller meals 3-4 times per day combined with TID works much better for Humphrey than 2 big meals and BID. Time will tell but I really believe this is the better way to go.

Just my 2 cents :)

-Jason
 
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