What to do????!!!!

Hi:
I need advice on what to do with my Buddy. He was diagnosed last October. I did not home test. I never knew about it until recently when I got involved with a Yahoo Group with diabetic cats. I was first told to give 2 units twice a day. I was shown how to fill the syringe for 2 units. I did that exactly as shown by that Vet. I recently found out that I was shown wrong. I was ACTUALLY giving 4 units when I thought it was 2. I started doing it correctly for a few days. His numbers were high. in the 400's and upper 300's.

I then started doing tight regulation as suggested by some group members following the recommended dose. His numbers remained high and actually went a little higher. SO, I went back to doing it the way I was supposed to by the Vet. No matter the number, I gave 2 units. Numbers still remained high.

My new Vet suggested I do a curve on Sunday. Here are the results of his BG's for awhile:
His insulin is ProZinc. For cats only.

His numbers have been: (I use military time. They are 12 hours apart.)

Date Time BG Units
May
25 1000 349 2
2200 238 2
26 1200 356 2
2200 504 2
27 1000 356 2
2200 323 2
28 1000 413 2
2200 324 2
29 1000 350 2
2200 274 2
30 1000 364 2
2200 373 2
31 1000 500 4 went to tight reg on the 31st
2200 408 4


June Time BG Units

1 0830 372 4
2200 322 3.5
2 0935 506 5
2200 438 5
3 0930 511 5.5
2200 364 4
4 0930 487 5
2100 421 4
5 0900 353 4
0930 ?? 3
6 Curve
1000 466 5
1200 472
1400 551
1600 425
1800 431
2000 484
2200 365 1

7 1000 ??? 2
2200 401

I told the Vet I had raised the units per tight regulation scale given to me because his numbers were so high. She was glad I was comfortable about doing home testing, and told me to do his curve on Sunday and let her know what it was. She didn't comment too much on the high dose I'm giving him, but I'm sure she didn't like it.

I tried getting Bud's blood this AM, but couldn't. After about 5 pricks, I stopped. He was jerking a lot this morning. He usually doesn't and I feel it's because of all he went through yesterday. I know I probably should not have, but I "blindly" gave him 1 unit. I was crying the whole time. I guess I'm getting a little emotional about what I'm doing to him. I also faxed his numbers to the Vet and she called telling me to give 4 units twice daily. She didn't have me checking his BG. And I am suppose to bring him in, in July to do a Curve there,

I need help to see what you all think. His number was tonight 401. I still haven't given him his shot. I'll wait a bit to see what you all say. If I don't hear soon, I'll give him like she said to do.

Thanks for your input!

Connie and Bud

connie welcome.
i need to see your #'s in a more understandable way. eventually start a spread sheet but for now go back as far as you already did and do like this

amps 340 2U
+2 180
+5 150
pmps 365 2U

the amps is you am (morning) pre shot bg #, before food
same thing pmps (evening)
the + is the hours since last shot
I would guess you are shooting too much but need to see it this way
Also what are you currently feeding?
are you using pzi pro zinc and is you syringe a U40?
overdosing your kitty could have resulted in some high rebound #'s
Lori

btw, it does not matter what time it is so leave that out altogether, it only confuses the issue. the important thing is the bg # before shot and the number of hours after the shot that you test again.
hope this makes sense.

This sort of makes sense to me. But, putting in the time shows how many hours between shots. I understand the amps 340 2U. That's AM shot, 340 BG, and 2 units given. You said the + is the number of hours since last shot. Is the short time and number mean you are doing a curve, and this is hours since and BG? I do exactly 12 hours apart every day and only test before the shot.

The Curve was:

amps 466 5U (per tight reg)
+2 472
+4 551
+6 425
+8 431
+10 484
pmps +12 365 1U (suggested by someone else)

Today:
amps ??(didn't get) 2U
pmps 401 4U (Vets advice after am shot)

I use ProZinc U40 syringe. I feed every 4 hours. Fancy Feast and some Friskies. Low carbs. He free feeds a little during the night on grain free, low carb hard food.

ok, can you eliminate the dry food altogether...it is way too high in carbs no matter what vet tells you. you are shooting way too much insulin with wild swings. did you happen to see where you can make a spread sheet? it helps us to really see what's going on with the insulin and the cat in terms of watching over time, like a few days to a week. i don't know why your #'s are so high without that info. it's great that your testing, that you know how to give a curve, that you've discovered the low carb wet food. your on the right track, just don't completly understand your dosing and #'s and won't without the spread sheet.
sorry if you already told me, but how long have you been at this, and has he been tested for ketones?

I think there are two possibilities to consider. Some cats really react to any dry food, even a tiny amount of grain free. You might cut that out. You can leave frozen wet lo carb out overnight if he gets hungry or use a timed feeder. Or it could be rebound. It does seem to be a pretty flat curve. Rebound is a tough thing to get your head around. Here is some info that may help: http://petdiabetes.wikia.com/wiki/Somogyi_rebound

I agree with Sue & Oliver: it could be the dry food, or it could be rebound.

High blood sugar numbers can be caused too ways: too little insulin, or too *much* insulin. The too little insulin is obvious . But, when you give too much insulin, what essentially happens is that the blood sugar levels start to drop, the body panics and dumps a whole bunch of stored sugar into the bloodstream, which then raises the blood sugar levels again. Rebound is a dangerous thing because, if the body runs out of stored sugar, the cat *will* hypo.

My suggestion would be to dump all of the dry food and feed only low-carb wet food. That'll eliminate the possibility of his food inadvertently skewing the BG numbers. And I'd drop back to 1 unit twice a day and see how the pre-shot and nadir numbers adjust. I should note that we were PZI-Vet users (the predecessor to ProZinc), so if folks who actually *use* ProZinc come in and say that you should start over at ... I dunno, 0.5 or 1.5 units or whatever, I'd take their advice over mine.

Good luck to you and your Buddy!

-- Jean and her Gwyn

Connie,
Hello and welcome.

It seems to me that the first thing to tackle is the dry food. Like you, I used to keep kibble out for the kitties to graze on during the night; as a supplement to the lc wet food. We were feeding the expensive d/m dry that is supposed to be designed in part for diabetic issues. It wasn't until after we discontinued the dry food, that Charlie went into remission. Its nearly impossible to get a fd regulated while feeding dry food. Even our vet has begun to advise an all wet low-carb diet. She suggests under 5% carbs; but I find that 7% and below works just fine for us.

Here's the link for Janet & Binky's food lists in case you haven't seen it yet:

http://binkyspage.tripod.com/canfood.html

The other thing to address right now is going from 2u to 4u in one day. This is unadvised. Most here adjust insulin in increments of 0.25u to 0.5u over a period of days. You're probably wondering how to measure a 0.25. Many here use u100 syringes and a conversion chart for their u40 insulin. This gives them the ability to fine tune doses in smaller amounts. I cannot find the link right now, but if you are interested, let us know. I'm sure someone can link it for you.

Please do not give a 4u shot again, you could potentially put Bud into a hypo event. If it were me, I would eliminate the dry food; make sure the wet food is 7% or lower; and start over at 1u.

Oh, and there are several tricks to making wet food last all night. Several people use timed feeders. Others freeze portions of food to thaw overnight. What I do is to add several tablespoons of water to their wet food and mix it into a 'slop'. This keeps the food from getting crusty, and it lasts them all night.

Good luck, and please keep posting your questions.

Just a couple of things that jump out to me (I will not repeat anything that has already been said though):

* The dose is changing way to quickly - keep with a dose level for 4-5 days and then reevaluate if a dose change is needed. Kitty's body is not getting a chance to get used to having a certain level of insulin.

* Why did the vet start you guys off with 2u? Were there any ketones involved? If not, 2u is way too high of a starting dose, and many are often good with less than that. I second the opinion to go down to 1u twice a day and hold it for a few days (only if ketones have not been an issue)


Here is a link on how to develop a spreadsheet in google docs: viewtopic.php?f=6&t=16 This will give you a good template to keep a record of your hometesting numbers, and it will also provide a way for us to easily view your numbers and help with interpretation or dosing decisions.

Hi. I'm not a usual poster on the PZI forum, but have used two forms of PZI for years, until last year we switched to a different insulin.

What pops out at me is there is no drop in the numbers at all, if it were rebound I'd expect to see a drop even into the 200s before going back up. This could be problem with the dry food, but we could also have a cat that has insulin resistance and possibly a cross post in the high dose forum could help.

This cat's been on insulin since October so I'd suspect that if this vial of insulin wasn't complete garbage to begin with, stored improperly before you got it and lost all potency, there is something else going on.

jenn, would'nt that inverse curve at +4 indicate too much insulin?
also would be nice to see a weeks or more worth of #'s.
thanks for stopping by here...
Lori

lori and tom said:

jenn, would'nt that inverse curve at +4 indicate too much insulin?
also would be nice to see a weeks or more worth of #'s.
thanks for stopping by here...
Lori

Click to expand...

Could be food spike causing the inverse curve. I agree, some spot checks would be helpful.

Unfortunately I can attest to the fact that an inverse curve doesn't always mean too much insulin, and rebound doesn't always equal a very shallow curve Kitty livers are crazy things :YMSIGH: Oscar likes to throw inverse curves at just about any dose you put him on. Its a matter of waiting many days at one dose to see if his body will stop fighting the insulin and give a breakthrough.

Hi everyone,
Got called in to take a peek, welcome to the board Connie! I'd like to address a couple of things. Well, 3 actually..

1. Congratulations on your hometesting!
2. Dry food. It can do this. Agree with the others, if you cut the dry you'll have a much clearer picture of the actuality of the situation.
3. The numbers: these numbers are actually all within the allowable meter variance. In other words, those numbers might all actually be the same, and there actually might not be an inverted curve. At very, very high numbers, the meter variance can be much more significant than we are used to seeing in the 100s and 200s.

In summary, Jenn (tuckers mom) has raised a very good point about the efficacy of the insulin, and the others have all honed in on what I suspect is Guilty Party Exhibit A, the dry food. If that could be removed, I think you'd find an easier time regulating your Bud, or at the very least determining whether we have a candidate for a higher dose.

((((hugs)))) to you, and again, good job with the hometesting!

Hi & welcome!

I haven't had time to study the data or others' comments, but I wanted to be sure you know that the sliding scale given in the TR protocol you may be following is only a starting point, and those doses are by no means the right dose for every cat. If fact I think the scale was updated a while back and the doses scaled back, with upper limit doses more like 2u rather than 4u. I haven't looked lately so can't say for sure, but I think I saw someone mention that a few months ago. Personally it scares me, because I know 4u would be WAY too much for my cat at any PS. Back when he was on dry food he needed that much, but on LC canned he needs less than 1u.

So.... if you do eliminate the dry food and go with LC canned, be sure to reduce the dose until you have more data, as others may have already said. I tried following the TR protocol back when my cat ate dry, and I wouldn't recommend to anyone to try it (while feeding dry that is), it's just too hard. It didn't work well for us (either in the #s, or in the hysterical crying department ;-) ), but once we switched foods life got a lot easier.

Keep us posted on how things are going!