intro and advice

Hello all. I'm Angela and Jimmy is my 13yr old newly diag. diabetic. Background: He was drinking/peeing alot, vet visit and diag. with FD, weighed 10lbs but is boney,vet orded rx food, AlphaTrac monitor, and insulin, changed food from dry purina one chicken and rice to can food recommend on Binky's list. Started with SophistaCat Supreme Chopped Grill and Seafood Dinner, saw a change 1st day on amount of water drank/peeing. Have since added rx Purina DM and Merrick Cowboy Cookout to his menu. We were feeding 10-12oz/day to get a little weight back on Jimmy, now we have cut back to 8oz/day in 4 feedings. He is using ProZinc insulin. We are still getting high bg numbers, but Jimmy is looking/feeling much better. Our routine starts about 3:00am when I get up for work, 2oz of food, bg number, shoot. My husband does round two about 9:00am, 2oz food, and bg numbers if Jimmy will be still, which he does not like to be still. Afternoon, about 4:00, 2oz food, bg number, shoot. Bedtime about 9:00, 2oz food, bg number. Thanks everyone for this awesome website. I hope the spreadsheet attaches for y'all to look at. Any advice would be apprieciated.

 

Welcome to our board! It is awesome that you are already home testing and already have a wonderful spreadsheet set up! I took a peek and it looks like you are getting a drop mid cycle where you should, but it just isn't going low enough. Are you guys testing for ketones? I'd worry about some showing up with numbers that high. Is there any possibility of an infection somewhere? (Mouth, URI, UTI.. etc) That can also cause perpetual high numbers. Its good to see that you upped the insulin dose to 2u. With numbers that high, I would keep at a dose level for 4 days and then evaluate then if another dose increase is needed. Sometimes if you are trying to center in on a dose, you need to stick with it for a week or so, but with number that high and that far from non-diabetic numbers, there is no need to stick with a dose for that long.

 

Hi Angela

welcome to the FDMB!

Good for you for starting home testing and diet change! One thing about the foods, anything with gravy tends to be a bit higher in carbs, ideally you'll want to stick with under 10% from Janet's Food Charts Janet & Binky's Food Charts

you can however, reserve higher carb wet fods for your Hypo Tool Kit
Jojo's Hypo tool Kit

Have you been testing for ketones? With high numbers you will want to be testing for ketones daily or every other day or so.
Ketones

I've cross posted your thread over in the PZI forum, others will be along thru the day to assist you with the insulin and lots more info!

 

Thanks. We are not testing for ketones. Our home has 3 other house kitties that share two litter boxes, so, the vet said lets just get those bg nmbers down. His blood lab work showed no other underlying issues/infections. Jimmy eats his food in our office, while the other 3 have their food in the kitchen. All food is picked up before Jimmy is released out of the office. He does not like us to get the bg reading. It's not the poke it is holding his head still he doesn't like. It takes both my husband and I to keep that little ear still for a moment! The shot itself is no problem at all for Jimmy. We are rotating scruff and side shots. We had a family emergency and was not around much for testing. We would have increased the insulin dosage sooner if we could have monitored more often.

 

Hi and welcome!

Have you tried wrapping him in a towel (burrito-style, or like swaddling a baby) to keep him still? This is how I test Odie and give him his other medicine. That way I'm able to keep all his paws and his body under control and just have his head sticking out so it doesn't move too much.

Odiesmom

 

Hi and welcome.

I would have expected to see some bigger drops on the spreadsheet.

Is the Purina DM dry food? If so, try to go with just canned only for little bit.

I realize the bloodwork showed no underlying infections, but I'm wondering could there be some allergy? Airborne maybe? Were the ears waxy, that might indicate an allergy.

There are conditions that would lead to a cat needing a higher dose of insulin, you can read up on those at some point, but at this time, I'd suggest, if there really is no underlying condition, is the vial of insulin actually good? Could have been shipped or stored improperly before you got it.

Did you check the monitor? Does it need coding to match the strips? Are the strips outdated? I know these sound like silly questions, but most of the time when a cat first starts insulin there's going to be some movement in the numbers, unless there is something like acromology (sorry, may have spelled that wrong), cushings or even something like rebound, however (talking to myself here ) I wouldn't suspect rebound without a drop in the numbers.

ETA: What insulin are you using?

 

Hi & welcome! I'm not sure of the carbs on the prescript food - I would probably ditch it if he is eating well on the LC foods from Binky's list, but I could be wrong thinking it's slightly higher carb than some of the o-t-c foods (?). I know the dry is HC compared to LC canned foods, but I'm not sure on the wet food. The #s are higher than what I would expect after a change to LC food, but of course there are lots of reasons that could be causing the high #s.

I would also suggest getting KetoStix - even with multiple cats you can usually still test. With my cat, I just lurk when I see him headed for the litter box, then once he's started going I sneak over and stick the test strip in the stream while he's going. He looks at me a little funny ;-) but it's never made him actually stop going & run away. Every cat does their own thing though, so everyone has their tricks for getting those tests in.

Hope the new dose gives you some good results!!!

 

Thanks again all. In reply to Tucker's Mom, The purina dm is the canned type, but I don't plan on ordering any more. He enjoys the SophistaCat Supreme and Merrick Cowboy Cookout, both with low carbs/high protein off Binky's list. Jimmy has had some allergies in the past, but doesn't seem to be showing symptoms of them,ie skin bumps or congested nose. We have also wondered about the insulin and test strips being good. It's hot here in Texas and they could easily be overheated in shipping. The vet ordered everything in new for us. The ProZinc was shipped UPS, and given to me in a package with an icepack for the ride home. We are on our 2nd vial of test strips. We changed the code on our monitor to match the new vial. The lable recommends storage at room temp. not above 86*f. I have worried they might have been too hot in shipping. How could I tell that? Rebound has also crossed our minds, but I have not seen any low bg numbers....

 

Welcome Angela :smile: ! Now take a deep breath. There is HUGE learning curve with feline diabetes and you are already doing great with the hometesting and switching Jimmie's food. WAY TO GO!!! Give yourself a LOT of credit for that!

What we we need to do now is try and get those numbers to come down ... I'm sure they are worrying you and, Jimmie probably isn't liking them too much either. Here are a few things that occurred to me after reading your intro. post :

1. Food - You don't need to use any of the Purina DM, not even the wet and especially not the dry. Not only is it expensive? But the quality of the food is poor. Save yourself some $$ and just go with any wet, low carb & high protein you find on Janet & Binky's chart that Jimmie likes . Many here use the Fancy Feast and Friskies.

2. Ketone Testing - I agree with the others, until we can help you get Jimmie's numbers down, testing for ketones will be important. Here is an old post I wrote about how to do it if you have multiple cats and, your kitty is like my Sabrina and in no way is she going to let you mess with sticking a strip in her pee AS she is peeing, lol . Getting this test will also give you peace of mind that Jimmie is not in danger of developing diabetic ketoacidosis (DKA) as you work on his numbers and dose.

http://www.felinediabetes.com/phorum5/r ... sg-1004307

3. "Kitty Ear poking antics" - Many of us have been there when we first started hometesting . For some cats, it's just a matter of getting used to something new. So the best thing to do is have a routine established ... our cats are definitely "creatures of habit". Another thing that might help is rewarding Jimmie. Does he have a favorite treat that he would do just about anything for? Doesn't matter whether it is a "diabetic appropriate" treat or not - you won't be giving him that much of it. But giving him some after each test can be a HUGE incentive for him to "tolerate" the poking.

Sabrina will do ANYTHING for just a little bit of skim milk. So before each test, I put some in a little bowl (which she always sees me doing, lol) ... we go to our "testing spot" - me kneeling down on the floor in the dining room and her "assuming" what she considers the proper "testing position", i.e. front paws & face down on the ground and butt up as high as she can get it, lol. As soon as I get the test, I take the milk bowl down from the dining room table and give it to her immediately. I don't ever restrain her, she knows she can get away ... but she wants that treat . Many people here use boiled chicken, canned tuna, Bonita Flakes (dried tuna flakes), a little bit of Deli meat, even Friskies Temptations Cat Treats. WHATEVER your cat loves.

This is a very unique and amazing community of people with a vast amount of collective knowledge about Feline Diabetes based on actual experience. I had a very tough time getting Sabrina's diabetes under control ... but by keeping an open mind, doing research on my own and listening to the advice of the people here ... she is finally a happy, healthy kitty living with diabetes. Jimmie will be too ... I hope you will let us help :smile: . Hang in there ... hugs to you and head scratches for your Jimmie ... jenn and sabrina

P.S. Don't be surprised if you are giving advice here that is not the same as what your vet is recommending that you do. Most of us here have learned, that even if our vet is very well-intentioned, feline diabetes is a disease that needs to be managed 24hrs./day and there is no "one right way" to treat it. Each cat truly is different and the only way to learn how to treat your cat is by testing, getting BG data and then adjusting the dose based on that ;-) .

 

Hi Angela,
Glad to meet you Don't forget to give Jimmy some delicious treats for being a good boy before and after testing. You can use deli meat, rotisserie chicken (no skin), freeze dried meats, Kitty Kaviar (bonito fish flakes), or even cheese. That might help him sit still for DH.

The DM if canned, is not very good quality food, believe it or not. You'd do a lot better with Fancy Feast or Sophisticat even. Personally I use Friskies, but there are tons of good OTC canned foods. Here's the ingredient list on DM:

Liver, poultry by-products, meat by-products, water sufficient for processing, chicken, salmon, oat fiber, salmon meal, guar gum, potassium chloride, carrageenan, salt, Vitamin E supplement, calcium phosphate, taurine, thiamine mononitrate, zinc sulfate, ferrous sulfate, niacin, calcium pantothenate, copper sulfate, Vitamin A supplement, manganese sulfate, menadione sodium bisulfite complex (source of Vitamin K activity), pyridoxine hydrochloride, riboflavin supplement, Vitamin B-12 supplement, biotin, folic acid, Vitamin D-3 supplement, potassium iodide.

Pretty crappy huh. Organ meat should not be the #1 ingredient, and there is no actual muscle meat listed before the 5th ingredient, which means there's very little in the can. Also of concern is the oat fiber. You can tell muscle meat because it just says the species, ie: turkey, chicken, salmon. That's the good stuff for kitties, lots of protein.

Onto your dosing.. I see you've been very cautious and consistent with your increases and that's good. I see your dose reduction test on the 3rd and 4th. Glad to see you didn't hold your dose low there. These numbers are not indicative of rebound, you just haven't gotten to your dose yet. In the early stages of treating diabetes, it can often look like a lower dose did better. That's because initially, the body fights back a little bit against the insulin. Just keep on going til you see some really good numbers, he does need more. I would recommend your next dose increase be soon. I am going to get a friend of mine, Nancy and Cody, and ask her to help you with the dosing. She's very familiar with Prozinc.

You're doing a great job with all this testing, I'm very proud of you! Your vet sounds pretty good too, though I would also recommend you see if you can catch him peeing and get a ketone test since his numbers are so high. (((hugs))) and welcome again!

 

Sorry ... forgot this in my last post, lol !!

A word about the AlphaTrack meter your vet is having you use ...

* Props to him for recognizing the value of hometesting and prescribing it for Jimmie ... that is FANTASTIC!!

* The strips are very pricey ... about $1 a piece the last I knew AND, if you run out in the middle of the night because you have to keep testing because Jimmie decides to throw you some low numbers, you are out of luck ;-) .

The vast majority of people here ... like 99.9% of them, lol ... use a human diabetic glucometer. The strips can be bought online on ebay, Hock's Pharmacy and other places for a LOT cheaper than $1/strip.

The costs of treating FD (feline diabetes) do add up ... so this is a GREAT way to help manage that ongoing. The type of meter is up to you ... I use the One-Touch Ultra ... Accu-check Aviva is very popular, the Walmart Relion. And many companies offer a really good deal on purchasing the meter. I think I got mine for $15. Check the Supply Closet board here on FDMB and there are often announcements about meter bargains or free meters.

Hope this helps !!

 

Did the monitor come with test solution? A little bottle with red colored liquid? It probably did, you would use a fresh test strip but instead of using blood, use a droplet from the bottle, the number it reads should be around 80-100 (I haven't used your monitor, but the ones I use that's usually the area).

Normally I don't bother with the solution and just test my own blood, but again, haven't used your monitor, so not sure if that would work.

I prefer the One Touch or Accu Check, but have recently switched to Relion for cost reasons.

 

Purina DM is in the 'old' canned food charts here. Assuming the formula hasn't changed, the stats are:

Protein (%): 46
Fat (%): 47
Carbs (%): 7
Fiber (g): 0.8
Phosph (mg): 259
Calories per can: 194

 

The Purina Dm formula did change completely in about Sept 2009. The old cans had gold tops and the new formula has a silver top. I asked Janet to help me figure the new data and this is what she said:

DM
According to Janet & Binky
the new DM contains
35% of calories from protein
60% of calories from fat
5% of calories from carbohydrate
262 mg phosphorus/100 calories

I somehow question the fat content however, because whenever I heat it in the MW alongside any other commercial food I use (for my civie), it takes much longer to get warm. this makes me think the fat content may be lower.

I use it as the primary ingredient in a 2-3 day recipe I make for Cody. (also add wellnes core fish, miralax, and a full can of boiled chix breast and another can of homemade bonebased chix broth)

 

Hi Angela,
I just went back and read this whole thread and you are doing a lot of things right with Jimmy - good job!
Carolyn asked me to take a look because I have used Prozinc pretty much since it became available (released in late Nov 2009).

You have received some very good pointers and suggestions. There are a couple things that I noticed that I would re-emphasize.

The alpha trac is a pet meter and does read slightly differently from a human meter (I never remember if it reads higher or lower), but almost all of us use human meters because they do the job of trending blood sugar just fine, for a LOT less money. and this is usually a marathon- you could be dealing with this for the next 7 years. It is also is very useful to get curves at home on weekends so you can get a better picture of what is going on throughout the course of a whole cycle. This can use up a bunch of strips. I have been very pleased with the Maxima meter available online from Hocks (green box above) and it is very affordable. http://hocks.com/hocks-healthcare/hocks ... FM-14.html Replacement strips are $16.50 for 50, free shipping on over about 4 boxes.

The ketostyx are available at any pharmacy behind the counter, without a prescription. You just have to ask for them. They cost about $14 for a box of 50. Ketones are quickly life threatening, so it is smart to keep strips on hand. My cat doesn't mind if I stick a strip in his pee stream, but I actually get the same reading if I stick it in a fresh puddle in the litter, if you can catch some before it soaks in. Ketones can show up with not enough insulin, infection, not enough food, even in our case stress, usually in combination.

I looked at your spreadsheet and it looks like he gets a response to the prozinc, but you are needing to gradually build up that dose. There is a PZI insulin support group where folks can help you do that. viewforum.php?f=24 There is some info there about typical onset, nadir, and duration of Prozinc in the stickies at the top of the PZI support forum.
Since Prozinc is new, folks are still trying to figure how best to use it, and there have been several lately that have mentioned that it seems to take a good 45 days to get a settled response to it. I suspect that it takes this time to slowly build up in their system. It is a durable, stable and flexible insulin. Have you checked out the website prozinc.us ?. If you go into the vet info you can read a study that was done in the testing phase.

Lastly,
I would be very careful to avoid milk based products, which are high in lactose sugar. Dehydrated chicken breast treats are a better treat. Even one or two regular treats, especially the hairball kind which contain molasses/cane sugar can really screw you up.

More tomorrow. Welcome!

 

Thanks again everyone. I'm listening to you all....Jimmy is now eating no Purina dm and we upped his dosage to 2.25 yesterday evening. His bg numbers were much better, 240 and then 270 at bedtime. We gave him 2 1/2oz of food at bedtime. This morning's number was high again 665. But we will continue and be hopeful. I will try to find the ketone testing strips today.

 

The newer silver top canned DM is 5% carb according to Janet (& binky), which is perfectly ok if he likes it. Liver is the first ingredient, and the liver is by far the largest internal organ in a prey animal. It provides an optional variety.

Prozinc does seem to build up in their system, so hang in there, his duration should get longer and his nadir should get later and more consistent as you go along.

Consider increasing the number of meals, or free feeding, but avoid food given in the last 2-3 hours before preshot.

The nadir value is extremely important in determining your dose increases, so try to get a variety of mid cycle readings on your off days.

Most of the PZI moms use u100 syringes with half unit markings with u40 insulins ( brand Prozinc is a u40 insulin- be careful of knock offs). This allows more precise dose increases. When you post in the "PZI Insulin support group" they will help you find the conversion chart and explain its use.

Again , please keep posting. There is a lot more, ... ;-)

It would be great if you could also tell us a bit about him. Is he a big kitty?