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One of our office cats (we have 2) was diagnosed with diabetes about 3 months ago. Stinky is a large, 14.5 year old short haired tabby. Our office moved a year ago, June 2012, and Stinky was not happy about the move and hid for the first few months. When she finally came out of hiding I noticed that she was drinking & urinating a lot. I have Type 1 diabetes so I tested her with my meter and her BG was in the low 70s. I tested her a couple more times over the next few days and her BG was always in the 70s. Went to the vet and he decided she had a UTI and prescribed antibiotics for 14 days. Nothing changed, he insisted she needed a longer course of antibiotics, 6 weeks this time. Nothing changed. He then decided it was her kidneys even though when her labs came back he said only one number was very slightly elevated.

For the next 6 months she continued to drink & pee like crazy. She stopped showing interest in many things, such as playing with toys and grooming herself. In March 2013, a little bump/cyst on her side exploded and we went back to the vet. She has a number of these bumps on her back/sides and the previous vet said they were nothing to worry about but the new vet by our new office removed a couple to have them tested (and they came back benign). Stinky was in an e-collar while her stitched areas healed. When we went back to have them removed the vet said her labs showed that her glucose was very high. He said it could have been from the stress and that it should be rechecked soon. I told him that I could test her BG for a few days to monitor her. The first test was 409, I think. I checked with a different meter because I didn't believe it and that was 398. By this time Stinky did nothing but sleep, drink, pee & eat. Some days she barely ate and even passed up treats. Her coat was filthy and greasy and she was covered in dander.

She was started on U-40 PZI insulin, 1.5 units twice a day. After a couple of weeks there was no change in her numbers, usually high to mid 300s and sometimes dipping to the high 200s in the late afternoon. Her insulin was increased to 2 units, no change. Then 2.5 units, no change. Then 3 units twice daily and it finally started to come down a little, she was usually in the 200s instead of 300s in the morning. One morning I decided to give her 3.5 units and it might have been a coincidence, but her BG came way down in the evening. I went back to 3 units and every day her BG was lower. I kept decreasing her insulin until she was back at 1.5 units which is where she is now. Her BGs are usually in the 80s to low 100s.

Stinky started grooming herself again, she started digging in the litterbox and covering her waste instead of just getting in and out. She's chased string. Her coat feels and looks so much better and her eyes are nice & bright. She still drinks & urinates more than she did a year ago but not nearly as much as she was just a couple of months ago. The vet said that's because of her kidneys.

She has had two low readings in the 40s. I tried giving her honey the first time and she fought like crazy so I gave her a bunch of Temptations treats (she really loved those things, and had been denied them for months). The vet had recommended Karo syrup, I think. Is that thinner than honey? I had filled the other cats liquid medication syringe (Lactulose) with honey for Stinky but even using that it was hard getting any into her. I told my co-worker not to give Stinky her evening insulin shot. She was 142 the next morning.

I'm wondering if I should drop Stinky's insulin down again to 1 unit and let her BG run a little higher. I am the only one who tests her BG but a number of my co-workers are willing to give her insulin. When I'm not there I do worry about her getting her insulin without knowing what her number is first. I also know that she feels much, much better at the normal BG levels than she did when she was in even the upper 100s.

Thanks for reading.

Liz

 

Is there anyway you would be willing to share some numbers with us?

We have a standardized color coded spreadsheet that you set up in google and then link into your signature. That way, we can see what is going on and make suggestions. Directions here: http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

Start with the most recent week of data, BG (blood glucose) numbers, Units given.
AMPS = morning pre-shot test
PMPS = evening pre-shot test
U = number of units given
+1, +2 = number of hours since the last shot

How far apart are the PZI insulin shots being given? What sort of schedule? Office cat so probably varying times.

You said the BG's were between 80 and 100 but what times were those numbers in relation to the shot?

What food are you feeding? Name brand, amounts, fed how many times a day, when during the day.

The Temptations treats are high carb so they will raise the BG's. The problem is, they take longer to soften and digest so will not raise the BG's quickly enough.

You can smear the honey on the gums with your finger. Karo is thick too. You can mix 2 drops of honey or karo in with 1 teaspoon of the wet food to get the BG's up quicker. The honey/karo wears off quickly so you need to keep giving it. The numbers can stay low for quite some time and you need to provide food/sugar support for hours, until the numbers keep rising. We like to see numbers back in the 80-100 range, without food influence for at least a couple of hours.

 

Welcome to the Board!

Great job with the testing - that is a tall hurdle for many!

For safety, we test before the shot and starting out, recommend not giving insulin below 200 mg/dL. To see how well the insulin is working, we test around the nadir - about 5-6 hours after the shot for ProZinc. It should remain above 50 mg/dL.

 

I think I've followed all of the steps for the Google spreadsheet and sig link.

We're using a Bayer Contour Next USB meter. I have been trying to test her twice a day but I have let a few tests go because she was so unhappy with it. I have been working 6 days a week because I'm always so worried about the cats. Our other cat, Harriet, has medical issues of her own. Many of my co-workers have been great at learning to give Stinky her injections but they're not comfortable testing her BG. On Sundays, she does not get tested. If I take off during the week one co-worker will try to test her but he gets very nervous. He also doesn't want Stinky to hate him, which wouldn't happen but he's convinced she will.

The cats live in a store that is open 8am - 9pm Monday-Friday; 10am - 7pm on Saturday and 11am - 6pm on Sunday so it means her injection & feeding schedule varies. Tuesday & Wednesday mornings there is nobody here at opening to give her the shot. I am sometimes able to make it in early but not always. On those days, she usually gets her morning shot at 10:15 - 10:30 when I arrive. Monday, Tuesday & friday she gets it at 9am. Saturday is 10am and Sunday is 11am. Sunday is the shortest day and I do worry about her then. I'm wondering if I should have them give her less insulin on Sunday since the injections are closer together and she doesn't get her BG tested. In the evening there is always someone at closing who is willing to give her the injection so her evening dose time is very steady, except a little earlier on the weekend due to our hours.

Also, because Harriet needs medication that nobody is willing to give her, the cats usually don't get fed until I get in. That could be up to 90 minutes after Stinky has had her shot. I can ask them to put kibble down for her and hope Harriet stays away from it. Harriet is supposed to get her medication before she eats. Stinky won't eat wet food in the morning now, she only wants kibble. She's eating a mix of Evo & Purina DM kibble and a mix of Purina DM & Wellness chicken canned food. She likes the wet food at night but ignores it in the morning. If I give her only wet food in the morning she doesn't eat at all.

I'm not sure if I will keep up with that spreadsheet as I am not good at spreadsheets and I despise manual entry. I download Stinky's meter and save the reports as PDF files.

I'd hate to see her BGs go back up into the 200 range because she still felt bad at those numbers. Only when they came down to the 100s did her old personality start to return. That's also when her belly fur started growing back. She had a kidney sonogram back in September and they shaved her belly. It remained naked, except for a very thin layer of fuzz, until a few weeks ago and now you can see all of her stripes & colors again and her belly feels like fur, not suede. I don't know if getting her numbers back into normal range cause it or if it was just a coincidence.

I plan on doing another curve, testing her every 90 minutes or so throughout the day, to see how her insulin is working. Een when her numbers were very high, they would usually drop some by the late afternoon test. I usually test her around 10:30am & 5:00-5:30pm. When her morning numbers were in the mid to high 300s in the morning, they were usually in the high 200s to low 300s in the evening. I still see lower numbers in the evening but there's not as much as a difference now. 105 am, 94 pm for example.

Looking at her numbers, do you think I should keep her at 1.5 units, drop her to 1.0 unit, or maybe give her one dose in the morning and a different dose in the evening?

 

You definitely want to drop her dose. Those numbers you gave us on the SS(spreadsheet) are really low.

Were those numbers taken before or after she was given the insulin? How long before or after her shot?

If she is that low at pre-shot, she is likely very very low at mid-cycle.

She also needs to eat much closer to shot time not 90 minutes or more later.

Any chance of getting a test today at mid-day, to see how low she is going?

 

On Saturday I did change the instructions to drop her down to 1 unit. This morning when I got in she was 130 so the 1 unit dose seems to be okay. I'll test her today after I eat lunch and again around 5:00-5:30.

They do give her some treats after the shot. I can have them put down some kibble right away but I really don't want Harriet eating it, which I know she'll do. I can try to get in earlier but I don't really see that happening as I'm exhausted all the time. I'm also in NYC which means an hour+ long commute on public transportation, so it's not like I hop in a car for 10 minutes to get here.

 

Were those numbers on your spreadsheet (SS) taken before or after she was given the insulin? How long before or after her shot?

How long after the insulin shot was that 130 BG reading from this morning?

A little bit of kibble for Stinky would be good. If your coworkers can keep it away from Harriet. Maybe only as much as Stinky would eat in a few minutes, maybe 5 minutes? I'm suggesting that because the food needs time to digest before the insulin starts working. We want the insulin to be working when the food has been digested a bit. Dry food takes longer to digest than wet food does.

I don't want you to try to get in earlier. You probably already drink to get you going in the morning. I was trying to see if we could make this more of a 'team effort' among your coworkers. Would something like that be possible?

You said you were already working 6 days a week because you are so worried about the office cats. You need to take care of yourself too. Just making a few suggestions here to see if they will work. You know your responsibilities and commitments so much better than I do. So think about any suggestions and see if they will work or not. There is always Plan B. ;-)

I hear you on the long commutes. I think my longest one was 1 hour 45 minutes each way, driving my car. Could take 3 hours or more in a winter snowstorm.

What does the store sell where you work?

I was also wondering, if there was a different way to give Harriet's medication that would be easier for one of your co-workers to do. What medication is Harriet on and why? How is it administered now?

We know about other conditions besides diabetes.

 

Her BG is usually tested after her shot. A co-worker will give her the shot (usually around 9am M-F; 10am Saturday, 11am Sunday) and I do the BG test when I get in, 10:15-10:30am. So the test is usually 75-90 minutes after the shot. Sometimes I can catch the bus before my usual one which gets me here around 9:45-10:00am. After I test her and medicate Harriet, I give them breakfast.

Stinky usually eats in my office and she also spends most of her time in my office or right outside it. One co-worker is here only two days a week and Stinky likes to take over his chair when he's not here. There are 4 of us back in the office area and the rest of the space is store. So the co-workers in the store can't see what the cats are doing and it would be hard to keep Harriet away. Once Harriet knows that food has been put out she will hunt it down.

I can ask them to put down a tablespoon of kibble for Stinky right after her shot, and then I can give her some more when I get in. On Sunday she does get her food right after her shot and on Saturday she gets her food 30-40 minutes after her shot, when I get in.

Books.

Harriet has megacolon. I believe she developed this some years ago when one of my co-workers was feeding her massive amounts of cheap Meow Mix kibble on the sly. She desperately wanted Harriet to like her but Harriet never did. When this co-worker would try to pet Harriet, she would growl and bite her. She discovered that feeding Harriet junk whenever she wanted made Harriet somewhat tolerate her. She gained a ton of weight and soon after started having problems going to the bathroom. One day I saw her going back & forth between the boxes over and over, but she didn't produce anything. Same thing next day. Went to the vet, they cleaned her out and sent her home. Same thing happened a few days later. They cleaned her out, sent her home. Repeat. They finally said to give her 1ml of Lactulose daily. That did nothing. They said give it twice a day. She also despised the lactulose and it was nearly impossible to get it into her. After going to the vet 5 times in as many weeks I took her to a different one. They told me where to get the Lactulose flavored and also prescribed cisapride (Propulsid). 2 years ago, we added Miralax mixed in her wet food. She does okay on this but she did get completely backed up again in December so she had to go to the vet to cleaned out. The cisapride is a tablet, Lactulose is liquid (we get it flavored) and the Miralax gets mixed in her wet food. Only one co-worker is willing to give Harriet the pill & liquid and he doesn't work on weekends. Harriet is the reason I started working 6 days a week. On Sundays she only gets the Miralax. Except for the occasional problem where she gets really backed up for some reason, skipping her medication one day a week has worked out well. I don't like letting her go 2 days in a row because she has had problems pooping before when I couldn't work on the weekend. She is on 2ml of Lactulose twice a day (down from 4ml several years ago), 1/3 tsp of Miralax and 5mg cisapride (all twice daily).

We have a large dog cage for harriet. I like to see her poop at least every other day. If she goes 2 days without pooping, she gets put in the cage at night (she has a littler box, bed, food & water). She knows that when she gets put in the cage she's supposed to poop and many times she goes right into the litterbox and does it and then demands to be let out of the cage. Harriet also has a tendency to eat stuff she shouldn't. Dry leaves and plastic are her favorites. She usually pukes the leaves back up but often they come out the other end. She had to have a looooong piece of plastic, not sure if it was something like Saran wrap or packing tape, removed a few years ago. That was back at our old office where the store workers were pigs and left garbage all over the floor.

 

Hello there

I was just popping in to say hi and saw the SS hasnt been updated for a few days - was wondering how the new dose was going?

I think you can probably tweak her food proportions to see if you can bring her down further and maybe get her off the PZI entirely ie stop the Purina DM kibble and only feed the Evo kibble since its lower carb ( Its innova evo cat and kitten right?). But maybe first lets see how that 1unit is doing. Is there any chance of a mid cycle test to see how low she is going?

I agree with Deb, i would ask to see if your coworkers can shoot and stand over Stinky for 5-10 mins while she eats a mouse size portion of her kibble and then take it away from her.

Wendy

 

I tested Stinky at 1:35 this afternoon (4 1/2 hours after her shot) and she was 101. Tested her again just a few minutes ago and she was 100. She will be getting dinner within the next half hour and then she'll get her evening shot around 8pm.

I'm wondering if I should just wait until I get to work to give her the morning injections. The vet said keeping them as close to 12 hours apart as possible is best but on Saturday the shots are 9 hours apart and on Sunday only 7 hours apart. When I can't get in early on Tuesday & Wednesday (nobody here those mornings willing to inject her) she gets her shot & food when I come in at 10:15-10:30. If I just do it myself every morning she would be able to eat immediately after the injection. As it is now, her shots are 11 hours apart (9am, 8pm) only 3 days a week.

Also, her appetite has decreased and she doesn't eat that much. She's refusing wet food in the morning and just wants kibble. I put down about 3 TBs and she usually eats all of it, maybe she leaves a few pieces some mornings. At night I give her the same amount plus an equivalent amount of wet food. I have no ay of knowing if she eats it all or if Harriet helps her. It used to be we had to constantly chase Stinky away from harriet's bowl and now it's the other way around. They eat in very separate areas.

 

I'm not sure on the dosing for the erratic work schedule. I've put a post in the ISG PZI forum to hopefully get you some advice on that shorter dosing schedule. It may take a while for responses.

I'm going to start a new post for Harriet and her megacolon issue. We have some members here who have cats with megacolon and they may know it the cisapride can be crushed and mixed into a bit of wet food. And other helpful information.

 

The numbers on your spreadsheet indicate she is in numbers too low for insulin. We suggest not giving insulin if the cat tests under 200' but to wait 20 minutes and retest without feeding. If they have good data, some ProZinc users shoot between 150-180, but tiny doses, certainly under one unit. I am wondering if Stinky is dropping very low midcycle and is feeling crummy and that is part of her eating issues.

For reference, we generally say a cat is in remission if they range from 40-120 off insulin. We consider a cat in a regulated range if they are in the mid200s at preshot and double digits at midcycle, but not under 40. Her numbers are certainly better than regulated.

I know you are dealing with lots of extenuating circumstances and difficult time restraints. I would lower the dose to .5 units and get some tests in between shots. once you see how the low the insulin is taking her midcycle (5-7 hours after the shot) you'll have better info about a good, safe dose. It is best, if possible, to test before each shot. (it sounds like you are getting a blood glucose level after the shot and after she eats?). Can you find a way to test her before eating and before you give the shot? If she is under 200, I would not shoot until she rises.

I am concerned that she is getting insulin on some very low numbers. Have you tried the meter on yourself to be sure it is working correctly?