Frodo - trying something different

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Ruth Ann and Frodo

Ruth Ann and Frodo

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We got so frustrated with not getting anywhere getting any consistent results for Frodo. I recently got Elizabeth Hodgkins book “Your Cat”’. The book includes her protocol for tight regulation for ProZinc (also on her website www.yourdiabeticcat.com). We are trying it on the basic of “test-and-shoot” 3 times a day, so far for only two days. I wonder if anyone else is or has used this protocol. We are still getting some high BG readings, but the once a day low one we get is really welcome, after 3 months of almost nothing below 350 no matter what we did. We’ll try it for a while on what will be for practical reasons, 9 hour and 7 ½ , 7 ½ hour testing.
I’m recording: time of test/shot, BG, units of insulin, and time gap since previous shot. Also sometimes a mid-cycle BG/time. Unfortunately I don’t know enough about spreadsheets to set up one that would work for this.
Ruth Ann
 
No one here is on that protocol. We find her dosing regiment pretty aggressive. Her advocates say no cat can hypo with low carb food, which we have certainly seen happen. If you want specific help with that protocol, you may find it on that site.

We have had a number of people dose every 8 hours with ProZinc. Sometimes that is a jump start to lower levels. The most important thing is to be sure his numbers are rising, not still falling, before you give him more insulin. And to be sure the dose is not taking him too low at each nadir, so as to avoid an ongoing pattern of bouncing from lows to highs. If you want help with TID dosing, we'll help. But I wouldn't be able to help with their protocol. I have seen a number of cats come here after trying it and it took a long time to get them on a safe regiment. It doesn't seem very safe to me.

BJM has a TID spreadsheet that she can share. You might send her a private message. Also, if you search on this PZI forum in the remission thread, B00kworm had Cassie on a TID schedule before he eventually started dropping and went back to BID and eventually OTJ. It might help you see how it can be done safely.
 
ralarson102 said:
...Elizabeth Hodgkins ..... I wonder if anyone else is or has used this protocol.
Click to expand...
Yep. Been there, done that, and 'got the T shirt'....

Back in early 2007 when I joined FDMB there were some Hodgkins folks on the FDMB forum, and one of those contacted me and encouraged me to try the Hodgkins protocol with my cat. (She was a lovely person who actually helped me a great deal (and gave me my first glucose meter) and I still remember her with enormous affection). However....the Hodgkins protocol didn't work for us, and, to be frank, it all rather 'ended in tears'....

I was using a PZI insulin with a similar duration to Prozinc.
I often gave shots 8 hours apart, and sometimes gave shots 6 hours apart if the numbers hadn't budged. But every so often my cat's numbers would drop like a stone, and then shoot up high again. And, because he was on the Hodgkins sliding scale dosage, the higher my cat's numbers went, the more insulin I gave (up to 5 units at a time).
I should say at this point that I remain a fan of sliding scale dosage (as long as it's calculated to suit the individual cat's needs). However, it is very dangerous indeed to increase the dosage if the preshot number that you're seeing is being caused by a bounce. If the bounce clears, and the numbers drop, and the cat has more insulin in it's system than it needs, you can get into serious trouble. But then we come to the really scary bit about the Hodgkins protocol: It is believed that a cat on a low carb wet diet cannot suffer from hypoglycemia. And it simply isn't true...

My cat had his first hypo while following the protocol. I found it to be a terrifying experience; not least because I had come to believe that it wasn't possible. But when I told other Hodgkins folks about this the response I got was that 'it could not have happened'...... So, I had to make a decision about whether to continue with the protocol, or to trust my own experience, and just walk away; and I did the latter.

As I said, I remain a fan of sliding scale dosage - as long as it is calculated for the individual cat's needs and and is used appropriately. And I've also seen merit in TID dosing (giving 3 shots a day) for some cats; although I think this should only be attempted once the caregiver has gained experience of giving shots twice a day, and has gathered data to show that TID dosing might be suitable for their cat.

Hoping this helps...

Eliz
 
Maybe try straight TID dosing (every 8 hours) first, before trying Hodgkin's approach. See how it works for your schedule, for your cat, and for your stress.

Here is TID spreadsheet. Save a copy to your Google Drive (not your PC).
 
Ruth Ann @ralarson102 , can I ask what you're feeding Frodo at the moment? Do you know if his food has less than 10% calories from carbs, and could he possibly have any access to higher carb food at any time..?
And is it possible that he has some underlying infection (dental, UTI...?)
(Sorry if you've already discussed this, but I wasn't able to check your previous posts (I don't think your 'privacy settings' allow access to that info.))

Are you monitoring Frodo's pee for ketones (using Ketodiastix or generic equivalent)? If not, it would certainly be advisable at these blood glucose numbers. Crumpling plastic food wrap in the litter tray is a good way to catch a sample; you only need a tiny amount.

I know it's frustrating to see a beloved kitty in high numbers. But don't give up hope. There is every chance that things will improve.
Reassuring hug to you, :bighug:

Eliz
 
First off, apologies for not replying earlier - a busy couple of days. Let’s see if I can answer everybody in one message.
First, to the two people who sent me possible spreadsheets for TID dosing, either one would work- I’ll have to reread just how to get it saved for me.
Second, and most important: we learned the “hard way” that Hodgkins protocol gives too much insulin - had a hypo episode Monday afternoon. Frodo was very sleepy that day, and I was just attributing it to it being the first really nice “summer” day. But we caught it on a test, he was “with it”enough to take a few licks of Fancy Feast, and 20 minutes later a couple spoonsful of Friskies Prime Filets (a 15-17% carb food he doesn’t usually get and was happy to eat). His BG rose gradually over the next 2+ hours, and was back to 300+ by evening. (My husband is a human diabetic, so we have some idea how to handle this.)
For now we have decided to give TID dosing a chance, and see how it works out. Since he was doing OK but high on 3U BID dosing, we decided to start with 2U TID, for the same daily total. Will give that a few days to see how he settles in - unfortunately had a probable “fur shot” this morning, but his BG had dropped a little anyway at +3 hours, so we decided safest not to try to give a partial late dose.
Finally: yes, he’s on low-carb food - FF Classics, Friskies Paté, and as much raw (really raw: grocery store meats, not some commercial brand) as I can persuade him to eat (sometimes he’s in the mood for it, sometimes not). We got a negative ketone reading off some very wet litter a couple of days ago. And he was vet-checked for infections maybe 3 weeks ago. Lab work normal except for BG and elevated calcium - vet not sure what that means.
Ruth Ann
 
OK, we're holding Frodo on TID dosing, and I have both the old and new spreadsheets linked. We've been dosing 2 units tid, and as of yesterday, if either morning or midday is over 400, we will dose 2.5U. But not both, at least for a while. I am wary of dosing more overnight, since he usually doesn't eat much) between the evening (12 midnight) shot and the morning. Can't leave canned out because another cat will wolf it down, so what's out for overnight is raw (on ice).
Would anybody like to comment on the (tid) spreadsheet results.
Another matter - Frodo's littermate Gandalf went missing Friday after being let out like usual. He's a CKD cat (also 16), and I'm just so afraid that we'll never see him again or know what happened to him. Doing everything we can, but no sign of him. We have looked everywhere we can think of, have flyers out, etc.
 
Today's +8 certainly is lower.The part you are missing (which I understand is hard because it requires extra numbers) is making sure he is headed up, not down. So, if today, the 241 is still dropping, adding 2 units on top of that can be a problem. You are going to need a +6 or 7 to be sure your +8 is no the lowest number of that cycle. You need more data period , to see how the 2 units is really working - whether those pink pre shots are bounces or not.

Do you think you can up the testing? My concern is that, if he drops low somewhere or if the +8 is still going down, your dosing can set up a big bouncing issue, or adding more insulin onto a dose that is still working can cause a low number. Neither are good. The only way to be sure that he is safe and that you understand what is going on is to get a number before that +8 dose, every time.
 
The more mid-cycle tests you can get, the better. Change the time by 0.5-1.0 hours on different days, as the nadir can and does change.

For Gandalf, be sure to check under bushes, up in trees, and ask your neighbors if you can check their yards. You'll check more thoroughly than they will.

 
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A couple more days of data, trying to fill in some numbers. Yesterday was wild, and I think we won't be doing the 2.5 in the morning, since yesterday he sat pretty much flat from am+5 1/2 to am+ 9 1/2. Didn't test then for a couple of hours and at am+12 he was HI and I decided to do a 2U 12-hour shot. Back on schedule today (22nd).
I really am getting frustrated with nothing working to get him down below 300. I don't think his swings look wide enough to be causing that much bouncing. I start wondering about doing something like taking him back to something like .5U tid and work dosage up from there. Or we had better start thinking about going to another insulin: strange situation - we have Lantus extra from my hubby's supply because of the combination of amount prescribed for him and expiration dates. So it would be no cost, at least at present. But Levemir might do better for Frodo.
Gandalf is still missing and we've done everything we can think of. There are very few if any hiding places here (Washington DC suburbs) after a hard winter and too many deer chomping everything down. I start crying every time I think about him - such a sweet kitty.
Ruth Ann
 
I just don't know, Ruth Ann. It doesn't look like the insulin is doing much at all. It could be that he is overdosed, but you started at one unit. You increased fairly fast but you still should have seen some movement. You don't have a whole lot of data at TID, but with what you have, he doesn't seem to be respondingwell.

If he were mine, I think I would change insulin. Levemir is a good choice just in case he does turn out to be a higher dose kitty; it is supposed to sting less at higher doses.

I sure hope Gandalf comes home.
 
So sorry to hear Gandalf is missing!!! Check outside at twilight...mine usually came around the house then when they got out. Not sure why. Sending good thoughts!
 
You have checked your local shelter? (I'm guessing yes)
Are you putting out food and water? (yes, you may get some strays, raccoons, and opossums)
Have you dragged a scent trail - rain washes away scent, and scent fades over time. Take clothing you've worn and drag a trail.
 
Gandalf is a 16yo long-term indoor- outdoor, not much outdoor during the past hard winter. He also has chronic kidney disease but seemed to be doing pretty well - last checkup early January. He had been acting what I have to call "somewhat confused"over the past week or two - lots of circling round my feet, getting in the way, getting his nails caught in the blanket he sleeps on, and so forth. With hindsight and some additional reading, I now think that he had developed hypertension and may have been going blind. And I didn't catch it and let him out! He had been out and around the house front to back within the week before he went missing (April 17), so I let him out around 10 that morning - it was a beautiful day. The neighbor's lawn service started up their noisy mowers just after I let the cats out. Didn't realize until about one that he hadn't come back up on the deck. We started looking, have been looking ever since every place we can think of, and no Gandalf. There's very little cover - the small wooded area behind us is pretty barren, since the deer eat everything, including most of the shrubbery around houses.
Water is out and it's been raining. Dry food out near cat door last couple of nights but untouched. Shelter notified. Also on craigslist and Facebook page for lost animals for our area. I had a good picture. And I'm crying!
 
You have to go to the shelter; they normally don't call for you unless there is a microchip with your info detected.
 
Have been to shelter once - going again today. They have picture and description - said his face is quite distinctive and they would likely recognize. No microchip but he did have a collar with rabies tag from local vet. How (and why) would he just vanish with no trace within a 3-hour time frame?
 
Someone could have taken him in.
Maybe see if you can enlist a troop of Scouts, boy or girl, to help search.
 
Don't know how much more can be done. Looked all over. Have to assume he would end up in Montgomery County shelter, if anywhere. Doubt I have time/energy to check DC and PG shelters - less likely anyway. If you want to see a pic, check Washington DC Craigslist under pets or Lost and Found, search Gandalf. This is so hard - I keep thinking about Gandalf but I need to get back to concerns about his brother Frodo, whether or not we ever see Gandalf again. Really have to decide if we need to switch Frodo to a different insulin, and do some reading on Lantus and Levemir.
 
Sue and Oliver (GA) said:
I just don't know, Ruth Ann. It doesn't look like the insulin is doing much at all. It could be that he is overdosed, but you started at one unit. You increased fairly fast but you still should have seen some movement. You don't have a whole lot of data at TID, but with what you have, he doesn't seem to be respondingwell.

If he were mine, I think I would change insulin. Levemir is a good choice just in case he does turn out to be a higher dose kitty; it is supposed to sting less at higher doses.

I sure hope Gandalf comes home.
Click to expand...
 
I’m back after an absence on the board. Frodo’s brother Gandalf had gone missing April 17, and we went through two weeks of hell hoping to get him back home. Flyers, calls to local vets, checking animal shelters, and so forth. Even a scent dog. The upshot is that after two weeks gone, and close to ½ mile away (according to the dog trace) he made it home on his own only to get tangled in some ivy growing into our deer fence, was too weak and maybe blind to get himself out, and died there, only 20 feet from our back door. It’s been two weeks now, and I’m still crying every time I try to think about him.
But there’s still Frodo to think about. He got his insulin shots, mostly on time, but I didn’t have any time to post or even keep his spreadsheet up-to-date. It’s caught up now. And he’s still hitting high numbers, even though we’ve upped the dosage a little. We weren’t able to do many mid-cycle numbers, but a fair sprinkling. I don’t think we went anywhere near a hypo - doubt we got any numbers below 200-, but there may have been some bounce in some cases. His readings seem mostly to depend on whether he’s eaten much or not - I could probably guarantee a rise just by feeding him, no matter where in the cycle. Anybody care to take a look and offer an opinion.
We are near the end of a vial of ProZinc and wondering if this is the time to switch to Levemir. Opinions?
 
Requiem aeternum, Gandalf
{{hugs}}

Which spreadsheet - BID or TID? And are the numbers up to date?
 
Awww, Ruth Ann, so sorry about Gandalf.:( RIP little guy, I picture you romping in a fragrant meadow, chasing butterflies, playing with new friends, I hear Rainbow Bridge is a beautiful place, where all kitties are restored to good health.cat_wings>o
I'm afraid I'm too inexperienced to offer opinions on Frodo, but I see that BJM is here, always has good info to share.
 
You may get longer duration with Levemir or Lantus, plus be able to shoot BID. I'd sum up the total daily dose, divide by 2, then take about 3/4 of that for starting either of those.

What I'm seeing is that the dose may not be high enough, based on the mid-cycle data in the 300s you've collected. I think you can take it up to 3 units. You also may want to consider the BCP PZI, which can come in a U-100 strength, thus a smaller volume per injection. And a different brand may last a bit longer.
 
Any thoughts on a preference: Lantus or Levemir. Situation is that my diabetic husband has prescribed Lantus on hand that he won't use before it expires. So it's "free" to use on Frodo.
 
Lantus can sting at higher doses, which is why I'm using Levemir with Gracie.
 
Ruth Ann, I'm so sorry to hear about Gandalf. My heart goes out to you!

I'm afraid my insulin experience is limited to ProZinc, but since the Lantus is essentially free, it might be worth trying it first. Hopefully, more L and L users will chime in.
big hug,
Joan
 
I am so sorry to hear about Gandalf. I am sure that you are heart broken. But don't forget the years of love and kindness you brought to his life.

I agree. If you have free Lantus, I would use it. Be sure to read the stickies on the Lantus Insulin Support page. They are full of great info.
 
I'm so sorry Ruth Ann. Fly free, sweet Gandalf!

I'd go with the free Lantus too. Why not give it a try? After all, it's free and there's lots of experience on the Lantus board here.

Big hugs to you!
 
OK, we are going to switch over to Lantus - already did 3 days at first dosage, and upped it. At least I feel more confident having an established protocol. I guess I'll be posting in the Lantus forum from here on.
 
I was looking to see if you'd posted there yet, but it wouldn't let me look at your profile to see what posts you had made. :(
 
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