Starting Hypurine after failed Vetsulin regime

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Hi guys, it looks like Rocky bounced! His BG now at +2 PM is 21.6!
Don't call me anything, I should have listen to you.
What now?
Please
 
Marlena said:
His BG now at +2 PM is 21.6!
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Hmmm, any chance that was a dodgy test, Marlena?
Or could the shot have been a 'fur shot' (ie some went onto the fur and not into the cat)?
Or has Rocky had any different food this afternoon? Anything he might have nibbled that he shouldn't have...?

Sometimes bounces can take a few days to settle out, and this may still be part of the bounce from 2 days ago. Perhaps the earlier shot is wearing off and the higher numbers are breaking though again... It's quite a jump though.

Try not to be concerned. Cats' BG numbers often go up and down quite a bit (if you look at a few people's spreadsheets you will see that they vary a lot), so don't worry about this one instance. It's just one day.
Make yourself a nice cup of tea. Or pour a glass of wine. Or eat chocolate...
Relax. Breathe......
.
 
Elizabeth and Bertie said:
Hmmm, any chance that was a dodgy test, Marlena?
Or could the shot have been a 'fur shot' (ie some went onto the fur and not into the cat)?
Or has Rocky had any different food this afternoon? Anything he might have nibbled that he shouldn't have...?

Sometimes bounces can take a few days to settle out, and this may still be part of the bounce from 2 days ago. Perhaps the earlier shot is wearing off and the higher numbers are breaking though again... It's quite a jump though.

Try not to be concerned. Cats' BG numbers often go up and down quite a bit (if you look at a few people's spreadsheets you will see that they vary a lot), so don't worry about this one instance. It's just one day.
Make yourself a nice cup of tea. Or pour a glass of wine. Or eat chocolate...
Relax. Breathe......
.
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Dear Eliz,
many thanks.
The only thing which was different today was that he was in pain - his front leg was bothering him and he was kind of waving his paw and I could see he was in pain. It seems to be arthritis.
 
Marlena said:
What now?
Click to expand...

Ta dah!!!!

iu


In this sugary world, everyone should have a pair of Patience Pants. ;)


Mogs
.
 
Hi Marlena,

Apologies if this is garbled, I've been out with the OH & might have had some wine.

There is no standard dose to start a cat on insulin. You judge by weight, and clinical history, including glucisamine & current BG levels.

Milo is not only a big cat (Maine Coon cross), but he had also been through ketoacidosis, and was walking on his hocks with neuropathy. We'd had *that* conversation about letting him go & hypurin was his last chance.

I chose his starting dose, not the Vet. I chose half the dose he was on with caninsulin. If you look at his scores, he didn't get into the 'green' numbers for 3 weeks - at which point I wanted to throw a party! If I had started him on a lower dose, he may have got there sooner, or he might not have done at all, who knows?

Consistent dosing is key to regulation in the outset. Keeping insulin at a constant level helps the liver store glucose, and gives the pancreas a chance to recover from the toxic effects of higher glucose levels. If you find that he has a sputtering pancreas like Bertie, then use a sliding scale, but at the moment, we don't know that is the case with Rocky.

Anyway, I am blethering. Start low & keep it consistent for a few days, then think about change if necessary. Only with a few days of data will we know what's appropriate for him.
J
 
Dr Schrodinger said:
Hi Marlena,

Apologies if this is garbled, I've been out with the OH & might have had some wine.

There is no standard dose to start a cat on insulin. You judge by weight, and clinical history, including glucisamine & current BG levels.

Milo is not only a big cat (Maine Coon cross), but he had also been through ketoacidosis, and was walking on his hocks with neuropathy. We'd had *that* conversation about letting him go & hypurin was his last chance.

I chose his starting dose, not the Vet. I chose half the dose he was on with caninsulin. If you look at his scores, he didn't get into the 'green' numbers for 3 weeks - at which point I wanted to throw a party! If I had started him on a lower dose, he may have got there sooner, or he might not have done at all, who knows?

Consistent dosing is key to regulation in the outset. Keeping insulin at a constant level helps the liver store glucose, and gives the pancreas a chance to recover from the toxic effects of higher glucose levels. If you find that he has a sputtering pancreas like Bertie, then use a sliding scale, but at the moment, we don't know that is the case with Rocky.

Anyway, I am blethering. Start low & keep it consistent for a few days, then think about change if necessary. Only with a few days of data will we know what's appropriate for him.
J
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Dear Juliet,
as always very helpful.
I am going back to the beginning.
So stick with 0.5.
I was going to fast and now we don't know.
Let's hope I get it right this time.
Best regards
Marelna
 
Marlena said:
Dear Eliz,
many thanks.
The only thing which was different today was that he was in pain - his front leg was bothering him and he was kind of waving his paw and I could see he was in pain. It seems to be arthritis.
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No, the test was ok, double checked and the shot was done properly I think, I had no evidence to think otherwise but who knows.
I am going back to low dose of 0.5 for as long as you tell me to continue.
It is not easy but you guys have experience so at least I have support.
Thank you
Marlena
 
Marlena said:
The only thing which was different today was that he was in pain - his front leg was bothering him and he was kind of waving his paw and I could see he was in pain. It seems to be arthritis.
Click to expand...
Pain can certainly raise blood glucose.
Are your sure it's arthritis? Could he have something wrong with his paw? Is there any swelling there? Any sign of injury?
.
 
Eliz, Rocky has had problems with his leg for sometime. It looks like he is waving and holding it up, he certainly is in pain with it as he hisses while he does that. It happens not too often. The vet thought it might be arthritis, she examined him and said his joints are a bit tender.
I used to give him turmeric extract and he always gets fish oil capsule. So this is an ongoing problem.
Marlena
 
Aw, poor litttle chap...
I do sympathise because my oldest kitty, Jonesy, has a bit of arthritis. He gets Cosequin every day (glucosamine and chondroitin supplement) and that seems to make quite a difference to him (I know that because if I forget to give it for a little while his symptoms worsen...:oops:).
Have you tried Cosequin for Rocky, Marlena?
.
 
Dear All,
Rocky is in pink this morning so hopefully there is an improvement.
I really have to start some holistic treatment for arthritis. I was considering Cosequin but have found that there is something else which might be better (forgot the name but it will come to me as soon as I feel more awake). I am going to take arthritic supplement together with Rocky as we both share the condition!
Another thing is acupuncture which I am having at the moment but the therapist didn't want to do Rocky (ha ha ha)!
We live in the sticks so it is too far to go to a holistic vet.
I hope you and your furry children are well.
Best regards,
Marlena
 
Hi, could you guys please have a look at Rocky's spreadsheet because we approaching PM shots and his numbers do not improve so I need your opinion as what to do. I am worried about his high BGs damaging his kidneys. He is drinking a lot of water. Do I still continue with 0.5 u?
 
Marlena said:
Do I still continue with 0.5 u?
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I would keep the .5 for this shot, Marlena, and maybe review it in the morning if there is no improvement in the numbers.

Try not not worry (easier said than done, I know) but Rocky is probably just drinking water because his BG is high.

How is his leg/paw? Does he seem to be any more comfortable?

Hugs,

Eliz
 
Dear Eliz,
Thank you.
Could anybody help me with review in the morning or could I please have some suggestions tonight please? So if his numbers are not better tomorrow am what do you suggest I need to do?
Rocky's paw is fine now, it only happens once in the blue moon and lasts for few minutes and then he's fine.
I am considering some supplement for arthritis.
Love,
Marelna
 
I feel for you over the worry, Marlena. I can't help with input on the insulin side of things but I am sending good vibes for Rocky and these for you -->> :bighug::bighug:


Mogs
.
 
Marlena said:
So if his numbers are not better tomorrow am what do you suggest I need to do?
Click to expand...
If there is no change in the numbers then I think you could probably try a small increase. But I think any increase should be done with caution because we've already seen that at a preshot of 21.5 a .75 dose dropped him to 4.1 very late into the cycle, and then he bounced.

These very flat numbers are odd, almost like there's some other factor in the mix. And if it's not the pain in his leg, and there is no change of food then it might be something else...
Marlena, these may seem like daft questions but...are you having any problems with the insulin shots? Are you sure the insulin is actually going in OK? With Hypurin it can be helpful to keep the syringe in place for a few seconds (I usually do a 'quick' count of 5) before withdrawing it.
And are you mixing the insulin (tipping/rolling the vial) before each shot? (I'm sure you are, but just thought I'd ask...)

I'm going to tag Juliet @Dr Schrodinger to see what her view is....

Eliz
 
Dear Eliz,
your questions are indeed needed to try to find out what the issue might be. His PSPM is now 23.6 so rising rapidly.
I can not be sure 100 percent that the injection was done properly but I really have no reason to think otherwise. I read everything and printed everything and keep it handy so I have it in front of me and I refer to it.
Strange
 
Sorry to be late to the party, Ladies, I just got in from work.
I agree with Eliz completely. Stick with 0.5u tonight.
It does look as if he hasn't has any insulin today- there's been no real change in BG. 'Fur shots' are so easy to do, and Milo had quite a few!
 
One more thing: I have a record of a very similar situation back in November (when on Vetsulin)!
I thought that the meter was broken so started using a different meter which gave me a completely different reading (lower).
In the end I started using the old meter again after checking it with control solution.
I did in the past missed shots but I was aware of that. This time I am pretty sure the insulin went in.
But his pm shot is done now. See what happens am.
 
Good morning,
time for morning shot and I am not sure what to do, his numbers don't change much basically staying high.
I am a bit worried.
Help please.
 
Marlena, are you going to be around today to test Rocky?
If so, then if it were my cat I would increase the dose to .75 at this point. I agree that it is important to get him out of these high numbers.
It may be that his blood glucose drops low and bounces, but that may not happen... And these high numbers are looking kind of stubborn...
.
 
Eliz,
I am at home today so testing often will be done, no problem.
I feed Rocky raw home made diet, more less the same all the time. Low carb, medium fat, high protein and supplements like fish oils, evening primrose oil, herbs, etc.
I have this feeling that the 0.5u dose is just not doing anything but this is just a feeling as I can't be sure.
When he went into remission with Vetsulin it was just like I could drop his dose slowly as his numbers were improving and it was kind of just predictable. Unfortunately Vetsulin did not work well last time as it was dropping his numbers quickly and then raising them high not lasting long enough.
 
Marlena said:
I have this feeling that the 0.5u dose is just not doing anything but this is just a feeling as I can't be sure.
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Yes, it is strange, Marlena, because he seemed to respond so well to the .5 unit on 10th January, and also (almost too well) to the .75 on the following day. So, there doesn't seem to be any clear pattern emerging yet.

These numbers are quite similar to the numbers that my Bertie had when he was first diagnosed (and on Caninsulin at that point). He'd have high numbers for a while interspersed with sudden low numbers. Very frustrating!
Sometimes we never know the reason for these patterns, but I do sometimes wonder whether one possible reason is the cat's own insulin output... Perhaps Rocky's pancreas is producing insulin of it's own intermittently. He's been in remission twice, so he has shown that his pancreas has the power to recover....
.
 
How weird! He has gone from responding really well 5 days ago, to just ignoring what you are giving him...

Stick with the 0.75u for a couple of days & see how he reacts, I think.

You're doing really well. How is Rocky? Still drinking & peeing loads?
 
Dear Juliet,
many thanks for your reply.
It is very strange, it looks like he doesn't get any insulin! We can expect maybe one missing shot (fur shot) but not every single one unless I am completely useless and don't know what I am doing (God help me).
He seems ok, not too bothered about anything. Oh, maybe food. His appetite is always very good and he always wants to eat regardless of having high or low BG. There was not one day in the 11 years of Rocky's life that he wouldn't eat his food!
He was drinking more this morning but since afternoon he is not drinking.
With regards to peeing - I don't know because he absolutely refuses to use litter tray and only does his business in the garden. I spy on him as much as I can, use a good torch in the dark but he is so good at hiding away from me...
Well, keeping him on 0.75u for now and see.
Please pray for us, I feel like crying now but I also feel positive at the same time.
Thanks for your time.
Marlena
 
Marlena said:
Please pray for us, I feel like crying now but I also feel positive at the same time.
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Oh, (((Marlena))) - hugs, hugs, huuuuuuugs!:bighug:

You are a truly wonderful cat-Mum. And you are doing everything that you possibly can.
This is very early days and there is every chance that this is just a wierd 'blip'.

Keeping fingers and paws crossed here that you will see an improvement tomorrow.
Chin up, sweetie!

Eliz
 
Dear Eliz,
thank you, thank you, thank you.
Your encouraging words are very much appreciated.
I need to stay focused and patient, I am sure everything will fall in place and it will start making sense.
Best wishes for you and your gorgeous Bertie.
Have a good night and "see" you tomorrow.
Marlena
 
Dr Schrodinger said:
:) Below 7! Go Rocky!
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Wowsy!
It's good to see that his numbers can drop. :)

...But that is also a very steep drop and may continue for a while yet... I'm sure you're keeping a very close eye on him, Marlena. ;)

Am keen to see what the next test result is. We don't want him continuing to drop at this same rate...:nailbiting:
If necessary, it is often possible to slow the drop by giving a little ordinary food. You can do this to level out the drop a bit, or to try to keep the blood glucose from dropping too low.

If it does look like the blood glucose is going to drop too low, and the low carb food doesn't do the trick, then it might become necessary to give something a little higher in carbs.
Do you have any higher carb wet cat food available just in case, Marlena?

An alternative (if the numbers really need to be stopped or brought up fast) is to give the kitty a little bit of honey/glucose syrup etc. That is the quickest way to raise blood glucose. These simple sugars also leave the system fairly quickly, so the effect is relatively temporary.
.
 
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Elizabeth and Bertie said:
Wowsy!
It's good to see that his numbers can drop. :)

...But that is also a very steep drop and may continue for a while yet... I'm sure you're keeping a very close eye on him, Marlena. ;)

Am keen to see what the next test result is. We don't want him continuing to drop at this same rate...:nailbiting:
If necessary, it is often possible to slow the drop by giving a little ordinary food. You can do this to level out the drop a bit, or to try to keep the blood glucose from dropping too low.

If it does look like the blood glucose is going to drop too low, and the low carb food doesn't do the trick, then it might become necessary to give something a little higher in carbs.
Do you have any higher carb wet cat food available just in case, Marlena?

An alternative (if the numbers really need to be stopped or brought up fast) is to give the kitty a little bit of honey/glucose syrup etc. That is the quickest way to raise blood glucose. These simple sugars also leave the system fairly quickly, so the effect is relatively temporary.
.

.
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Dear Eliz,
I thought that as well - a little steep drop! And it happened when his numbers were high and I thought I would relax a little about frequent testing because frankly I was prepared to wait a bit and not panic so I don't know now when his onset happened. I am going to test him again at +2 from the last test. I give him small amounts of his regular food every so often but I know what to do in case of his numbers dropping down to hypo.
Rocky is so easy because he would eat anything if allowed including mashed potatoes, that would do the trick I think in case of hypo! I also have glucose syrup in a tube (special one for diabetics).
Let's just keep our fingers crossed that he won't go too low for sake of his health and my sanity!
Thank you guys for keeping an eye on us, I shall keep you posted.
Next test at 2.15 pm Greenwich time.
 
Marlena said:
... I don't know now when his onset happened ...
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For future reference, if you keep an eye out for a sudden uptick in appetite a little while after the insulin dose was given it can help you spot when the insulin is kicking in. If Rocky is running in good numbers at PS, then checking BG when the appetite picks up can help you get an early warning that you need to monitor more closely during the current cycle.


Mogs
.
 
Shortly before his check up Rocky went to his bowl to drink and I thought it is a bit strange because his BG is supposed to be low. Guess what?
It is now 14. Is it ok?
 
Elizabeth and Bertie said:
I agree, Mogs. That does look like a bounce.

@Marlena , sometimes just the speed of the drop can cause a bounce.
.
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Eliz,
There is one thing I need to mention: this morning when I drew the insulin into syringe I really struggled to get 0.75u. I needed to draw a little bit more than 0.75 and squirt some out to get to the dose but I struggled with it and in the end it is possible that the dose was just over 0.75. Maybe even this tiny increase in the dose (unintentional and I can not be sure that that was the case) could have some sort of effect.
 
Marlena said:
Maybe even this tiny increase in the dose (unintentional and I can not be sure that that was the case) could have some sort of effect.
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Yes, it's possible, Marlena. Or it may just be that the .75 dose was starting to build up in his system. It may be that Rocky is sensitive to small dose changes.

My cat usually gets between .5 and 1.25 of a unit, and I have to hold the syringe close to a light source to see the dose clearly. (I'm very longsighted, and also need strong reading glasses for close vision). It sometimes also involves a fair amount of squinting and eye-rubbing as well, especially first thing in the morning, ha-ha!

Please don't be discouraged by the up and down numbers at this point. All the test results you are getting are providing really important data. You're doing a brilliant job! :bighug:
.
 
Elizabeth and Bertie said:
Yes, it's possible, Marlena. Or it may just be that the .75 dose was starting to build up in his system. It may be that Rocky is sensitive to small dose changes.

My cat usually gets between .5 and 1.25 of a unit, and I have to hold the syringe close to a light source to see the dose clearly. (I'm very longsighted, and also need strong reading glasses for close vision). It sometimes also involves a fair amount of squinting and eye-rubbing as well, especially first thing in the morning, ha-ha!

Please don't be discouraged by the up and down numbers at this point. All the test results you are getting are providing really important data. You're doing a brilliant job! :bighug:
.
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Eliz, many thanks.
I feel a lot more positive now and kind of more relaxed.
The biggest problem with the syringe I have is that when you draw insulin in you need to take some more and then push some out to arrive at the correct dose (0.75u ) but trying to push the plunger ever so lightly or slightly I should say to push it to the right level is soooooooo difficult. My husband gave me a wonderful magnifying glass on a stand so I can see really well and I think it helps.
Anyway, Rocky seems well and not really bothered about my struggles but it is typical behaviour of cats, am I right?
Lots of hugs to you,
Marlena
 
Try twisting the syringe plunger at the same time you are depressing it gently. I never got that exact with doses, but I've read others have used that technique.

It looks like "patience" paid off looking at today's numbers ;)

I wanted to ask @Elizabeth and Bertie and @Dr Schrodinger (as they are familiar with hypurin PZI and I am not) a couple questions.

A "typical Prozinc cycle" looks like this:
Onset at +2 - +3
Nadir between +5 & +7
Duration between 10-14 hours.
(According to the Prozinc website)

Today, I found this on the petdiabetes wikia site about Hypurin PZI:

  • onset 2-5h,
  • peak 12-24h
  • duration: maximum 36h
Would you say that in your experience, that would be accurate as far as "typical"?

If so, it isn't anywhere close to what most PZI users here would be familiar with. I'm thinking that " typical" must be defined in order for "atypical" to be recognized.

To me, it would appear that if HPZI works the way it is shown above, you almost have to think "depot insulin" instead of using your "PZI brain" in order to use it effectively. Is that a fair way of thinking?

In fact, today's +5 could be the nadir from last night's dose if the "peak" can be 12-24 hours after a shot, right?
 
A magnifying glass on a stand? OH, that's just what I need. Wonderful! I'm doing the squinting thing too..plus I'm developing cataracts, grrr. But a magnifying glass would be so helpful!
 
Carl & Polly & Bob (GA) said:
Today, I found this on the petdiabetes wikia site about Hypurin PZI:

  • onset 2-5h,
  • peak 12-24h
  • duration: maximum 36h
Would you say that in your experience, that would be accurate as far as "typical"?
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Hi Carl,
I remember seeing that info before on the petdiabetes wikia, and did a 'double take' at the time because those numbers are the ones that refer to it's action in humans. I made a mental note back then to get in touch with the author of the site (Steve, from FDMB?) to ask how he got that info. But time passed, and I just forgot about it...

My cat possibly has an earlier cycle than most. His typical onset is +1.5 to +2 hours, then peak at around +4 to 4.5, and maybe a surf for a few hours (although for a 'larger than typical' dose his onset will the same but the peak could be a few hours later).

One lady on here struggled with HPZI because her cat had long cycles on it, maybe 18 hours.

Juliet @Dr Schrodinger did, as I recall, start to work with HPZI as a depot insulin using one of the known protocols (?). But there wasn't a lot of time for this experiment because her cat, Milo, went into remission!
Milo's SS is here:
https://docs.google.com/spreadsheets/d/19uMgm1_fhGUbwouy15pCn1NNYwsQaD5Otrr251-HM8U/edit#gid=5

One of the things most people notice when starting using it is that the preshot numbers come down. So, despite the pattern during the initial 12 hours there does certainly seem to be some overlap/depot effect going on. I have tried many times to find out more about this, but there just isn't the info out there that there is on Lantus and Levemir. (I don't know how HPZI is stored in the body, for example).

I tend to think of HPZI as the 'love child of PZI and Lantus', because it seems to have some of the properties of both. It certainly has some kind of overlap/depot, but can also adapt to sliding scale dosing (although the overlap/depot does have to be factored in).

Over on DCC and similar sites they seem to think that HPZI is good for their protocol 'as long as people can handle the overlap'. And the dosing is done after 10 hours as long as the number is rising. Given HPZI's overlap/depot the thought of giving shots 10 hourly on a routine basis scares the pants off me! ;)
.
 
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