Just returned from vet - newly diagnosed and confused

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Korynn

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Hi there:
Sharon14 suggested I hop over here from intro forum with some of my questions. Desi was diagnosed 3 weeks ago and, because we were about to go out of state (which we did), we only got insulin this morning (we did change his diet immediately and start testing his BG - with a Relion). In the interim, I also read up A LOT on this site so came in with some ideas/thoughts. Vet is frowning upon our use of a human glucometer but I did not budge on that. Then he is prescribing 2ccs of ProZinc (which we got today) 2x/day, after feeding Desi, and only feeding him 2x/day. (He is used to small amounts throughout the day.) And then the 2ccs after he eats. What concerns me is that he wants us to test his BG only once a day, and "ideally in the afternoon." (By the way, we never saw the vet - only a tech who ran and asked the vet things and then came back to tell us.) Does this sound reasonable to you? We are to do this 2-3 weeks and then run a curve.
The vet tech compared the Accu-check numbers (their machine) and our Relion and said, "There is a 100 point difference!" Like I didn't expect there would be a difference. He said to deduct 100 from whatever the Relion reads - this is NOT right, is it? It's not that simple! What the heck?
Thanks in advance for reading this.
 
Hi there Korynn and welcome
Desi is absolutely adorable
first - when you mean 2cc of Prozinc, I hope you mean 2 units of Prozinc - there is a HUGE difference - please do not give 2 cc!!!!!
what kind of syringes are you using? Did they vet tech show you the proper amount - what 2 units looks like in the syringe?
Most people here do feed multiple small meals throughout the day - it is easier on the pancreas
We test, feed, then shoot - so twice a day (every 12 hours) you would test him with your meter, feed him, and then give the insulin if the test result says it is safe to do so (over 200 for newbies) - some people give the insulin while the cat is eating, others (like myself) wait until they are finished We then also test usually between 5 and 7 hours after the insulin was given (the normal nadir or low point for Prozinc)
Please read the yellow stickies on top of the Prozinc forum
I myself use an alpha trak2 meter (the pet meter) because it does more accurately reflect what the laboratory would get if the vet had the blood tested
I know the human meters do run lower than the alpha trak - so your result would be lower than the vet's results - but 100 points sounds too much
What are the results you have been getting with your relion?
I'll look for some other links for you - like setting up your signature and spreadsheet but please tell us the blood sugar results and please do not shoot 2cc -
 
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Welcome to the ProZinc group!
Don't worry about the meters - they ALL read +/- 20% around what a lab would get as that is an FDA ruling for glucometers sold over the counter. They aren't intended to replicate lab equipment, just give you an idea of where the glucose is.
At the low end, 50mg/dL +/+ 20% is a range of 40-60 mg/dL - and 50 mg/dL is the lowest you want to see the glucose without intervening, because a lab number below 50 in a diabetic receiving insulin risk hypoglycemia.
See my signature notes on this for more detail on this.

1 cc = 1 mL. ProZinc is a U-40 insulin, which means there are 40 units of insulin in 1 mL. If you were giving 2 ccs, ie 2 mL, you'd be giving 80 units of insulin. That would kill almost any cat, except one with a high dose condition such as acromegaly. I think you mean you are giving 2 units, correct?

We advocate testing before you shoot, and until you have some data, not shooting below 200 mg/dL. Once you have data showing it is safe, you may reduce that no shot level to about 150 mg/dL.
The nadir, or lowest glucose post-shot is roughly +5 to +7 hours after giving insulin. Testing in that period will help keep your cat safe, plus give you information about how well the insulin dose is working.
Because you've changed the food already, try to get some of those mid-cycle tests as soon as possible! The 2 units was based on how he presented at the vet, before you changed the food, right? If so, he may already need a reduction in dose to stay above 50 mg/dL.
Just to be prepared, do you have Karo syrup? Or some leftover high carb canned food? (Kibble takes too long to bring up the glucose should he drop low.) Here are the instructions for How To Handle A Hypo.


When you have a moment, could you add a few tidbits to your signature? It will help us give you feedback.

Editing your Signature

In the upper right corner of the screen, within the dark blue bar, you will see ID, Inbox, and Alerts

Click on your ID.

On the left, under Settings, Click on Signature.
This is where you will put information that helps us give you feedback. You are limited to 2 hard returns, so separate pieces by | or -.
This is where you paste the link for your spreadsheet, once it is set up.
Add any other text, such as your name | cat's name | date of Dx (diagnosis) | insulin | meter general location (city and state/province) any other pertinent issues like if there are any food issues, history of DKA, hepatic lipidosis, pancreatitis, allergies, IBD, etc.

Click the Save Changes button at the bottom.

Always click the Save Changes button at the bottom when you have changed anything.

 
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Hi Korynn - I just saw your thread on the intro forum and saw that Desi's blood sugar without insulin was in the 200s -
Let's see what @Sue and Oliver (GA) @Rachel @Robin&BB would think about a starting dose of 2 units -I think BJM asked some good questions above
In addition to your signature, it would enormously helpful to set up your spreadsheet so we can see the insulin dosing and how he is responding to the dose Here are the instructions for setting up the spreadsheet http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
 
Hi there Korynn and welcome
Desi is absolutely adorable
first - when you mean 2cc of Prozinc, I hope you mean 2 units of Prozinc - there is a HUGE difference - please do not give 2 cc!!!!!
what kind of syringes are you using? Did they vet tech show you the proper amount - what 2 units looks like in the syringe?
Most people here do feed multiple small meals throughout the day - it is easier on the pancreas
We test, feed, then shoot - so twice a day (every 12 hours) you would test him with your meter, feed him, and then give the insulin if the test result says it is safe to do so (over 200 for newbies) - some people give the insulin while the cat is eating, others (like myself) wait until they are finished We then also test usually between 5 and 7 hours after the insulin was given (the normal nadir or low point for Prozinc)
Please read the yellow stickies on top of the Prozinc forum
I myself use an alpha trak2 meter (the pet meter) because it does more accurately reflect what the laboratory would get if the vet had the blood tested
I know the human meters do run lower than the alpha trak - so your result would be lower than the vet's results - but 100 points sounds too much
What are the results you have been getting with your relion?
I'll look for some other links for you - like setting up your signature and spreadsheet but please tell us the blood sugar results and please do not shoot 2cc -
Yes, I meant 2 units!

The syringes are Monoject U-40 1/2 mL insulin syringes.
 
Welcome to the ProZinc group!
Don't worry about the meters - they ALL read +/- 20% around what a lab would get as that is an FDA ruling for glucometers sold over the counter. They aren't intended to replicate lab equipment, just give you an idea of where the glucose is.
At the low end, 50mg/dL +/+ 20% is a range of 40-60 mg/dL - and 50 mg/dL is the lowest you want to see the glucose without intervening, because a lab number below 50 in a diabetic receiving insulin risk hypoglycemia.
See my signature notes on this for more detail on this.

1 cc = 1 mL. ProZinc is a U-40 insulin, which means there are 40 units of insulin in 1 mL. If you were giving 2 ccs, ie 2 mL, you'd be giving 80 units of insulin. That would kill almost any cat, except one with a high dose condition such as acromegaly. I think you mean you are giving 2 units, correct?

We advocate testing before you shoot, and until you have some data, not shooting below 200 mg/dL. Once you have data showing it is safe, you may reduce that no shot level to about 150 mg/dL.
The nadir, or lowest glucose post-shot is roughly +5 to +7 hours after giving insulin. Testing in that period will help keep your cat safe, plus give you information about how well the insulin dose is working.
Because you've changed the food already, try to get some of those mid-cycle tests as soon as possible! The 2 units was based on how he presented at the vet, before you changed the food, right? If so, he may already need a reduction in dose to stay above 50 mg/dL.
Just to be prepared, do you have Karo syrup? Or some leftover high carb canned food? (Kibble takes too long to bring up the glucose should he drop low.) Here are the instructions for How To Handle A Hypo.


When you have a moment, could you add a few tidbits to your signature? It will help us give you feedback.

Editing your Signature

In the upper right corner of the screen, within the dark blue bar, you will see ID, Inbox, and Alerts

Click on your ID.

On the left, under Settings, Click on Signature.
This is where you will put information that helps us give you feedback. You are limited to 2 hard returns, so separate pieces by | or -.
This is where you paste the link for your spreadsheet, once it is set up.
Add any other text, such as your name | cat's name | date of Dx (diagnosis) | insulin | meter general location (city and state/province) any other pertinent issues like if there are any food issues, history of DKA, hepatic lipidosis, pancreatitis, allergies, IBD, etc.

Click the Save Changes button at the bottom.

Always click the Save Changes button at the bottom when you have changed anything.
Also, we changed the food around 3 weeks ago. When we first brought him in to vets (pre-diet change), his BG was 471 using cat glucometer. So it's down a lot (200 points, more or less) just by the food switch. First 2 units of insulin ever were given to him this morning. We have not tested him since then. I gotta read up on the other things you suggested now. Thanks for the support!
 
Hi Korynn, glad you made over here! What was Desi's BG reading at the vet this AM, before his shot? If you can, try to get a test in this afternoon as well as the PM preshot test. You want to know how low the 2 units are taking him, and if he's rising or still falling at PM shot time. If you can set up the SS, that would be great, if you need help, just ask and someone will do it for you.
 
OK. Geesh, this is a lot to learn! I just tried to figure out how to place info in my signature line...did it work?
Also, I think I made the SS but I have no idea how to use it! Just write the date in the first box and fill in things?
Should I test him before feeding him?
We don't want to just feed him twice a day like the vet (tech) reommended - he's used to eating small amounts throughout the day (one of us is usually home) and it's better for his body to eat that way, isn't it?
I wish the vet had been more in sync with what I have read on here.
 
Oh yes, the BG reading: On our Relion it was 267. It was the vet's - I'm sure he was freaked. His pupils were dilated. He hates that place.
 
Agree with everyone. If you can get a number now we can advise you better. We generally use 200 as a no shot number for new diabetics. And yes, 2 units could be too much. We like to start with 1 unit and increase slowly
 
Is there a link to a tutorial on how to fill out the spreadsheet? I tried to look on someone's else's to figure it out but it wasn't extremely helpful. I made the spreadsheet (see signature link - which I also just figured out) but I don't know how to use it!
 
Yes I see your SS. To fill it out AMPS (&PMPS) are the numbers you get before you feed and give the shot. You should always get these. Then units, and +1,+2 etc are 1 hour after the shot, 2 hours after... As for feeding, feed after the test and before insulin and anytime during the day, just not for two hour prior to his insulin shot. Does that make sense?:confused:
 
Yes I see your SS. To fill it out AMPS (&PMPS) are the numbers you get before you feed and give the shot. You should always get these. Then units, and +1,+2 etc are 1 hour after the shot, 2 hours after... As for feeding, feed after the test and before insulin and anytime during the day, just not for two hour prior to his insulin shot. Does that make sense?:confused:
Yes, it does.
Can you tell me what AMPS and PMPS stand for? (I get the AM/PM bit...) Just to clarify...don't do exactly what just for two hours prior to his insulin shot at night? Test him? Or feed him? (Sorry if I'm confusing you but I'm not sure what you meant by the last part of your directions.)
So I should test at least twice a day, right? In the morning, before feeding him, and at night, before feeding him. Not the once a day like the vet suggested (in the middle of the day).
I'm hesitant to change the 2 unit dosage he suggested but I'm very happy to test Desi more frequently and chart that. It only makes sense to me.
Thanks again, Sharon! You are extremely helpful!!!
 
Don't feed for the two hours before the Preshot tests. So if you are giving him his shot at 6 PM, you can feed him up to 4 PM, then take away the food (@4) so that when you test at 6 there's no food to influence his glucose number. For tests during the rest of the day, it's ok for him to eat. Only at the preshot times do you need to remove the food. Have you gotten a test in since his shot this AM?
 
Don't feed for the two hours before the Preshot tests. So if you are giving him his shot at 6 PM, you can feed him up to 4 PM, then take away the food (@4) so that when you test at 6 there's no food to influence his glucose number. For tests during the rest of the day, it's ok for him to eat. Only at the preshot times do you need to remove the food. Have you gotten a test in since his shot this AM?
No. His shot was about 4 hours ago. Do you recommend we do it now?
 
Wouldn't hurt to test now. Then if you could get another one @+6 or 7 that will tell us how he's reacting to the ProZinc, and give you some data for your new SS!
 
Hi Korynn! 2 units is a fairly high starting number. I'd be interested to see what numbers you get mid cycle today. It may be that 1 unit was a better starting dose. But some mid cycle numbers will help us see what he does on this dose!
 
I just took a reading and it was 292 - higher than his AMPS level! I'll take another reading this evening, maybe at +7 or so. Seems like it should be lower to me but I have NO idea! Maybe it takes awhile to kick in? It was his first dose of it ever. Also, we feeding him is usual small meals during the day - that's what he is used to, and from what I read, it's better for him vs two large meals.
 
Food often causes a spike. Plus, with the +/- 20% meters may read, that test could be as low as 0.8 * 292 = 234, so actually, it could be similar to the pre-shot test. Be sure to record it in the spreadsheet.

And, while you work to get a handle on blood testing, check my signature link Secondary Monitoring Tools for some other observations to help you evaluate how your cat is doing.
 
Good you got that test in and yes, try to get one @+7 or so. By testing frequently when possible, you will see when the insulin begins to work(onset) and when it reaches it's peak(nadir) and how long it lasts. What are you feeding Desi, still the purina DM, canned?
 
Good you got that test in and yes, try to get one @+7 or so. By testing frequently when possible, you will see when the insulin begins to work(onset) and when it reaches it's peak(nadir) and how long it lasts. What are you feeding Desi, still the purina DM, canned?
Yes, the DM canned and also some Sheba stuff that looked like it fit the bill. Sheba Perfect Portions.
 
Hi, Korynn - Welcome to the "Clan of the Sugar Cats.":)
Agree with everyone. If you can get a number now we can advise you better. We generally use 200 as a no shot number for new diabetics. And yes, 2 units could be too much. We like to start with 1 unit and increase slowly
Ditto; I totally agree! And noting your comment above re: Desi's reaction to being at the vet's office:
It was the vet's - I'm sure he was freaked. His pupils were dilated. He hates that place.
It's really quite stunning how much a cat's BG level an rise from a stress reaction; my cat reacts so horribly to being @ the vet's office that she has a red warning sticker which reads "Fractious Cat" all over her records! (It's almost embarrassing...:rolleyes:) AND her BG# skyrockets every time she has to go in for a visit.

I'm so happy to see that you got that first at-home BG test under your belt - that's so important to help you keep Desi safe, as insulin is a very potent hormone. That pre-shot BG test, before every injection, is extremely valuable: Without it, you're essentially "shooting in the dark."

Starting lower with the ProZinc (as Sue mentioned, we like to start with just 1 unit) gives you a better margin of safety at the beginning - as you can always increase the dose later based on what your at-home BG testing is telling you. "Start lower, go slowly" is a very sensible course of action.
And as you've already switched to low-carb food (you smart girl!), you're ahead of the game there.;) (Which canned food is Desi eating; how much per day? And what's his weight: Underweight, overweight, just-right?) Getting the amount of his total daily rations in line with his optimum weight goal can be a key to good glucose regulation, as the amount of food can either work with or against the insulin. So it helps to look at his food almost as though it's "medicine," too.

About your Relion Confirm meter, I hope this helps reassure you: I recently switched over to the Relion Confirm myself, from an AlphaTrak2 meter (the one often recommended by vets) - and we're doing just fine using the Relion for Bat-Bat - it's just a different BG reference range is all (and most people here at FDMB use human glucometers, so you're in good company). Either type meter (human or pet-calibrated) works just fine for keeping good track of your kitty's BG levels. So please don't let the tech person at your vet's office spook you about that! (Just in case you're wondering: I love my AT2 meter; had been using it since 2013. But a downturn in my health has spiked my own medical expenses sharply; in short, something had to give: Couldn't afford the AT2 strips at this point, not @ $59 for a vial of 50. The pricing is pretty outrageous.:()

Will be looking forward to seeing those BG #s accumulate on your new SS. Again, welcome to FDMB! - Robin
 
Good you got that test in and yes, try to get one @+7 or so. By testing frequently when possible, you will see when the insulin begins to work(onset) and when it reaches it's peak(nadir) and how long it lasts. What are you feeding Desi, still the purina DM, canned?
Yes, the DM and some Sheba Perfect Portions.
 
Saw this post from last year (8.3.15) by another member, which read:
We started feeding out cats the sheba perfect portions a few weeks ago and noticed that our diabetic cat has gained weight. While our cats love Sheba we are switching them back to fancy feast because there is nothing concrete about the breakdown and it seems to change with the different sites I look at.

While the Purina DM canned is 3% carbs (I used to use that exclusively), some of the Fancy Feast Classic pates are just as low (and far less expensive than the prescription DM). You are using the original formula DM canned, I hope, rather than the DM Savory Selects? As the latter is much higher in carbs than the original formula.

Nowadays I use FF turkey/giblets and also FF Savory Salmon pate (supposed to be 1% carbs, but I think it may be closer to 3% in reality). I limit the amount of salmon she gets per week, though, because of the mercury that fish-based foods contain. (It's not recommended to feed more than the equivalent of a 5.5 oz can of fishy cat food weekly).

Here's a handy link to a chart that helps in assessing your kitty's optimum weight:
http://www.wsava.org/sites/default/files/Body condition score chart cats.pdf

Hope some of this info is useful to you.:)
 
Korynn just looked at your SS and saw your PMPS. Did you give Desi insulin? If so how much?
Sharon, we just are waking up out here...but please do look at his SS when you have the chance.
I tested him twice last night (one reading was 128 and the other 129) because I was doubting it and then twice just now (50 and 59!). And now we are letting him eat and he's hungry and gobbling. I even just tested myself on the Relion, because the numbers are so low and he's not had insulin since the vet's office yesterday morning. What do you make of this?
 
Korynn just looked at your SS and saw your PMPS. Did you give Desi insulin? If so how much?
Oh, to answer your question more directly, no, I did not give insulin. Nor have I just now after the AMPS check. I keep thinking, what if we had followed the vet's advice and given Desi 2 units morning and night? Egads.
 
I'm thinking that
1) the dose was too high for him and/or
2) he may be one of those who can get off insulin quickly.

No shot if under 200 mg/dL!


If he gets up over 200 mg/dL, I wouldn't give more than 0.5 units max.
He dropped 139 mg/dL from 267-128 over 12 hours. Normally, the insulin starts wearing off around +5 to +7 hours post shot. When the dose is too high, the cat continues dropping after the low point or nadir in the +5 to +7 hour period.
 
Korynn, you did great this morning! Wow, what a low AMPS - this is a very good sign that he could be OTJ quickly, as BJ mentioned above!:D
 
So glad you didn't give Desi insulin! When I saw last nights PMPS I was worried. Like BJ said no insulin if Desi is under 200 at PS time. Get a couple tests in today and see how he's doing. Fingers and paws crossed that he will not need insulin for long!
 
Hi everyone: My husband was remarking about what people did before such a forum was viable - just try to figure things out in isolation; how frightening! I was concerned about the drop last night, too - and this morning surprised me even more. I ran out and bought more test strips and will test him in about half an hour (3 hours from the AMPS (although there was no S because of his low numbers). He ate a good breakfast and is now just sleeping (his usual this time of day). I had read about "OTJ" in some other post on another forum - it made me laugh once I figured it out. Thanks again for all your ongoing support. It makes this journey so much easier.
 
So very glad you did not listen to vet! BJM gave you some really good advice above.
I agree. What if I'd given him the 2 units last night...and then again this morning? (Or would he have even made it through the night?!) What was the vet thinking? I don't understand it at all. I think I will switch vets, though. (Maybe he's better with dogs?)
 
I agree. What if I'd given him the 2 units last night...and then again this morning? (Or would he have even made it through the night?!) What was the vet thinking? I don't understand it at all. I think I will switch vets, though. (Maybe he's better with dogs?)
It's sad but a lot of the vets just don't have enough experience with FD as they only get the equivalent to one day's instruction in school on the subject. Also, unfortunately a lot of people will euthanize their animal when they get DX because they just don't want to deal with it and be confined. So sad, right?

My vet didn't want to teach me how to test , he said: "Once he gets regulated, I will show you" I went over him and made an appointment with the vet tech and had her show how. Korynn, if I would have listened to my vet, I could have sent Bubba into serious hypo events several times! A medical doctor would NEVER tell a parent to shoot insulin to their child without testing first and knowing that it was warranted. And these kitties are our children. :) So very happy you found us and keep asking questions as that is how we all learn. And then we pay it forward.
 
What was the vet thinking? I don't understand it at all.
I know - it seems crazy that there are quite a few vets around who aren't well-versed in best practices for the treatment of feline diabetes. @BJM has a great list of vet interview questions attached to her signature; you might find those helpful as you look for a different vet.
 
I have always loved cats, but Desi is extra special because he was my mom's and I "inherited" him 7 years ago after my mom unexpectedly and suddenly died. I think he reminds all of us (Mark and our sons) of my mom because she loved him so. He's a good boy.
that's so sweet - we are all pulling for him - I have to ask - was he named after Desi and Lucy?
 
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