Dosing advice

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Kathryn Cavanaugh-Dias

Kathryn Cavanaugh-Dias

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We finally put our kitty on insulin. She has trace amounts of ketones so it was time, especially after our little visit to the emergency vet due to her UTI the other day. So we got her Prozinc. But here's my dilemma: her glucose has ranged from the lowest we've seen at 171, to the highest being 389. The vet wants us to start out with 2 units every 12 hours. But isn't that much? I was thinking maybe to start off with 1 unit every 12 hours. We got the insulin a couple days ago but we are waiting to start tomorrow so we will be home all day to monitor and test her blood. What would you recommend for dosage? She weighs 11-12 pounds, it varies with every scale we have used.
 
Hi and welcome! I don't give dosing advice, I leave that up to @Sue and Oliver (GA)
@Rachel or @Robin&BB I'm sure one of them will be along to help you soon. In the meantime, can you tell us what you are feeding, is she on antibiotics or any other meds and what meter are you using? Sarah mentioned setting up a spreadsheet. If you can do that, it will help you, your vet and us to see what's going on with your kitty.
 
I think starting with one unit twice daily is a good idea. My thinking is that you can always raise the dose, but if the dose is too high, you have to deal with the consequences of perhaps getting a number that is too low. It is great you will be testing. You'll be able to keep her safe. And I definitely would get the ketone strips and get that testing in also.

Our protocol is here:

http://www.felinediabetes.com/FDMB/threads/protocol-for-prozinc-pzi.109077/

In general, we suggest new diabetics not get a shot under 200. A cat is generally considered regulated if they are in the mid 20os at preshot and in low 100s or double digits midcycle (but not below 50 on a human meter or 68 on a pet meter). So those are the first ranges to aim for.

What food is she eating?
 
Sue and Oliver (GA) said:
I think starting with one unit twice daily is a good idea.
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Rachel said:
I agree that one unit twice a day would be best. I think that is a safer dose than 2 units and, as Sue said, we can raise if needed over time.
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I agree with Sue and Rachel 100%!
Sharon14 said:
In the meantime, can you tell us what you are feeding, is she on antibiotics or any other meds and what meter are you using?
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Also will be helpful if you tell us how much food (ounces) she gets daily and when you're feeding her, too. I'm so glad you'll be monitoring:) BG#s - so very important! Sounds like you'll be off to a great start, Kathryn.

And welcome!!!:D
 
Thanks everyone! She is currently eating EVO Chicken and Turkey. She gets fed 1/4 of a 5.5oz can and 1/16 of EVO dry food twice a day. We are really trying to get her weight down. And she is also currently on 1ML of Clavomox liquid since Wednesday night, twice a day. And we are using ReliOn human meter.
 
2 more questions, should we give her insulin about 30 minutes after she eats, right before she eats, or while she is eating? She eats everything in one sitting. And with the Ketone strips... do we catch her while she is peeing or how do we exactly go about using those? Because I am going to get some tomorrow.
 
Walmart carries the ketone strips in the diabetic area if you have one near you. They are about $7 for a bottle of 50(?). The relion type are about 4" long and I have been able to get them under Cooter while he's going,but if that is not an option for your girl there are alot of tricks to try... a container to catch a sample, or plastic wrap in the box.... With the prozinc it is safe to test, feed then shoot, no need to wait a half hour, just make sure she is really eating before giving her dose. Nadir (the low point) on Prozinc is usually between +5 - +7, but some cats hit it early, and some later. Welcome to the group :)
 
Generally speaking, you test, feed, then shoot all in about 15 minutes. You can give the insulin while she is eating if you know she is going to get her food in. Some cats are easier to shoot then since they are distracted by food. You always want to test first so that if she is too low (under 200) you can stall WITHOUT FEEDING for about 20 minutes and see if she rises on her own.

Ketones...whatever works for you. Some swoop in while the kitty is peeing (that's how I tested Gypsy). Some use a long handled spoon to catch the urine from further away. It depends on what works for you and kitty. Some folks have used a litter box with aquarium gravel or plastic beads or something so the urine doesn't get absorbed.

Peak time (what we call nadir or mid cycle) is anywhere from 5 to 7 hours after the shot. It can be earlier or later but that's usually when it hits. You find your cats just through testing. When you can test mid cycle, grab one and then the next day, maybe grab one an hour earlier or later to see if it's lower. You'll figure it out over time.
 
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Hi, Katelyn and Ember! Just wanted you to know who I am here. It's Lisa. You are in excellent hands here. The people here are wonderful and their wealth of knowledge about feline problems is infinite. You can definitely trust their advice. I can say with confidence that they saved Ben's life. But feel free to call me anytime with questions too. Good luck today! You got this.

For the rest...Katelyn and her wife adopted Ember from the rescue group I work with. They were an answer to my prayers for Ember. I told her about this group and knew that you all would be here for her. I can be the "boots on the ground" physical resource for them since we currently live in the same town. But I told her to come here for advice and support.
 
Just want to let you guys know, we have been testing her blood today every 2 hours and gave her 1 unit this morning at 7AM. We did a test about 15 minutes ago and right before we tested, she vomited. It has no food in it, it was yellow foam. And not quite positive if it was her since we have 3 cats, but she might have had diarrhea about 2 hours ago. Any advice? And her blood sugar was 347.
 
So what kind of numbers did you get? Post like this

Amps (morning number before insulin and food). Number and dose
+2. Number
+4. Number
+6.
+8
Etc.
Pmps evening number before insulin and food
 
So the insulin is working and does drop her. She has room to drop further, but I would give this dose a few more cycles. Her body has to learn to work with the insulin. Maybe after 3-5 cycles, you could increase by 0.25 if she doesn't settle in and drop a little lower.

Also, if you can dump the dry, that might help. (You can free feed wet food - either use a feeder with an ice pack or freeze the food and leave it out to thaw.)

Nice job getting the curve!
 
Good job, Kathryn! I knew you'd be amazing sugar cat Moms. You are already doing a better job than I did in the beginning. Keep up the good work.
 
Thanks everyone so much. I was a nervous wreck. I've shed some tears over her. There's just something about her. But, her pmps was: 407- and 1 unit. Which is the highest she's ever been since we've had her. So that is a little concerning. She also got her 1ML of Clavamox at dinner time as well. But we just tested her so her +2 was: 313. So it is going back down. I was curious for a snack could I give her a piece of shrimp? She's so spoiled already, but she was a trooper today with getting her ears pricked all day long. It's already cooked frozen shrimp, but of course I would thaw it and take the tail off. Thoughts?
 
I think the shrimp should be fine - as long as there are no spices or seasonings.

If she continues to run high, then you could increase by a little.in a cycle or two. Now that you can test regularly, you can stay on top of her numbers.
 
Kathryn Cavanaugh-Dias said:
Thanks everyone so much. I was a nervous wreck. I've shed some tears over her. There's just something about her. But, her pmps was: 407- and 1 unit. Which is the highest she's ever been since we've had her. So that is a little concerning.
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Don't get too worried about a single high number. It's easy to get too focused on one response and not see the overall trend. You and Ember just starting out. Give it time to work.

When Ben was first started on insulin his sugar in the office was 300. But at home, he would sometimes bounce over 500 until his body learned to respond to the insulin without over reacting. Sometime I'll have to show you Ben's early spreadsheet pages.

She dropped by a 100 with the insulin and her system might not used to that. So it over reacted by releasing extra sugar. She'll get the hang of it. Until then just buckle up and hang on. We'll be here to ride the sugar cat rollercoaster with you.
 
Likameow said:
Don't get too worried about a single high number. It's easy to get too focused on one response and not see the overall trend. You and Ember just starting out. Give it time to work.
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One other thought, Kathryn - after Bat-Bat was finished with a course of Clavamox her #s started coming down; so being on the antibiotic can factor into the higher #s you're seeing from Ember right now, too. (Was she put on it for a urinary tract infection, btw?)
 
Your doing great Kathryn, Ember is lucky to have found you :) She will get to those lower numbers, but sometimes they seem to go higher first. i thought we were doing great with with Cooter his first week on the Prozinc, finally seeing some yellow and pink numbers, and then we had a PM cycle where i had 4 readings in a row over 600 (meter just says HI at that point). Her body is figuring out what to do with the insulin, and it will get better at using it :) The infection isnt helping with the numbers either, they should come down a bit once it clears up! :bighug::bighug:
 
Dropping the dry food may reduce her glucose by 100-200 mg/dL and reduce her required insulin dose by 1-2 units.
 
The Clavamox can cause diarrhea. Elektra is on it too right now, and she had some last week. She also threw up just a little bit one night. I think the antibiotics can cause a bit of upset stomach, just like they do for us. I wouldn't worry about it too much unless she is throwing up a lot or having a ton of diarrhea.
 
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Hi and welcome to Prozinc (sorry if I am a little late here) My cat is also on a mix of dry and wet - a word about Evo - it has a ton of calories in it - 600 per cup so keep that in mind Some people have great luck with it, but it does seem to affect Murphy's sugar somewhat. I think the best dry is Young Again Zero Carbs - there is also a semi moist one (which has a lot more moisture in it than regular dry) and no starches - low carb - it's called Waggers www.waggers.com Young Again is also very high in calories - Waggers less so and there's another no starch dry called Epigen 90 from Wysong which is also lower in calories than Evo and young Again . But everyone will tell you that if possible, it is best to stick with all low carb wet. Murphy has been on Prozinc since August and it has been a wild ride - it definitely takes their body's some time to get used to the exogenous insulin and their requirements aren't static. So have patience - it is a marathon to get your kitty regulated but the ketones do add another layer of urgency to it. The UTI isn't helping - hopefully that will be cured soon
 
Hey guys, I made my spreadsheet public. Her numbers at her feeding times have been the highest they've ever been since we've had her, and it seems her nadir is at the +3 - +5 area. So I feel as though it is wearing off rather quickly. But I am learning to have patience. Would you suggest we complete 7 days on the 1 unit and then maybe start trying 1.25 units starting Sunday? Also, what is a good website to purchase syringes and insulin instead of my vet? Or is it best to purchase insulin at my vet and the syringes online?
 
Good job on testing and the spreadsheet. I think I would up the dose by 0.25 and even 0.50, on a cycle when you can monitor.

I also think I'd try to get rid of the dry and see if the numbers improve. (I wouldn't do both the increase and diet change at the same time. You want to do it carefully)

You can buy U40 syringes on AWD online and other websites. You might look at buying U100 syringes instead and use the conversion chart (because you are using U40 insulin with U100 syringes). U100 syringes can be bought at your local drugstore because they are on the same ones human diabetics use; they are cheaper. ProZinc can be bought online, but you need a vet's prescription. Sometimes it is cheaper but be sure to check out the shipping costs.
 
CarePoint makes U-40 syringes with half unit markings - makes dosing by 0.25 or .5 increments alot easier if you want to stick with U-40s. You can get them at ADW website as well
 
Kathryn I dont know what your vets charging for the prozinc, but mine was about $100 for the vial at the vet. Cheapest I found it online was about $95 plus cold shipping cost so it was a wash between them. As far as the syringes if you do decide to switch to the U100's, Walmart sells boxes of 100 for $13. They have half unit marks on them for easier dosing
 
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Kathryn Cavanaugh-Dias said:
Also, what is a good website to purchase syringes and insulin instead of my vet? Or is it best to purchase insulin at my vet and the syringes online?
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I buy my syringes and testing supplies from American Diabetes Wholesale. But I've not found any place that the insulin is cheaper than at the vet here in GF. Most places add 30-40$ for cold shipping so it makes the price about the same. But if you do find somewhere cheaper, let me know. :-)
 
Hi Kathryn! Sounds like you are on the same boat as me! I am a newbie too and Micah was also prescribed 2 units of ProZinc 2x daily (who is telling vets to prescribe this initially?) and he was on 1mL of Clavomox for a bacterial infection on a broken tooth. It's good that you are starting with a lower dose than the 2 units like I did because Micah just went hypo :(. I am going to lower his dose to .5 units and move up slowly instead of being scared that he's going too drop to low and need emergency care, and checking his glucose levels every 30 minutes! Looks like there's lots of good advice on how to monitor and up the dosage safely for Ember :)
 
Maybe that is their "standard" starting dose in a textbook somewhere? My vet started Cooter on 2u as well, I just figured because 1u of vetsulin wasnt cutting it when I asked to swap him she went with 2... He went from over 600 to 94 in 4 hours, my first PJ party!
 
Sarah Smith said:
Maybe that is their "standard" starting dose in a textbook somewhere? My vet started Cooter on 2u as well, I just figured because 1u of vetsulin wasnt cutting it when I asked to swap him she went with 2... He went from over 600 to 94 in 4 hours, my first PJ party!
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Yep it's a good thing my home monitor came in the mail when it did instead of Friday like it was supposed to! What is "vetsulin?"
 
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