Advice for bouncing BGs

[Amanda and Button]

Hi all,

I posted a previous thread on the introductions page with some of my cat’s history. Button has been diabetic since 2012, honeymoon from 2013 – Aug. 2016. We are back on PZI and after taking care of a tapeworm which may have been affecting her ability to absorb insulin I am trying to find the right dosage for her. She is underweight (an issue we have been making some progress on) and very tiny, thus a little insulin goes a long way. My vet thinks she is burning through the insulin we give her because her metabolism is so high, and so the insulin does not last the full day. We have been seeing nadirs near 100 during the day and preshot values above 300. We recently reduced her dosage to try to counter the bouncing she has been experiencing. She is also in the early stages of CKD and we are administering fluids and Azodyl for this, but it is possible some of her symptoms could be related to kidney failure as I have seen a lot of parallels there.

Below are some of the ideas I am researching and talking to my vet about. If anyone has had a similar experience and can assist in pointing us in the right direction, please reply to this post.

- A few days ago I switched to an 11/13 shot schedule to try to see if this helps with her PMPS since this one is typically higher than her AMPS. The insulin seems to last longer for her at night. I’m not sure this is going to work as she has had GI issues since the change, but it might be too early to tell yet.
- I would like to see if anyone has recommendations for a decreased dosage when she has preshot values lower than 200. I know the typical recommendation is to not shoot, and I would never give her a new insulin dosage without checking her in the middle of the day, but the high numbers have such an immediate effect on her digestion and therefore her appetite and mood that I don’t like going without any insulin unless she is very close to 100. I have read that some people have had success giving PZI on a sliding scale as opposed to the same amount every time. This might help when we get numbers above 350 as well and I am curious to try this but my vet is not familiar with this technique. I have u-100 needles with half marks indicated so I can adjust as small as 0.1u.
- I have discussed the possibility of switching to Lantus with my vet. Perhaps her body will react differently to Lantus and take more time to absorb it. If anyone reading this has gone from PZI to Lantus, why did you decide to do so? Was it successful?
- Another option I discussed with my vet was giving additional short acting insulin shots two hours before her PZI shot to give her a boost before her next shot. If anyone has tried this, let me know.

Thank you for listening and for any advice you can give.
Amanda and Button

 

[Critter Mom]

Hi Amanda and little Button,

I'm not familiar with PZI but I'm tagging member @Sue and Oliver (GA) to see if she can help you.

Re the CKD side of things, just in case you've not yet visited here's a link to Tanya's Site where there's a wealth of information to be found about how to help kitties with renal issues. There are also some members here with experience of managing both diabetes and CKD in their kitties and who may be able to assist you. Just let us know anything you'd like help or advice with.


Mogs


For members reading this thread looking for additional background information, here's a link to Button's introductory thread on the Welcome board:

http://www.felinediabetes.com/FDMB/threads/meet-button.169333/

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[Kris & Teasel]

I would like to see if anyone has recommendations for a decreased dosage when she has preshot values lower than 200.

Another technique is to stall 20 minutes without food and retest. I've often stalled up to an hour in 20 min increments. You want to be sure BG is rising unaffected by any food. Once you're at or near your lowest "shoot" number, give a slightly reduced dose. How much to reduce is tricky. You need to have tried it a few times to see how much of a reduction your kitty is good with. Maybe try 0.5 u to start?

I have read that some people have had success giving PZI on a sliding scale

Many people use a sliding scale. Have a look at some spreadsheets on the ProZinc forum. I don't with my guy because he's near impossible to predict so I keep it as simple as I can. Most vets aren't going to suggest this because they're likely not experienced with it and they don't want their FD clients being overburdened with decision making.

giving additional short acting insulin shots two hours before her PZI shot

This is a very high level technique that I, personally, would be reluctant to use. My opinion is that it could so easily go wrong with more than one nadir to track, etc.

 

[Kris & Teasel]

Button is cute little girl. I had a tiny kitty years ago who was never more than 5 or 6 pounds in her prime. She was almost 22 when she was PTS.

 

[Amanda and Button]

Hi Amanda and little Button,

I'm not familiar with PZI but I'm tagging member @Sue and Oliver (GA) to see if she can help you.

Re the CKD side of things, just in case you've not yet visited here's a link to Tanya's Site where there's a wealth of information to be found about how to help kitties with renal issues. There are also some members here with experience of managing both diabetes and CKD in their kitties and who may be able to assist you. Just let us know anything you'd like help or advice with.


Mogs


For members reading this thread looking for additional background information, here's a link to Button's introductory thread on the Welcome board:

http://www.felinediabetes.com/FDMB/threads/meet-button.169333/

.

Thank you! I did recently find Tanya's site and have been perusing it in small chunks whenever I get the chance. There is so much on there and much of it seems to relate to what Button is dealing with, but I was a little overwhelmed thinking about what to try and how it will effect Button's diabetes. I will be posting in the future with specific questions I am sure. I am also going to take Button in soon for another blood test.

 

[Amanda and Button]

Another technique is to stall 20 minutes without food and retest. I've often stalled up to an hour in 20 min increments. You want to be sure BG is rising unaffected by any food. Once you're at or near your lowest "shoot" number, give a slightly reduced dose. How much to reduce is tricky. You need to have tried it a few times to see how much of a reduction your kitty is good with. Maybe try 0.5 u to start?


Many people use a sliding scale. Have a look at some spreadsheets on the ProZinc forum. I don't with my guy because he's near impossible to predict so I keep it as simple as I can. Most vets aren't going to suggest this because they're likely not experienced with it and they don't want their FD clients being overburdened with decision making.


This is a very high level technique that I, personally, would be reluctant to use. My opinion is that it could so easily go wrong with more than one nadir to track, etc.

Stalling is a tactic I have had success with in the past, though sometimes I am not able to because of my work schedule. My partner can sometimes come check her in the middle of the day when I can't be there though.

I will sift through some spreadsheets to see if I can find anything. If anyone reading this has a small FD kitty, please reply to this post. I am reluctant to base my adjustments off of most spreadsheets since Button is so much smaller than most diabetic kitties.

Thank you for the feedback on the short acting insulin. It is my least favorite option as I have concerns about it dropping her too low too quickly, and tracking more than one nadir wasn't something I had even thought of yet, but definitely increases the amount of checking her BG.

 

[Critter Mom]

Hi Amanda,

If anyone reading this has a small FD kitty, please reply to this post. I am reluctant to base my adjustments off of most spreadsheets since Button is so much smaller than most diabetic kitties.

If you post a separate thread about this subject on Feline Health and set the question mark prefix next to the thread title more members will see that you need help on this and hopefully share experiences that will help you and little Button.


Mogs
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[Amanda and Button]

I will look for the question mark prefix and update my thread on the Feline Health board. Thank you!