? 15yo Cat, Regulation, Home Testing - Not Sure Where to Go from Here

[Danny MacDonald]

My 15 year old female cat was diagnosed with diabetes in November of 2017. She went in to get a growth on her back checked out, as well as some mild mouth sores, when the diabetes was discovered. The vet tested a level of 380 and put her on 2 units twice daily of ProZinc, along with prescription diabetic food.

Until Christmas, she seemed to be doing fine. She had a vet checkup between diagnosis and the holidays of 91. At Christmas, we unfortunately had to board her at the vet for 4 days. Since then, she has had a very rough time becoming regulated. I started home testing with a Relion Micro and the readings seem to bounce up and down so much. Yesterday I tested her 4 times and the vet tested once. I had a +5 hours from first shot of 71, a +7 of 81, the vet tested her at 186, a test right before her second dose of the day at 279 and then a final test of 199 at 4 hours after the second shot. The vet was going to increase her dose to 3 units, but the number of 186 made him go back on that.

Today I've tested her twice. Once before her first shot, before eating, and got 450. And just now, 3 hours after her second shot, and got 494.

I don't know what to do with these numbers. Is the Micro not reliable? I don't know how she could go from below renal threshold yesterday to so high today. I'm not sure what to trust - the vet or the meter.

Another note: the vet did get her an antibiotic because he thought she might have a urinary tract infection. She has had a problem since just before diagnosis of drinking a lot of water and urinating a lot. She still is, which could either be the UTI or that she is above renal threshold. I just don't know.

I'm not really sure what I'm even asking here. I just don't know how or why she can be "fine" one day and so high the next. It could be the meter, but she is still urinating huge puddles and drinking a lot of water. Otherwise she's acting fine. Obviously, my thought is that her kidneys are going bad and that's causing her stress, but the vet didn't want to go there yet. It's so bizarre to go from fine to not-fine in 12-18 hours. I'm supposed to go back in on Monday or Tuesday and I think I'm going to insist on a fructosamine curve so I'll know for sure if my meter is off.

Anyway, thanks for reading. If anyone has any advice or knowledge, I'd be grateful to listen. Thank you!

 

[Chris & China (GA)]

I don't know how she could go from below renal threshold yesterday to so high today.

It's called "bouncing".

Bounces happen when 1. they drop too low, 2. they drop too quickly, 3. they drop into numbers their body isn't used to anymore (or any combination of all 3)

The liver releases stored sugars and hormones to bring the blood glucose back up quickly to either 1. save their lives from being too low, 2. because the fast drop triggers the liver to think there's something wrong, 3. their body has become "used to" living in higher numbers, so even if they don't drop too much or too fast, the liver doesn't "recognize" those lower numbers as being OK anymore.

Bounces can take up to 6 cycles to clear.....but as you get her under better control, hopefully her body will re-learn that it's OK to be in those better numbers and not bounce so high and clear the bounces quicker.

 

[Sarah Smith]

Just wanted to throw my 2 cents in on the micro meter. I started with the micro when Cooter was diagnosed and really liked it. The sample is small which is great when you first start testing. I did wind up switching over to the relion prime just for cost reasons. The strips for the micro run $36 for 100 where the prime are $18 for 100. The prime is also less then $10 for the meter. I did notice between the 2 meters, my micro tends to read slightly higher then my prime, but it was never enough to worry about. So as far as reliability of your meter, I dont think thats an issue, the micro is a good one.
The difference in the numbers at the vet vs home could definately be caused by stress. The trip in the car and being at the vets office can lead to higher numbers on the vets tester.

 

[Chris & China (GA)]

The vet was going to increase her dose to 3 units, but the number of 186 made him go back on that.

Do not let your vet increase that much....Ever!! Insulin is a very powerful hormone and even small amounts can make big differences in numbers.

We only suggest increases in .25 to .5 unit increments until you're really close to a "perfect" dose....and then you may only make changes of a drop or two!!

Since you're using ProZinc, you should either get U40 syringes that have half unit markings or you can use U100 syringes with a conversion chart

 

[Danny MacDonald]

Thank you both for the responses. It did help calm me down a bit and I greatly appreciate it.

Bounces can take up to 6 cycles to clear.....but as you get her under better control, hopefully her body will re-learn that it's OK to be in those better numbers and not bounce so high and clear the bounces quicker.

How long is a "cycle" ? Is a cycle every section of 2 shots? So, 3 days of 2 shots a day? Or is a cycle longer than that (or shorter I suppose)?

Sarah, thank you for the reassurance with the Micro. I like how easy it is to use. It sure sends back some high numbers though!

The difference in the numbers at the vet vs home could definately be caused by stress. The trip in the car and being at the vets office can lead to higher numbers on the vets tester.

I expected the numbers to be different. We went from 71 pre-vet to 186 at the vet. Later that night, once she was back home for a few hours, the Micro read even higher than the vet (276, the 199). The next day her numbers from the Micro were back in the upper 400s. I guess I didn't expect the "bounce" to last that long once she was back home.

Thank you both again for the quick replies. I (and my grouchy cat) really appreciate it.

Edit:

Do not let your vet increase that much....Ever!! Insulin is a very powerful hormone and even small amounts can make big differences in numbers.

I very much like my vet. He was very hesitant to increase the dosage at all and we were both glad to see the low numbers being read so we didn't have to increase it at all. Of course then I got home and the numbers shot way back up. I will keep this in mind. I'm not one to suddenly increase a dosage on my own, that's for sure!

 

[Sarah Smith]

A cycle is one 12 hour period. If you give insulin at say 6am, that cycle is until 6pm when you give the next dose. Sorry if you've said before, but what kind of food is your kitty on? Dry food can cause high numbers like you are seeing as well. Cooter was (and still is!) a kibble addict, and it was frustrating to no end the numbers he would throw at me because he had gotten into the dry food!

 

[Danny MacDonald]

She is on the Royal Canin Glycobalance prescription food. It is dry food. I've tried throughout the years I've had her to switch her to wet at various times, but she is obnoxiously picky. May be time to try again. She went right to the Glycobalance. An issue at first was that I have two other cats, so we have two different foods going on now, and making sure the cats only eat "their" food was initially a challenge, but that's taken care of now.

I just tested her again with the Micro. She had her shot at 6am, so this is five hours later and the meter gave me a 379. She went to the vet at 4pm on Friday, so it has been 4 "cycles" since that time. It does seem to be trending downward, just slowly.

Attached is my relatively crude spreadsheet from the last few days of her readings, including from the vet. She gets her shot at 6am and 6pm, for reference.

 

[Danny MacDonald]

It seems the "bounce" was exactly right, as she has returned to "normal" levels after the 7th dose post-vet. She was 209 before her 6pm shot, and 95 now at 10pm (4 hours post shot). That's more in line with where she was before Christmas. Now to just keep her out of the vet!

A question though about hypoglycemia. The vet said if she was going to go hypoglycemic, the most likely time would be within an hour or the shot. Has anyone heard this before? I tried to find an answer or more info on it, but haven't turned up anything. She's doing fine so I'm not worried or anything, but I'm definitely getting on a stricter schedule of testing her before food+shot, just in case.

Thanks again for the help. I really appreciate everything.

 

[Sarah Smith]

Your on Prozinc, it does not really start kicking in until 2hrs after the dose. The lowest point us usually between 5-7 hours after the shot. I've not had either of my prozinc kitties drop much, if at all in the first hour, they usually come up a bit from feeding them at shot time. I usually saw the big drops on Cooter around+3 or +4, Mary didnt have any big drops in her short time on insulin.

 

[Sarah Smith]

Also Danny I invite you to come over to the Prozinc forum, alot of good info and knowledgeable folks that know the ins and outs of Prozinc. Heres some info about the insulin from one of the stickies over there
http://www.felinediabetes.com/FDMB/...prozinc-pzi-insulin-for-diabetic-cats.164995/

 

[Kris & Teasel]

Yes, please go to the ProZinc forum to get insulin specific help. The way we figure things out here is to ask members to follow a structured blood glucose testing routine and log the numbers in a specific style of spread sheet. We can go into more detail over there.

The vet said if she was going to go hypoglycemic, the most likely time would be within an hour or the shot. Has anyone heard this before?

It could happen if her BG was too low at the time of the insulin dose but otherwise it's more likely to happen when she hits nadir (the peak action time of the insulin, hence lowest BG), generally 5 to 7 hours after the shot for ProZinc.