Prozinc, Fancy Feast and questions inbetween

L

lionessheart_90

New Member
Hello all,

My Kitty was just diagnosed about a month ago. We noticed increased thrist, decreased activity, lack of grooming, scruffy coat and just odd behavior (staring at the wall) and lo and behold he comes up positive for blood (530) and urine glucose at the vet. He had lost about 20% of his body weight in about 6 months and he has never been a fat cat, body condition was always at 3. (Was 14lbs about 6 months ago, now 10 lbs). We have been working and learning together on how best to manage this new "adventure" as I like to call it. My biggest concerns are: 1. Am I feeding his too much (2 cans twice a day) and 2. His numbers dropping so low the past few days (lowest has been 56 post insulin/food). I have a spread sheet since we first started everything though I've been a bit lacking on recording urination and defication recently. Any advice on his numbers/doses/feeding schedule or management would be greatly appreciated! I want to do the best thing for my boy. All his info is as noted below:

Started Prozinc on 08/01
Currently giving Prozinc (U-40 syringe) 3 units twice a day 07:30 and 1730 (is 17:30 too soon?? I read 12 hours today on a few of the threads)
Feeding twice a day with 1 can Royal Canin Glycobalance and 1 can of Fancy Feast (Slowly switching to Fancy Feast Low Carb, recently discovered how many carbs RC glyco has but don't want him to have a hypo event!).
Testing with Alpha Trak 2 Pre-feeding twice a day and as needed inbetween (when he exhibits odd/off behavior)
Fructosamine was 700 two weeks ago

The spreadsheet:
https://docs.google.com/spreadsheets/d/1QkpeYqlkyJlR7O1tDMmBZgqirv_Jp2dLZnHMAswhPx0/edit?usp=sharing
 
Hi there, and welcome!

Great job getting started on home testing! Having some data to look out is really helpful.

I'll try to get to each question, but if I miss something don't hesitate to ask again.

Food: I'm not sure how many calories are in a can, but if your cat has lost too much weight and is hungry, then keep feeding him. Especially at this point in his diabetes journey, you can really feed him as much as he wants. If he's telling you he's hungry, believe him. You may need to spread out the food so he doesn't just inhale a whole bunch and then puke, but it's okay to keep giving him snacks. The only time you don't want him to eat is the two hours right before each blood glucose (BG) test. The rest of the day and night he can eat. If he starts to get too much weight back on him, then you can start limiting his intake. I agree about holding off on fully changing food until you get some more data, especially given some of the numbers you're talking about.

Blood Glucose (BG): 56 is too low on an AlphaTrak. It's hypoglycemic. Based on the data on your spreadsheet, he's getting too much insulin right now. I'm guessing you got to 3u because the vet told you to do that. If you're willing to listen to folks on the internet you've never met, I would strongly recommend that you drop him down to 1u at his next shot. That may not be enough, but right now his dose is dangerous. It will be better to start over and do small, slow increases based on home data.

Fructosamine: remember that the scale for fructosamine is not the same as your home meter. It doesn't mean his BG was 700. although even on fructosamine, 700 is pretty high. This test gives you an average over time, so it's good for diagnosing, but not helpful for determining a proper dose.

Testing: You're doing a great job of getting tests in before each shot. However, to determine a safe dose, we need to see his BG at nadir. Nadir is the lowest point during the cycle. It's usually somewhere between +4 and +7 for cats using prozinc (+4 = four hours after the injection - since we are all in different time zones, we tell time by the hours since the shot - that way everyone can understand what's going on without having to figure out time zones, DST, etc.). If you could get a test or two in during that part of the cycle, it would be really helpful. If you're working all day, try to at least get a test in before bed so we can get a hint as to what's happening mid-cycle. You mentioned a 56, so I'm guessing you're doing some of this testing since I don't see that number on your spreadsheet.

Spreadsheet: It would be really helpful if you would put some of your data on this spreadsheet: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/ The color coding happens automatically when you input your numbers, so it's super easy. We keep this pretty standard around here so that we can quickly see what's going on if someone is in a crisis situation. You can click on the spreadsheet in my signature to see one filled out.

Schedule: Yes, the two shots should be 12 hours apart. If you give them less than that, the insulin may not have worn off enough to be safe, or may have worn off too long ago and left him in high numbers. 12 hours works best for most cats. There are occasionally exceptions, and sometimes work simply makes it impossible, but if you can, try to be as consistent as possible.

BG Meter: Most of us around here use a human meter instead of the AT2. There are a variety of reasons. The most important is that the protocols we follow are from a study that was done on cats using human meters, so it makes them easier to interpret if you're using the same type of measure. Second, it's waaaaaaaay cheaper to use a human meter. It's fine if you want to continue to use the AT2, but because of the amount of testing over time, many of us keep the AT2 for communicating with our vets, but use a human meter for day to day use. It's up to you what you prefer to do with that. We can work with the numbers either way as long as we know which meter you're using.

Okay, that's a lot all at once. Let us know what questions this raises. We are happy to help you figure out this new adventure!
 
Hi and welcome to ProZinc Land! (Although I’m sorry for you and your kitty that you had to join us.).

I would recommend that you take a look at the yellow stickies at the top of the ProZinc forum, especially the Beginners Guide and then the Protocol one. I found them extremely helpful a couple of months ago when we first started, just to get some bearings on the whole “adventure,” and hope that you do as well.
 
Welcome! Djamila has given you an excellent rundown on how to begin. Here's something I put together for new members. It might be helpful to you:
__________________________________________________________________________________________________________________

It would help us if you set up your signature (light grey text under a post). Here's how:
  • click on your name in the upper right corner of this page
  • click on "signature" in the men that drops down
  • type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using /glucose meter you're using/what he eats/any other meds or health issues he has.
Another thing that will help us help you now that you've started BG testing at home is to set up a spreadsheet like the one we use here. We can all see it and look at it before offering advice: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

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Here's the basic testing routine we recommend:
  1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
  2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
  3. do extra tests on days off to fill in the response picture
  4. if indicated by consistently high numbers on your spreadsheet, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
  5. post here for advice whenever you're confused or unsure of what to do.

This is useful: http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

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Here's an explanation of what we call "bouncing". It explains why a kitty's BG can go from low to sky high:
  1. BG goes low OR lower than usual OR drops too quickly.
  2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
  3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
  4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
  5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
  6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.
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Here are some tips on how to do urine ketone testing (VERY important if BG is high and kitty isn't eating well!):
  • put the end of the test strip right in his urine stream as he's peeing
  • slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
  • put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee.
Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light.
 
Welcome! The others have covered everything... just to reiterate a few points...
Please fill out one of the spreadsheets we use, you will see that it will be SO much easier to use. Patterns are important, and they are clearly seen with the color-coding on our spreadsheet. Shots should be give every 12 hours.
If you have scheduling issues on occasion, ProZinc allows up to an hour of 'play' time with the dosing; however, the dosing should not normally be out of whack by that much and definitely not by more than that. Consistency is very important. The starting dose is normally 1 unit twice a day. 3 units is a large dose, and based on the fact that you have seen his #s go too low, it is definitely too high a dose for him.
It is usually best to feed multiple times during the day. I feed 4 times (6am/pm; 12am/pm). A lot of people use auto feeders for when they are at work or sleeping. About 20 calories per pound of ideal body weight is supposed to be appropriate for the average indoor cat. So, make sure he is at least getting that. I leave the leftovers out for my girls to graze on since that is their preferred eating style (as it is for many cats). When a cat's glucose is not yet regulated, they tend to eat more since their body cannot properly utilize the food (hence the weight loss). The RC food definitely has too many carbs. There was someone here who was able to drop the insulin dose in half once he switched his cat from that food to FF. So, transitioning is a good idea - it is also important to monitor carefully during the transition (and go ahead and reduce that large dose!).
 
Question: For those who use automatic feeders -- it's OK to leave wet food in there? If you feed 4 times a day, do you give equal portions, or more at the dosing times? I read that when you give insulin, the cat should be get most of his calories then.
 
Yes, it’s okay to put wet food in the timed feeders for the day although personally I’ve never had it sit for more than 10-12 hours (and usually more like 4-6 before she eats it). Some of them have a little space where you can put an ice pack (we don’t have one that fancy!), and you can also put a couple of ice cubes in with the food if you want.

We feed Josie a full 3oz can at each shot time and half a can around +4/+5 in between as a snack for a total of 9oz/day, which is probably about 1/2 can too much in terms of calories. She was really scrawny two months ago bc of the diabetes, and we’d give her whatever she wanted to eat (usually four cans/12 oz), but she is back up to 12+ pounds now so we’re working to get her on a more “calorie appropriate” diet. I like to leave her 1/2 can in her timer though during the day bc it gives me peace of mind that she can steer herself up if she goes too low when we aren’t around during the workday to check on her.
 
Thanks for your answers. Also, how can I find out how much to feed my cat? The label on the can is confusing -- it says 1 can per 3.5 pounds. He weighs 16 pounds, so he should get 4 1/2 cans per day. But it also says 98 calories per can. My vet says he should get 250 cals per day. So that would mean only 2 1/2 cans a day. I emailed Purina, which makes FF, and asked, but they didn't give me a direct answer., just that I should consult with the vet. So what do I go by? Very confusing.
 
fatcat said:
Thanks for your answers. Also, how can I find out how much to feed my cat? The label on the can is confusing -- it says 1 can per 3.5 pounds. He weighs 16 pounds, so he should get 4 1/2 cans per day. But it also says 98 calories per can. My vet says he should get 250 cals per day. So that would mean only 2 1/2 cans a day. I emailed Purina, which makes FF, and asked, but they didn't give me a direct answer., just that I should consult with the vet. So what do I go by? Very confusing.
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The rule of thumb is about 20 calories per pound of ideal weight. Assuming you aren't trying to get him to lose weight.....

16x 20=320. So about 3-3.5 cans of ff at about 90-100 calories per can. If his diabetes is not yet controlled he may need a bit more until numbers improve.
 
Thanks JanetNJ. His diabetes is not yet controlled. Was diagnosed at end of June, started with 1 unit of ProZinc and was told to increase it to 4 this week. But I reduced it after I changed his food to FF classic pate. I'm not sure what his ideal weight is. He is a big cat and was 25 pounds when we got him 10 years ago. I guess I should ask my vet what his ideal weight is.
 
This might help too. It doesn't take into consideration that many cats have the primordial pouch, so I find the top down view to be the most helpful.
bodycondition_cat56232.jpg
 
Hello! My cat was diagnosed in February but I just joined the message board in July when things got serious, so you are already doing well! There is so much helpful information here and I hope you and your cat will benefit as much as we have!

Ideal weight questions are on my mind this evening as well. A question for my vet tomorrow, certainly.
 
Congrats on getting the food switch taken care of. That's always a challenge.

We base dosing on the mid-cycle numbers, not the pre-shot numbers, so is there a day or evening when you could get a test between +4 and +6? We'll need a couple of cycles worth of those to figure out what's going on with your little guy.
 
I will definitely work on getting that this weekend but I will test tonight up to 4 hours, I don't think I can stay up until 130 and make it work on time tomorrow :). I was wanting to get a glucose curve in this past weekend but it didn't work out :/ Thanks for the info I will hold off on changing anything until I can get a better picture.
 
Hi. I posted some pictures on this thread, post #5. http://www.felinediabetes.com/FDMB/threads/should-i-or-not.200950/#post-2234633

They’re not particularly good pix! But it’s .25 and .75 shown side by side on half-unit and full-unit syringes. Perhaps they will be helpful to you. It’s what we did until we ordered half-unit syringes, which are very easy to draw in .25 increments since the little black plunger at the top is a quarter of a unit wide. That means, for example, if we want to draw .75, we put the bottom edge of that little plunger on the one unit line instead of the top of that plunger like normal.
 
lionessheart_90 said:
I don't think I can stay up until 130 and make it work on time tomorrow :).
Click to expand...

Lol...oh I can relate to this! Definitely no need for sleep deprivation. The +4 should be fine! And just to clarify: you don't need to test every hour. Just one or two extra tests is fine (and just one for tonight - us humans need our sleep too!)
 
lionessheart_90 said:
Hey,

Thanks everyone for the infomation! I have finally switched fully to 2 cans of fancy feast twice a day and 1 unit of insulin but he is slowly creeping up again. I'm not sure how to only increase by 0.25 unit as I am using a U40 and it only has increments of 1. Any advice?

Here is his new spreadsheet https://docs.google.com/spreadsheets/d/1a2SiYGT0oVWaf5g_yKo9R71dolCb1VNZq2Y03wSQaEU/edit?usp=sharing
Click to expand...
Go to adw and order u40's with half unit markings to make fractional doses easier. These are the ones I use.

https://www.adwdiabetes.com/product/18553/ulticare-u40-pet-29g-3-10cc-1-2in-half-unit
 
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