New, Questions on managing my cat's blood glucose

dianna_liu

dianna_liu

Member
Hi, my name is Dianna. I am new to this forum and I am really lost with what to do to manage my cat, Grape's diabetes and diet. I went on a trip for a couple days and came back to my cat in skin and bones and not being able to walk. I had a pet sitter feed my animals at home during that time and she said my cat hasn't been eating. I rushed her to the vet and they said she went into DKA and was severely dehydrated. She stayed there for 5 days and was placed on prozinc insulin 6 units once a day. Her diet changed from dry to canned food.

In the beginning she started doing very well and then slowly she went back to before. She became very picky of her food, still eating and demanding food but sometimes would be too lazy to chew anything even if it is soft canned food. She is definitely drinking enough water but is becoming hypoglycemic. I changed different wet food, broths, different flavors to try to find something that would be tempting enough for her to eat properly but it's been a battle. I ended up changing the insulin dosage from 6 units to 5 and then to 4 units. I am very worried because she still hasn't gained any of her lost weight back. Sometimes her blood glucose would be low and she would be wobbly on her legs. The vet just instructed me to give 6 units a day and change her diet to wet food, that's it. I was checking this forum out and realized that insulin should be given twice a day...I am at lost of what to do. I just ordered a pet glucose monitor on amazon today because I realized the necessity to monitor her glucose regularly. I was never told the need to check it by the vet and didn't realize it until I came across this forum.

She is my first diabetic cat and I am very lost with what to do. I tried following the doctor's instructions only to find my cat not getting any better and is constantly going into hypoglycemia. I read the pamphlet on Prozinc insulin and knows that it needs to be given twice a day but my vet instructed me to give 6 units once a day. I have decreased it from 6 units to 5 units to 4 units right now because I noticed she is wobbly at her feet and showing signs of hypoglycemia. I will be stopping by walmart on my way home from work to pick up a human glucometer before receive my pet glucometer tomorrow by mail. Right now, I am feeding her 2 times a day with some FF broth packs during the day. She is very picky and isn't eating as much as I would li

Any advice or help is appreciated!!
 
That your vet started her out on 6 units once a day indicates he has no knowledge of how to treat diabetes. Having a prior DKA definitely needs to be taken into consideration but 6 units once a day is irresponsible... as you have already noticed! Prozinc should be started at 1 unit every 12 hours and slowly work up from there in .25 or .5 unit increments.

Symptomatic hypos are serious business. I applaud your decision to start home testing. This is the best way to keep him safe! Also read the stickies at the top of this forum, and prepare a hypo toolkit, so you can steer him back up if you find 4 units is still too much - which I suspect it is. 4 units is still a really high dose so I would encourage you to test often until you see where his numbers are.

It’s so unfortunate that you can’t depend on your vet to give you good advice in this, but you have come to the right place!!

Edit: the only reason I’m not saying to reduce his dose right now is due to the DKA. It’s risky for her to not have enough insulin.. but it’s also risky to have too much... so test and see where she is, then adjust accordingly. Hopefully someone with DKA experience will chime in soon....
 
Hi Dianna! Welcome to you and Grape!

First piece of advice: breathe. It's going to be okay! We can definitely help you to help Grape...you're not alone in this.

It sounds like you'e got a good handle on things so far. You're right...insulin should be given twice a day, 12 hours apart. You said you're down to 4 units now? You can split that in half and give 2 in the morning and 2 in the evening. Getting a human meter is great. A pet meter is fine too, but if you'd rather, you can stick with the human meter...the strips are way cheaper. A lot of vets don't suggest home testing for some reason...I think they figure owners won't do it.

For testing, you want to do it a few times a day. Before every shot for sure. If she's under 200 at shot time, don't shoot. You can try stalling 20 minutes without food to see if she is rising and can give a shot. You can also post here to ask for advice. Then try to get whatever mid cycle tests you can. Between 5 and 7 hours after the shot is good because that's around the middle of the cycle. But I know that can be hard with work, so just get what you can (we usually get a before bed test on work days) and then try to get that mid cycle during the weekends if you can.

Since you don't have a meter yet, how do you know she's going hypo? Just symptoms?

I know you said you're giving wet food. What kind? We recommend low carb wet. Most people feed Fancy Feast or Friskies pates, but I wouldn't change food until you're home testing regularly.

As for the eating, you do want to get her to eat as much as you can. With DKA in the history, it's super important she gets enough food. While you're picking up a human meter tomorrow, try to get some ketone testing strips too. They're the same ones used for humans (just ask the pharmacist if you can't find them). They're urine strips. You just dip them in the cat's urine and wait 15 seconds (I think...check the bottle) exactly and then compare the colors on the strip and bottle. Anything above trace is an emergency. If you need help getting some urine for a test, let us know...we have some good tips. :)

I don't want to overwhelm you so I'm going to stop now. But please ask ALL the questions you have. It's a lot to learn at first, and we're happy to answer anything!
 
Thanks for the replies!

Right now she has been eating Friskies prime filets right now alternating with some fancy feast broth packs when she is picky. It is extremely hard to find something she would actually finish....I will be picking up a human glucometer today on my way home and I have also ordered a pet monitor online which should arrive in a day or two.

Will there any dangers in splitting the insulin to 2 units AM and 2 units PM since she has been getting it 4 units PM after eating her meal.

I only know she is in hypo because of her symptoms. She is still perking up and demanding for food but definitely gets wobbly on her hind legs when she is hypo.
 
You've been given good advice.
dianna_liu said:
Will there any dangers in splitting the insulin to 2 units AM and 2 units PM since she has been getting it 4 units PM after eating her meal.
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No, if anything she'll have better BG control around the clock by splitting the dose. Give 4 u once a day can cause her to drop low then go high once the insulin wears off. With two doses a day you're giving another dose as the previous one is wearing off.
 
Nope splitting the doses is fine. It's possible it will actually help the hypo stuff since she'll be getting less at one time (but testing is still the way to go for sure!).

As for food, just keep trying. We can help you find a good lower carb food, but stick with what you have for now. Does she eat it better with the broth on it? You can try tuna water on it too, or forti flora (cats love the flavor of that). Or some cats love parmesan cheese on it! Will she finish her food later or does she just refuse to eat the rest of it all day?
 
Hi Dianna and welcome! Rachel, Kris, and SpotsMom have already given you some great advice. One thing about the wobbly legs is that diabetes often causes neuropathy in cats where their legs are really wobbly and they don't walk right, have trouble jumping, will sometimes just sort of flop over....all kinds of things like that. So that may be contributing to what you're seeing as well. Once you are able to get a few tests in and we see the numbers, we can help sort out some next steps. We have so many tips and tricks for every part of this, so we are more than happy to help you get this all figured out. Where there's a will, there's a way! :) I'm so sorry your vet wasn't much help, but you've come to the right place now!
 
Hi Dianna, and welcome. I’m too new to give much advice except on very practical matters (especially with a cat who has DKA), but you’ve certainly found the right place with many wise, generous folks to help you help Grape.

And I always love it when people cross-post! With both Rachel and Kris &Teasel posting the same advice and the same time about splitting the 4 units, you can be confident it’s the right thing to do! :)
 
Thank you so much for all the information! I can't tell you how grateful I am. I was so lost and worried but now I feel more confident in what I have to do to help Grape feel better and I know I have all the help I need here :).
 
Hi, so I just got home and my babysitter had given her a pack of FF broth, I just tested her BG and it is extremely high. It is 470. I don’t know if it is just high because she was low earlier on. I haven’t been able to get a ketone test done on her because she hasn’t peed since I got home yet. She is still wobbly and hungry. What should I do at this point? I am so worried.
 
If she is asking for food, I would feed her. When cats are not producing insulin well, their little bodies cannot properly use the glucose from what they ingest, and so in a sense they are “hungry” on the cellular level. Josie was constantly eating as if she were starving — and yet still losing weight — until we got her more or less regulated.

I don’t know about the carb content of the FF broth, but I wouldn’t worry about that much right now. Here’s a sortable food chart created by Dr Lisa Pierson, a feline nutrition expert. Generally speaking, less than 10% carbs is optimal for a diabetic cat. We feed Josie FF chicken pate and chunky chicken; on occasion, she gets the roasted chicken or roasted turkey.
http://catinfo.org/chart/index.php

From your description, it seems likely that your kitty is “bouncing,” which happens when their BG (blood glucose) level drops too low or lower than they are used to. @Kris & Teasel has a great explainer for it ... but it’s pretty much the cat’s way of releasing an “emergency supply” of glucose in response to the low number. And that’s a good thing because it can pull them out of a danger zone, but it has the consequence of resulting in a period of high numbers until the bounce/emergency glucose clears their system.

Now that you’re testing — great job on that, by the way!! — it would be very helpful if you set up a spreadsheet and link it in your profile so that we can all see it and help you to figure out what is going on with Grape and how best to help here.

Here’s the link to the instructions for setting up a spreadsheet:
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
 
Jenna Josie said:
If she is asking for food, I would feed her. When cats are not producing insulin well, their little bodies cannot properly use the glucose from what they ingest, and so in a sense they are “hungry” on the cellular level. Josie was constantly eating as if she were starving — and yet still losing weight — until we got her more or less regulated.

I don’t know about the carb content of the FF broth, but I wouldn’t worry about that much right now. Here’s a sortable food chart created by Dr Lisa Pierson, a feline nutrition expert. Generally speaking, less than 10% carbs is optimal for a diabetic cat. We feed Josie FF chicken pate and chunky chicken; on occasion, she gets the roasted chicken or roasted turkey.
http://catinfo.org/chart/index.php

From your description, it seems likely that your kitty is “bouncing,” which happens when their BG (blood glucose) level drops too low or lower than they are used to. @Kris & Teasel has a great explainer for it ... but it’s pretty much the cat’s way of releasing an “emergency supply” of glucose in response to the low number. And that’s a good thing because it can pull them out of a danger zone, but it has the consequence of resulting in a period of high numbers until the bounce/emergency glucose clears their system.

Now that you’re testing — great job on that, by the way!! — it would be very helpful if you set up a spreadsheet and link it in your profile so that we can all see it and help you to figure out what is going on with Grape and how best to help here.

Here’s the link to the instructions for setting up a spreadsheet:
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
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Thank you!! I will feed her now. Do you generally give the insulin after feeding or before feeding? Also how long after feeding and insulin should I recheck her glucose??
 
Also at this point do I go with dividing the dose to 2 units AM and 2 units PM or change it because of how high her BG is??
 
dianna_liu said:
Thank you!! I will feed her now. Do you generally give the insulin after feeding or before feeding? Also how long after feeding and insulin should I recheck her glucose??
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Dianna,
when you are starting insulin you need to take into account your work schedule. It is best to shoot 12 h apart although Proz is more forgiving.
 
Tanya and Ducia said:
Dianna,
when you are starting insulin you need to take into account your work schedule. It is best to shoot 12 h apart although Proz is more forgiving.
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I am able to give it around 12.5 hrs apart. But that schedule would have to start tomorrow morning since I’ve been giving once a day at night...
 
dianna_liu said:
Okay! I won’t be able to keep the schedule at the current time if I shoot tonight. I would have to start over tomorrow morning (about 10 hrs from now).
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she needs insulin..
can you please hold a little bit while someone answers?

I cannot possible tell you to skip the shot after DKA.
I would give the dose for sure tonight and work out timing /schedule beginning tomorrow.
To dose is more important, IMHO.
 
Tanya and Ducia said:
she needs insulin..
can you please hols a little bit while someone answers.

I cannot possible tell you to skip the shot after DKA.
I would give the dose for sure tonight and work out timing later on.
To dose is more important, IMHO.
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Okay. I will wait till someone responds. Thank you!
 
Before I forget, here’s a link on how to set up a profile so that we’re all not constantly asking you the same questions: http://www.felinediabetes.com/FDMB/threads/editing-your-signature-profile-and-preferences.130340/ :)

The general protocol is to test and, assuming the number is above 200 (at first. You can adjust that lower after you and Grape have more experience and data about how she’s handling the doses), feed and give the shot. We “shoot” while Josie’s face is shoved in her food bowl, and she doesn’t even notice, the little glutton!

If I’m worried about a shot, I test at +2 hours after the shot. That number should be about the same or slightly higher (because of a normal “food spike”) than the pre-shot (PS) test number. Otherwise, it depends on what we can get. I am fortunate to live close to work, so I try to get a mid cycle (+5 or +6 hours after the shot) during the day, and we get a “before bed” test (+3 or +4) in the evening.

Whatever you can get is what will be best! But definitely a pre-shot test to be sure Grape is high enough for the injection. You can use non-work days for more tests to fill in the gaps. :)

Do try, though, because of the “food spike,” to pick up her food two hours before her pre-shot test so that you get a “true” number and not one that is inflated because of a foodspike.

EDIT: written in reply to post #13.
 
Dianna, just FYI. I checked the other brand you mentioned feeding, the Friskies Prime Fillets. They are either 14 or 15 % carbs. You are doing very well, and really trying to take good care of Grape.
 
Do I continue to wait? It’s been 30 min since I fed her and I normally give insulin right after or during feeding. She ate about 1/4 of a can of Friskies pate- Mariners catch.
 
I think that I would give the 2u. It is half of what she has been getting and unlikely to bring her too low. And certainly better to give something with the recent DKA.

The question is what/when to shoot in the morning. It seems like your work schedule will mean an AM test/shoot about 10 hours (+10) after this shot?

If you could please give a shot time for this shot **and your time zone** that will help for people in the morning.

I’m sorry I can’t be more helpful. :(
 
Jenna Josie said:
I think that I would give the 2u. It is half of what she has been getting and unlikely to bring her too low. And certainly better to give something with the recent DKA.

The question is what/when to shoot in the morning. It seems like your work schedule will mean an AM test/shoot about 10 hours (+10) after this shot?

If you could please give a shot time for this shot **and your time zone** that will help for people in the morning.

I’m sorry I can’t be more helpful. :(
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I just gave 2 units at 11:18PM (central time zone). I am hoping to start the schedule at 8:45AM and 9:15PM. I am a nurse so I work 12 hr shifts and the schedule I can give the insulin on is 12.5 hrs apart. But I don’t know how to start tomorrow considering how late I just gave the insulin....
 
dianna_liu said:
I just gave 2 units at 11:18PM (central time zone). I am hoping to start the schedule at 8:45AM and 9:15PM. I am a nurse so I work 12 hr shifts and the schedule I can give the insulin on is 12.5 hrs apart.
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Can you adjust his shot times for the next few cycles? If you're 2 hours late tonight, we wouldn't suggest shooting before 10:45am in the morning, then 10:15 Saturday AM, 9:45 Sunday AM, 9:15 Monday AM or PM

We usually suggest making time adjustments by 15 minutes per cycle or 30 minutes per day
 
Chris & China said:
Can you adjust his shot times for the next few cycles? If you're 2 hours late tonight, we wouldn't suggest shooting before 10:45am in the morning.

We usually suggest making time adjustments by 15 minutes per cycle or 30 minutes per day
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Okay. I don’t work tomorrow so I can give it at 10:45am tomorrow and try to adjust it slowly during the weekends. How should her BG look like after a couple hrs of shooting and feeding? I’m not too sure of how to regulate and decide when to go up or down on the insulin.
 
I am in CDT! And I believe Rachel is, too. She is often here early mornings, around 4-5am our time, so hopefully she will be able to weigh in before tomorrow am’s shot.

Although we try to keep a 12/12 hour schedule, ProZinc allows up to an hour leeway. With that hour + the reduced dose, I would *think* you’ll be good getting on a regular 2u schedule every 12.5/11.5 hours beginning tomorrow am, but again, hoping someone more experienced than me can weigh in especially with the DKA.
 
Okay! Got it! Thank you all so so much! I don’t know how I would’ve gotten through tonight if it weren’t for your suggestions!
 
dianna_liu said:
How should her BG look like after a couple hrs of shooting and feeding?
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A +2 test is a good test to get....a lot of times it can give you an idea of what's going to happen later in the cycle.....the +2 should be about the same as the Pre-shot test....if it's a lot lower, it's important to get tests in later in the cycle.

dianna_liu said:
I’m not too sure of how to regulate and decide when to go up or down on the insulin.
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Hold this dose for 2-3 days while you're getting some data on how she's responding.

I haven't read through everything but if nobody else has suggested it, it's a real help to us to start keeping track of her test numbers on our spreadsheet.

Here are Instructions on getting the FDMB spreadsheet
 
dianna_liu said:
Okay. I don’t work tomorrow so I can give it at 10:45am tomorrow and try to adjust it slowly during the weekends. How should her BG look like after a couple hrs of shooting and feeding? I’m not too sure of how to regulate and decide when to go up or down on the insulin.
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What great timing! Excellent that you are home tomorrow and so can ease her into a regular schedule! Recording your tests and setting up the spreadsheet would be super helpful for helping you figure out the best dose.
 
Chris & China said:
A +2 test is a good test to get....a lot of times it can give you an idea of what's going to happen later in the cycle.....the +2 should be about the same as the Pre-shot test....if it's a lot lower, it's important to get tests in later in the cycle.



Hold this dose for 2-3 days while you're getting some data on how she's responding.

I haven't read through everything but if nobody else has suggested it, it's a real help to us to start keeping track of her test numbers on our spreadsheet.

Here are Instructions on getting the FDMB spreadsheet
Click to expand...

Okay! I will start doing the spreadsheet. Right now I have it on paper since I’m not on my computer.
 
Jenna Josie said:
What great timing! Excellent that you are home tomorrow and so can ease her into a regular schedule! Recording your tests and setting up the spreadsheet would be super helpful for helping you figure out the best dose.
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Thank you so much sticking with me while I panick over all this!
 
Dianna, I have to go off to bed now, but you are doing great, and Grape is a lucky kitty to have you taking care of her. :) Remember that the “take action” number is 50 on a human meter, and her PS number was quite a ways away from that, so while we definitely want to work to get her average numbers down, she should stay in safe numbers tonight on this 2u dose.

Edit: But do still get that +2 and maybe a +3 if you can (Josie tends to begin to show insulin’s onset around +3 although “every cat is different “ [ECID]). It will be great data to have for the future!
 
Jenna Josie said:
Dianna, I have to go off to bed now, but you are doing great, and Grape is a lucky kitty to have you taking care of her. :) Remember that the “take action” number is 50 on a human meter, and her PS number was quite a ways away from that, so while we definitely want to work to get her average numbers down, she should stay in safe numbers tonight on this 2u dose.
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Gotcha. Good night! Thank you!
 
Gooooddddd morning! What I love is that Jenna knows my schedule :joyful:. Yes, weekdays at least I'm here between 4-5. Weekends I'm usually much later since I'm just up to feed the cats and back to bed...but I'll always check in if I know someone is going to need me.

So let's see. Yes, I am in CDT (why I missed your tag...I'm up early so I go to bed pretty early). I'll be at work when it's your shot time, but barring anything nutty happening, I should be able to pop in around 10:45 and see what's going on. Most likely someone else will be around too, but if not, I should be around.

When you pop in later, please do list any and all tests you took last night. Let us know how many hours after the shot each test was. That will help us figure out what's going on. :) As Chris said above, you want to hold the dose before raising. We usually hold 3-4 cycles, which is 2 days or so. As for lowering the dose that happens after some low numbers that you weren't expecting, and we'll help you figure that out.

So you'll be doing 12.5/11.5 for shooting? That should be fine. Prozinc does have the flexibility, and if we notice that it isn't working, we can adjust the dosage some, but I'd start with 2u/2u.

Looking forward to seeing what your numbers look like today!
 
Good morning! Yes, we are an early rising little group, and tend to sign off fairly early in the evening. Jenna takes the night shift ;):coffee::).

@Jenna Josie, you did a really great job with your advice (as usual). I know you don't love giving dosing advice, but you definitely know enough at this point to do so!

Dianna, great job getting started with testing! It will make such a difference for you in helping keep Grape happy and healthy! If you need any help getting the spreadsheet linked, just ask and we can connect you with someone who can help. I hope you and Grape had a good sleep and enjoy your day off today!
 
dianna_liu said:
Hi, my name is Dianna. I am new to this forum and I am really lost with what to do to manage my cat, Grape's diabetes and diet. I went on a trip for a couple days and came back to my cat in skin and bones and not being able to walk. I had a pet sitter feed my animals at home during that time and she said my cat hasn't been eating. I rushed her to the vet and they said she went into DKA and was severely dehydrated. She stayed there for 5 days and was placed on prozinc insulin 6 units once a day. Her diet changed from dry to canned food.

In the beginning she started doing very well and then slowly she went back to before. She became very picky of her food, still eating and demanding food but sometimes would be too lazy to chew anything even if it is soft canned food. She is definitely drinking enough water but is becoming hypoglycemic. I changed different wet food, broths, different flavors to try to find something that would be tempting enough for her to eat properly but it's been a battle. I ended up changing the insulin dosage from 6 units to 5 and then to 4 units. I am very worried because she still hasn't gained any of her lost weight back. Sometimes her blood glucose would be low and she would be wobbly on her legs. The vet just instructed me to give 6 units a day and change her diet to wet food, that's it. I was checking this forum out and realized that insulin should be given twice a day...I am at lost of what to do. I just ordered a pet glucose monitor on amazon today because I realized the necessity to monitor her glucose regularly. I was never told the need to check it by the vet and didn't realize it until I came across this forum.

She is my first diabetic cat and I am very lost with what to do. I tried following the doctor's instructions only to find my cat not getting any better and is constantly going into hypoglycemia. I read the pamphlet on Prozinc insulin and knows that it needs to be given twice a day but my vet instructed me to give 6 units once a day. I have decreased it from 6 units to 5 units to 4 units right now because I noticed she is wobbly at her feet and showing signs of hypoglycemia. I will be stopping by walmart on my way home from work to pick up a human glucometer before receive my pet glucometer tomorrow by mail. Right now, I am feeding her 2 times a day with some FF broth packs during the day. She is very picky and isn't eating as much as I would li

Any advice or help is appreciated!!
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Hi Dianna and Grape. You have found the right place. I have only been at this month and without these guys I would have been a puddle on the floor or in a straight jacket! I cannot contribute much regarding dosing as I am still trying to get little regulated but I have switched her food and dosing many times over the last month. I found that Fancy Feast fish and shrimp is like kitty crack. Both my girls love it although it smells awful... I spent days analyzing the food chart that someone sent you in a post below and that flavor of FF is said to have 0 carbs which can only help. Perhaps you should give that flavor a try. 1 can is 87 calories so let her eat and and eat if she will.. I hope she does. Good luck and welcome. And take a deep breath. I can say after only a month and not much regulation I am calmer and more confident that I am doing the right thing.and heading in the right direction. You will get there too I promise
 
Good morning! Thanks for the replies. I checked her BG at +2 last night and it was 552. I just checked her BG at the ideal time I would be giving later on (8:45AM) and it was 183. She was hungry so I gave her food which she took a couple licks to before laying down and resting again. Can you all give me advice on what the plan of action would be depending on the values of the BG? When should I feed or be alarmed or be worried that it is way too high?
 
dianna_liu said:
Good morning! Thanks for the replies. I checked her BG at +2 last night and it was 552. I just checked her BG at the ideal time I would be giving later on (8:45AM) and it was 183. She was hungry so I gave her food which she took a couple licks to before laying down and resting again. Can you all give me advice on what the plan of action would be depending on the values of the BG? When should I feed or be alarmed or be worried that it is way too high?
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The best way for us to help you is for you to set up the spreadsheet we use here and enter all data you have to date. We look at the trends, the whole picture to assess a dose. If you need help with the SS just ask. There are people here who can set it up for you. :)

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/
 
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