Should we take a step back?

[vstarjewel]

Max has been on the prozinc now for a month. The vet has increased it twice since he's been diagnosed. His BG numbers are just loopy, over 600 in the morning when he hasn't eaten for 8 hours, in the hundreds 6 hrs later, and over 600 again before dinner. He's now doing 7 units prozinc total per day. Knowing what I know now about feline diabetes, I believe the vet should have advised us to switch his food over first to see if that leveled out is blood glucose levels. If that didn't work then you start insulin. I don't feel good about going against the Vets recommendations, he is the doctor and I only know what I've read on the internet. But I get the feeling it would be good to go back to square one stop the insulin give him just the wet food and see how it goes. Has anybody here done that? I can be home Fri thru Tues to watch over him. Any thoughts would be appreciated

 

[Panic]

More experienced people can chime in here but you definitely can't just stop insulin now that Max is on it.

I was under the impression that Friskey's pate is a good food choice for diabetics so what food did you have in mind to switch him to? Proper food can lower the glucose numbers but most of the time they need insulin as well, especially in those high numbers! Again, someone more experienced can chime in but it sounds like Prozinc just isn't a the right insulin for your kitty.

Edit: Just checking since you said he is on 7 units total, is he taking 3.5 units twice a day?

 

[Lisa and Witn (GA)]

I think there may be a couple things going on. ( I updated my response after I realized that you are giving 7 units per day and not per shot. ) You are right about the diet change. Your instincts I think are spot on. You should start over with a diet change and also drop the dose back to 1/2 or 1 unit. With the doses you started with and increased, I think you miss the optimal dose and maybe bouncing. Bouncing occurs when too much insulin is given. In order for the cat's body to protect itself from hypoglycemia, it sometimes produces extra glucose to keep its glucose readings from dropping too low. So even though you're increasing the dose you're also seeing the glucose readings increase too. By changing the diet to a low carb wet food diet and starting over at a very low dose such as 1/2 to 1 unit twice a day, I think you will see better results. Wait at least 1 week between dose changes, before increasing it again. If an increase is needed, then only increase it by one half unit. Again wait another week before determining if you need to increase again. By doing this you will be able to find the optimal dose that works best for your cat.

 

[CandyH & Catcat]

this may be only incidental, but I notice when Catcat is eating Friskies pate (scored the large cans at a discount), his numbers seem to be running higher than when he's eating Blue Wilderness or 4Health or Fancy Feast (all grain free pates) -- I noticed that Friskies includes rice in the ingredients, and it may be that the rice is more of a glycemic load than the potato in BW .. we're learning in humans that it's not just the carb % but which carbs seem to have the most effect on the insulin production, cf the South Beach diet .. may be a fad but seems to be some genuine research behind it

 

[vstarjewel]

More experienced people can chime in here but you definitely can't just stop insulin now that Max is on it.

I was under the impression that Friskey's pate is a good food choice for diabetics so what food did you have in mind to switch him to? Proper food can lower the glucose numbers but most of the time they need insulin as well, especially in those high numbers! Again, someone more experienced can chime in but it sounds like Prozinc just isn't a the right insulin for your kitty.

Edit: Just checking since you said he is on 7 units total, is he taking 3.5 units twice a day?

Sorry, wasn't real clear on the post. I shall try again .

When Max was diagnosed with diabetes (with a reading of 521), the vet asked about his diet. I told him dry food was out 24/7. First thing he said to do was dump the dry, and do wet pate due to protein/carb ratio. He then said to start insulin, put Max on Prozinc, 2 u AMPS, 2 u PMPS (which, from what I've read here, is a pretty high dosage for just starting off). I believe that the vet should have advised us to do only wet food for 5 days and check his numbers throughout the day. Do a second reading 5-7 days later to determine Max's numbers on new diet, THEN decide on the best insulin dosages. Pretty sure they do that with people . . . adjust diet first, insulin shots if necessary. Like I said, I wish I had done more research on feline diabetes . . . at least I'm not learning 5 or 6 months into it. Grateful I'm questioning things somewhat early in the process. On the high side, Max is very happy with his pate . . . not changing that, that's for sure!

Max gets 4 u morning and 3 u at dinner. He started at 2 units in morn and at dinner (which, from what I've read, is still a high starting amt). I asked the vet about switching insulin (2 weeks into it, and I will admit it was due to cost). He said he didn't recommend it as Prozinc is specifically for cats. I'm not impressed with the Prozinc, esp for the cost. From what I've read, there seem to be other options. But that is a whole party . . .

Going cold turkey with ANY medication is a big no no . . . but I AM going to reduce the amount. I gave him his morning 4 units today, will try 1 unit tonight, and test him before bedtime. I am going to cut his dosages to 1 unit twice a day starting tomorrow and see what happens. Good think I'm home all day . . .

I think there may be a couple things going on. ( I updated my response after I realized that you are giving 7 units per day and not per shot. ) You are right about the diet change. Your instincts I think are spot on. You should start over with a diet change and also drop the dose back to 1/2 or 1 unit. With the doses you started with and increased, I think you miss the optimal dose and maybe bouncing. Bouncing occurs when too much insulin is given. In order for the cat's body to protect itself from hypoglycemia, it sometimes produces extra glucose to keep its glucose readings from dropping too low. So even though you're increasing the dose you're also seeing the glucose readings increase too. By changing the diet to a low carb wet food diet and starting over at a very low dose such as 1/2 to 1 unit twice a day, I think you will see better results. Wait at least 1 week between dose changes, before increasing it again. If an increase is needed, then only increase it by one half unit. Again wait another week before determining if you need to increase again. By doing this you will be able to find the optimal dose that works best for your cat.

 

[Noah & me (GA)]

he is the doctor and I only know what I've read on the internet

This is the hardest thing to accept, ordinary people who are living with this know more than "It's doctor actually".
We use two clinics and both vets admit feline diabetes is something they were taught nothing about. They are both great doctors, it's usually the techs that are the annoying ones.

 

[CandyH & Catcat]

LOL -- yes, feline diabetes doesn't come with "a cookbook" -- I trust those here with on-the-job-training ---

 

[Noah & me (GA)]

Unless you cook like my mom, a pinch of this and a dash of that. It all came out just fine.
It's been a long time since a doctor said to me "it's doctor actually". I wanted to ask him if Actually was a Slavic name but I needed the prescription.

 

[Panic]

Sorry, wasn't real clear on the post. I shall try again .

When Max was diagnosed with diabetes (with a reading of 521), the vet asked about his diet. I told him dry food was out 24/7. First thing he said to do was dump the dry, and do wet pate due to protein/carb ratio. He then said to start insulin, put Max on Prozinc, 2 u AMPS, 2 u PMPS (which, from what I've read here, is a pretty high dosage for just starting off). I believe that the vet should have advised us to do only wet food for 5 days and check his numbers throughout the day. Do a second reading 5-7 days later to determine Max's numbers on new diet, THEN decide on the best insulin dosages. Pretty sure they do that with people . . . adjust diet first, insulin shots if necessary. Like I said, I wish I had done more research on feline diabetes . . . at least I'm not learning 5 or 6 months into it. Grateful I'm questioning things somewhat early in the process. On the high side, Max is very happy with his pate . . . not changing that, that's for sure!

Max gets 4 u morning and 3 u at dinner. He started at 2 units in morn and at dinner (which, from what I've read, is still a high starting amt). I asked the vet about switching insulin (2 weeks into it, and I will admit it was due to cost). He said he didn't recommend it as Prozinc is specifically for cats. I'm not impressed with the Prozinc, esp for the cost. From what I've read, there seem to be other options. But that is a whole party . . .

Going cold turkey with ANY medication is a big no no . . . but I AM going to reduce the amount. I gave him his morning 4 units today, will try 1 unit tonight, and test him before bedtime. I am going to cut his dosages to 1 unit twice a day starting tomorrow and see what happens. Good think I'm home all day . . .

Your vet seemed to know a lot more than mine did starting! ^-^ My vet told me dry Purina DM was the best thing!
I have a packet laying around here somewhere that my vet printed off and gave me with all the info on pet diabetes and recommended starting dosages per insulin...I want to say for Prozinc it was 1u? Maybe lower? So that is a bit of a high starting dose. Maybe you in particular don't know the answer to this, but is it normal to have different dosages from AM to PM like you're doing with Max? I can see where it makes sense since it's night time but I haven't seen it done personally yet. I agree with you I think food switch should have been done first, my own vet did it because she didn't want to overwhelm my cat with two changes (insulin and food) at the same time.

I'm surprised though because Prozinc is definitely one of the better insulins, but every cat is different and maybe Max needs something even better, Lantus or Levemir probably, but as you know those are even more pricey. Please keep us updated so we can see how Max does on a lower dose!

They are both great doctors, it's usually the techs that are the annoying ones.

Oh man I had the same experience XD I love my techs, they're very sweet girls but I did end up arguing with one when I brought in Fancy Feast to a curve xD At least they had my cat's best interest at heart!

 

[Bron and Sheba (GA)]

If you are going to reduce the dose back to 1 unit, please make sure you are testing each day for ketones in the urine. You can do this by buying a bottle of Ketostix from Walmart or a pharmacy. It is a simple test just follow instructions. Anything above a trace needs vet attention.

 

[Djamila]

Hi there Julie, and welcome. It's great that you're taking the time to read and learn and ask questions.

A couple of things. First of all, while I love that you set up a spreadsheet to track your data, I would really recommend that you start using the one that we all use here before you go too far into this. Seeing when the numbers occur is really important in figuring out what's going on with a cat. While you have columns to enter the times, the visual is a really powerful tool in your toolkit for treating this disease. Here is the link to get you started: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Okay, logistics aside, I would definitely not go down to 1u. From looking at the data you have, it does not look like Max is getting too much insulin. And lowering the dose will put him at greater risk of developing ketones, which can develop quickly and have grave consequences for our sugar cats. The numbers I see on your spreadsheet indicate that most likely Max is going to need even a bit more insulin than he's getting right now. If you have more time at home the next few days, I would use it to collect data and get those doses evened out. It looks like you're shooting 4u in the AM and 3u in the PM. Ideally you want to be shooting the same dose for both cycles. It isn't the total per day that makes any difference, it's the right amount of insulin at the right time.

 

[Rachel]

Hello Julie! Afer reviewing your SS, I have to agree with Djamila. While 1 unit is a normal starting dose that we recommend, when people arrive with a cat who is already on a higher dose, we rarely recommend just dropping back to that. I'd only suggest that IF the data you had proved that the cat was on too high of a dose...dropping into very low numbers and needing to be steered back up with food. Thus far, Max isn't dropping as far as we'd like him to on the dose you have now. That tells me that Max probably needs more insulin, not less. I think that evening the doses out to 3.5 units twice a day and getting tests in to see what that does would really help. Then we can determine if the dose needs to go up further, or if just evening the dose out some has helped bring Max to better numbers.

 

[vstarjewel]

this may be only incidental, but I notice when Catcat is eating Friskies pate (scored the large cans at a discount), his numbers seem to be running higher than when he's eating Blue Wilderness or 4Health or Fancy Feast (all grain free pates) -- I noticed that Friskies includes rice in the ingredients, and it may be that the rice is more of a glycemic load than the potato in BW .. we're learning in humans that it's not just the carb % but which carbs seem to have the most effect on the insulin production, cf the South Beach diet .. may be a fad but seems to be some genuine research behind it

Eureka! "Keto For Kitties"! We can put it online and that will help take care of everyone's expenses . Brilliant Candy!!!!

 

[vstarjewel]

If you are going to reduce the dose back to 1 unit, please make sure you are testing each day for ketones in the urine. You can do this by buying a bottle of Ketostix from Walmart or a pharmacy. It is a simple test just follow instructions. Anything above a trace needs vet attention.

I felt uneasy with a drop of more than half the dose he's been on. So this morning I did 1.5 u after test and bfast. He was much more alert after he ate (which are in my SS notes).

Not sure about the urine testing. Max went to the litter box to do his business (it's in a separate laundry room). When I peeked around the corner and he saw me he stopped tinkling. He came out, and as soon as my back was turned headed back to potty. I heard him dig and do his thing again. Unless I can just drop a ketone stick in the litter box and wait, I don't see that testing happening any time soon.

 

[Tomlin]

Hi Julie. I'm new here, but what has helped me tremendously are Nest Cams!! They aren't very expensive & easy to use. Allows you to see whats going on without disrupting them which in of itself can change their behavior (aka watching them eat, pee etc). Just a thought that may be helpful...you may be able to get in there fast enough since you won't be "peeking" (except by using your app on the phone or computer).

 

[vstarjewel]

Hi there Julie, and welcome. It's great that you're taking the time to read and learn and ask questions.

A couple of things. First of all, while I love that you set up a spreadsheet to track your data, I would really recommend that you start using the one that we all use here before you go too far into this. Seeing when the numbers occur is really important in figuring out what's going on with a cat. While you have columns to enter the times, the visual is a really powerful tool in your toolkit for treating this disease. Here is the link to get you started: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Okay, logistics aside, I would definitely not go down to 1u. From looking at the data you have, it does not look like Max is getting too much insulin. And lowering the dose will put him at greater risk of developing ketones, which can develop quickly and have grave consequences for our sugar cats. The numbers I see on your spreadsheet indicate that most likely Max is going to need even a bit more insulin than he's getting right now. If you have more time at home the next few days, I would use it to collect data and get those doses evened out. It looks like you're shooting 4u in the AM and 3u in the PM. Ideally you want to be shooting the same dose for both cycles. It isn't the total per day that makes any difference, it's the right amount of insulin at the right time.

Good morning! Thank you for the info . . . the more I read here (i.e. the same amt of insulin should be given both times), the more I question my vet. I try to remember that vets take care many different critters, it would VERY difficult to be thoroughly educated on every one of them. However, I think if a vet isn't familiar with FD, he/she should step up and say so and have a specialist they could refer you to. I work for a dentist . . . he won't do extractions because it's hard on the patient. He refers to a specialist - he gets no money from it, but knows the person will be well taken care of. Just that simple.

Bottom line though is I am Max's mom and I am responsible for his care. It is MY job to educate myself and READ READ READ (I have a notepad with all sorts of scribbles in it as I learn along the way). My SS is set up like it is because I don't have a desktop computer; I have a 13 inch laptop. I had to make the SS smaller and more concise so I could see the whole thing at one time.
I did try the SS template, but kept having to scroll and move, which ended up with me putting info on the wrong day and line. I did that for over an hour before I gave up and tried to redo it so I could read it. I do apologize that it doesn't follow the template, but this is the easiest way for me to track his numbers.

And yeah . . . I didn't go to 1 u this morning. I did go down though to 1.5 u. Being I'm at home all day today, I can keep an eye on Max and see if the lowered amt is stressing him or putting him in hypo. So far he's been doing ok. Next test is at 11:58 am . . . will be posting results

 

[CandyH & Catcat]

will have to look to see where I saw this option -- replace the litter in the litter box with lentils (or swap in a box with those) -- don't know if your cat would deal with a sudden change in litter, I haven't tried it myself -- but the way Catcat digs, that setup would be more likely to catch sufficient pee to test than putting crumpled up plastic wrap in his usual box -- we had to go to a Booda-type (looks like an igloo) box because dog is coprophagic ... no chance to use the spoon/ladle technique

 

[vstarjewel]

Hi Julie. I'm new here, but what has helped me tremendously are Nest Cams!! They aren't very expensive & easy to use. Allows you to see whats going on without disrupting them which in of itself can change their behavior (aka watching them eat, pee etc). Just a thought that may be helpful...you may be able to get in there fast enough since you won't be "peeking" (except by using your app on the phone or computer).

I've heard of them . . . I may get a set (or however they come) and use them when I'm at work (which is 2 days a week). I know I wouldn't be fast enough to catch him in the act . . . the litter box is in the corner of a small rectangular laundry room (we keep it in there so litter isn't tracked everywhere and the smell is more or less contained). BUT . . . I was reading here about people putting the strips on a stick and slipping it in from a distance. Perhaps I can piece something like that together . . . hmmmmm.

 

[CandyH & Catcat]

computer suggestion -- does your laptop have the option to attach a larger monitor? that's what I did, more to ease the strain on my neck but also to see things in a larger font than my laptop manages -- monitor is up at my eye level when I sit, laptop is hip level so I can type without exacerbating carpal tunnel

 

[vstarjewel]

will have to look to see where I saw this option -- replace the litter in the litter box with lentils (or swap in a box with those) -- don't know if your cat would deal with a sudden change in litter, I haven't tried it myself -- but the way Catcat digs, that setup would be more likely to catch sufficient pee to test than putting crumpled up plastic wrap in his usual box -- we had to go to a Booda-type (looks like an igloo) box because dog is coprophagic ... no chance to use the spoon/ladle technique

Yeah, Max is a digger before a tinkler also, which is why the plastic wrap wouldn't work . Tried again to sneak in a little bit ago . . . no go. Minute he saw me he turned the faucet off. I think he is leery of me a little cuz I'm the one testing him. Not a bad way, but in a "I gotta keep my eyes on that one" way.

 

[vstarjewel]

computer suggestion -- does your laptop have the option to attach a larger monitor? that's what I did, more to ease the strain on my neck but also to see things in a larger font than my laptop manages -- monitor is up at my eye level when I sit, laptop is hip level so I can type without exacerbating carpal tunnel

It does, and I did LOL. My son had an extra monitor that he gave me to use. Worked great . . . till one of the cats (still don't know which one it was as all 3 were in the vicinity) jumped up on my desk and knocked it over. It was trashed . . . turned on but only had squiggly lines on the screen. On the positive side, the plug to my laptop gave way . . . my $1300 laptop stayed on the desk. Whew. Right now I make the font a little larger to make it easier to see. A new monitor may be in my future for Christmas . . .

 

[CandyH & Catcat]

check the sites online for used equipment, Craigslist, Freecycle, whatever is local to you, monitors there can be dirt cheap, I've gotten them for free, especially around quarter ends if there is a college nearby, show up frequently in garage sales -- I have seen monitors with the bases C-clamped to the shelf/table/etc they sit on

 

[vstarjewel]

Oooooooh . . . never thought of that. Come to think of it, my daughter picked up ALL kinds of things that kids were throwing away when they went home for summer break at college. SNAP! And yeah, I will have to either think of a way to clamp it down, or remember to unhook it and put it on the floor under my desk THANK YOU!