at the end of my tether

[Galaxy (GA)]

Ok my titles tend to be a bit dramatic, but I have been crying for three days now. If you look at our SS you'll see why. Clear case of insulin resistance ergo pancreas related issue and/or acromegaly.

Or can anyone tell why his numbers are going up in spite of the increasing dose? did I raise the dose too quickly? Should I go back to 2.50? he did show some promise of a downward trend there.

He can't be bouncing because he is INVARIABLY in the black range pre-shot, and DOES NOT go lower than red. So basically he spends most of his time in the black range. I soooo feel like swearing and throwing a tantrum!! I've never had such a sense of failure before! Every morning and evening I put him on the table, I'm thinking, OK, let's see, will it be in the red at least? Please be red or better; but nooooo, and what's even worse the number is even higher than before!!!?!?!?!? I feel so frustrated, and then I think of Puss, spending most of the day riding the high sugar, looking clueless, just staring in front of himself. And then I bawl my eyes out.

I spoke to the vet, and asked for a pancreatitis test. But that's not going to show tumor, is it, if it's a tumor.

Anyway, do you think it was too quick a raise from 2.50 to 3? Vet also says, it takes 2-3 weeks for a cat to adjust to a NEW TYPE OF INSULIN (switched from caninsulin to Prozinc 15/05/2019, that is about two weeks ago). Is this still the period of adjustment?

Another interesting thing the vet came up with was, he's concerned that I am using caninsulin syringes with the Prozinc. He reckons I should have switched to prozinc syringes. Well, both types are u40 syringes, so what can be the difference? He says it's to do with the diameter (of the needle? or the syringe?), and therefore it affects the dose; I'm not giving him the correct dose. But clearly, a difference of micromillimeters we're talking here. Galaxy's sugar is not going to be affected by a micro-milliliter difference in dose. Or is it? Do you also think I should change the syringes?

and my last question: what should I do about dosing?

I am sorry to pour it all over you guys, but I have literally no one else to ask, the forum has become my second home. (speaking of which, I called my mom, first thing she said, I should have Puss put down - I knew she wasn't the right person to ask to start with, but who do you go to when you're crying your eyes out with frustration and failure?)

 

[Diana&Tom]

I feel for you! It is incredibly frustrating when we try so hard and get so little positive results. I'm not going to attempt to answer your specific dosing questions - try the Prozinc forum for that - but I would say that the vet should be very concerned about the black numbers and the fact that whatever dose you give barely lowers them. It could be that Galaxy just needs much higher doses and you have to continue increasing steadily until you see a breakthrough, or, yes, it could be other health issues including something like acro which is a whole new ballgame. Have you asked the vet about that, or mostly just read about it here? Some vets aren't very clued-up on acro, although it is not uncommon, and if a test turned out positive there may be avenues you could pursue which would at least be better than crying in frustration.. I do understand, my Tom was an acrocat and I've been where you are. It is very difficult, but that was some time ago and things have moved on a lot. I am not saying it is acro, by any means, but it may be worth sounding the vet out at least.

Sorry I can't be more help but those are just my thoughts.

 

[Bron and Sheba (GA)]

Hi Edy
This is the place to vent your frustrations. We understand and empathise ..you are not a failure. You have just not found the right dose yet that will start moving the BSLs. Every cat has different needs as far as insulin doses go. And some cats do better on some insulins then others.
Where do you give most of the shots ? The scruff often has poorer absorption rates. If you haven’t tried other spots, try the abdominal walls.
You mention in the remarks column of the SS that Galaxy is drinking s lot, peeing a lot ( which is understandable with those high BSLs), not always eating, and is just lying down all day. Do you think he might be dehydrated? Does his scruff fall back quickly or slowly when you pull it up? And are his gums slippery or tacky.? If he is dehydrated, he would feel much better having some subQ fluids at the vet. They don’t take long to give.... 10 mins... and don’t require a hospital stay , just a normal vet visit.
I would ask for a test for pancreatitis also to eliminate that.
How are his teeth? They can contribute to high BSLs if a dental is needed.

I can’t help with Prozinc either but I will tag @Djamila for you. She is in the US so won’t be online until later but she is experienced with Prozinc and will be able to help you.
Are you testing for ketones in the urine? With those high numbers I would go to a pharmacy and buy a bottle of Ketostix and test the Urine. It’s a simple test. Just follow the instructions on the bottle. Anything above a trace of ketones needs a vet visit.
Hang in there. You have come to the best place to get help and support.
Bron

 

[vstarjewel]

Ok

Anyway, do you think it was too quick a raise from 2.50 to 3? Vet also says, it takes 2-3 weeks for a cat to adjust to a NEW TYPE OF INSULIN (switched from caninsulin to Prozinc 15/05/2019, that is about two weeks ago). Is this still the period of adjustment?

Another interesting thing the vet came up with was, he's concerned that I am using caninsulin syringes with the Prozinc. He reckons I should have switched to prozinc syringes. Well, both types are u40 syringes, so what can be OTE]

Ok my titles tend to be a bit dramatic, but I have been crying for three days now. If you look at our SS you'll see why. Clear case of insulin resistance ergo pancreas related issue and/or acromegaly.

Or can anyone tell why his numbers are going up in spite of the increasing dose? did I raise the dose too quickly? Should I go back to 2.50? he did show some promise of a downward trend there.

He can't be bouncing because he is INVARIABLY in the black range pre-shot, and DOES NOT go lower than red. So basically he spends most of his time in the black range. I soooo feel like swearing and throwing a tantrum!! I've never had such a sense of failure before! Every morning and evening I put him on the table, I'm thinking, OK, let's see, will it be in the red at least? Please be red or better; but nooooo, and what's even worse the number is even higher than before!!!?!?!?!? I feel so frustrated, and then I think of Puss, spending most of the day riding the high sugar, looking clueless, just staring in front of himself. And then I bawl my eyes out.

I spoke to the vet, and asked for a pancreatitis test. But that's not going to show tumor, is it, if it's a tumor.

Anyway, do you think it was too quick a raise from 2.50 to 3? Vet also says, it takes 2-3 weeks for a cat to adjust to a NEW TYPE OF INSULIN (switched from caninsulin to Prozinc 15/05/2019, that is about two weeks ago). Is this still the period of adjustment?

Another interesting thing the vet came up with was, he's concerned that I am using caninsulin syringes with the Prozinc. He reckons I should have switched to prozinc syringes. Well, both types are u40 syringes, so what can be the difference? He says it's to do with the diameter (of the needle? or the syringe?), and therefore it affects the dose; I'm not giving him the correct dose. But clearly, a difference of micromillimeters we're talking here. Galaxy's sugar is not going to be affected by a micro-milliliter difference in dose. Or is it? Do you also think I should change the syringes?

and my last question: what should I do about dosing?

I am sorry to pour it all over you guys, but I have literally no one else to ask, the forum has become my second home. (speaking of which, I called my mom, first thing she said, I should have Puss put down - I knew she wasn't the right person to ask to start with, but who do you go to when you're crying your eyes out with frustration and failure?)

FWIW, my cat was put on Prozinc at the end of April, and his glucose numbers are all over the place. They will be off the charts high in the morning when he hasn't eaten for 8 to 10 hours. Same thing just before dinner, I know he hasn't eaten anything for 3 to 4 hours but his sugar level is off the chart high again. I'm starting to think that we should have switched over his food first to see if that would have controlled his glucose without shots. There one or two other people who are on prozinc that report the same issues, makes no sense and is frustrating as all hell. You may want to go over to the prozinc forum and read some stuff there. I'm trying to be patient myself but it's maddening that none of this makes any logical sense. One thing for sure, you are certainly not alone

 

[Lisa and Witn (GA)]

Has the vet done any blood work and checked if a dental is needed? An infection or pain will increase glucose levels.

What insulin were you using before the ProZinc?

Also a U40 syringe is not insulin specific. The barrel may be different sizes but a unit is the same amount in all U40 syringes.. if you switch to a U100 syringe you do need to convert the dosage if you are using a U40 insulin.

 

[vstarjewel]

Vet also says, it takes 2-3 weeks for a cat to adjust to a NEW TYPE OF INSULIN (switched from caninsulin to Prozinc 15/05/2019, that is about two weeks ago). Is this still the period of adjustment?

Another interesting thing the vet came up with was, he's concerned that I am using caninsulin syringes with the Prozinc. He reckons I should have switched to prozinc syringes. Well, both types are u40 syringes, )

You didn't say, but why did the vet switch the insulin? And no, U40 syringe is a U40 syringe. The diameter of the needle has nothing to do with delivering the dose . . . you push the plunger, insulin goes in, regardless of sizes. I will say a smaller needle will be more comfy for the recipient, but it would be a huge change.

 

[CandyH & Catcat]

have been looking at U-40 syringes -- discovered that, unlike what I initially thought, I've been using what the vet sold me, 1/2 cc syringes, not the .3 cc syringes with the "nice" half unit markings .. so, while the U40s aren't specific as to type of insulin, it IS easier to measure small doses with the .3cc rather than the .5cc (mine doesn't have half unit markings, I've been eyeballing it -- and hubby went to Harbor Freight and bought me a digital caliper for use, to increase the precision with small doses

 

[Galaxy (GA)]

Has the vet done any blood work and checked if a dental is needed? An infection or pain will increase glucose levels.

What insulin were you using before the ProZinc?

Also a U40 syringe is not insulin specific. The barrel may be different sizes but a unit is the same amount in all U40 syringes.. if you switch to a U100 syringe you do need to convert the dosage if you are using a U40 insulin.

He had a tooth extraction under gen. an. a month ago, recovered beautifully from that. I've been checking his teeth since, it's the usual plaque building but I'm looking into getting his dental care sorted, I can do it myself, like brush and the toothpaste specifically for pets. He's not exhibiting any pain, I do know when he's in pain, saw it when he was home after the extraction. nothing like that anymore (yowling when eating then turning away from the food, leaving it).
we switched to prozinc from vetsulin/caninsulin 15/05/2019. had no results with canisnulin, none to speak of. huge peaks and not low enough lows also never lasted long enough. 7-8 hours into the cycle he was back where we started.

 

[Galaxy (GA)]

have been looking at U-40 syringes -- discovered that, unlike what I initially thought, I've been using what the vet sold me, 1/2 cc syringes, not the .3 cc syringes with the "nice" half unit markings .. so, while the U40s aren't specific as to type of insulin, it IS easier to measure small doses with the .3cc rather than the .5cc (mine doesn't have half unit markings, I've been eyeballing it -- and hubby went to Harbor Freight and bought me a digital caliper for use, to increase the precision with small doses

same here, have no half markings, have to eyeball it... nice SS, yours, I wish I could see those colours on ours... I know it's not green like we want them but still, yellows are at least some hope, aren't they?

 

[CandyH & Catcat]

we're hoping things will stabilize, that he'll stop bouncing (if that's what's happening) or at least bounce less -- will hang in with vetsulin until I have a chance to discuss with vet, possibly adjust dose -- now that I know I can switch to Lantus, that may be the answer instead, we will see

 

[Galaxy (GA)]

Where do you give most of the shots ?

I have recently started injecting him on the left and right shoulder, alternating, and the side of the belly but I felt uncomfortable about the latter, so will do shoulders for now. His scruff has felt a lot thicker as well lately, so it did occur to me too, and read articles that recommended site change as well.

Do you think he might be dehydrated? Does his scruff fall back quickly or slowly when you pull it up? And are his gums slippery or tacky.?

His skin sort of slides back, so I guess that's kinda dehydrated. I also put a lot of water in his wet food, he loooves that. When I still gave him the diabetic dry as main meal (before I found the forum), I used to turn it into a 'biscuit soup' by soaking it in water. anyway, I know drinking a lot doesn't mean staying hydrated. I might need to look into what you suggest about the subcutaneous hydration thing.

I would ask for a test for pancreatitis

I have told the vet that I want one. I'll book him in as soon as he tells me the cost.

How are his teeth?

he recently had an extraction, recovered quickly. I have yet to get the home toothbrushing kit for him. I am actually looking forward to doing that...

Are you testing for ketones in the urine?

at least once a week, with the urinalysis dipsticks. always negative. on the other hand, I seem to remember (though might be wrong), that dandruff, of which he has LOADS, is a sign of keto? not sure... but his urine tests always come out negative.

thanks for all the feedback, I am feeling better, Puss is looking less clueless today... and we were just under 39 for the PMPS WOW!

 

[Bron and Sheba (GA)]

Dandruff is not a sign of ketones but it can be a sign of dehydration. My Sheba was always a bit dehydrated after she fell out of remission and stayed in high numbers for ages and her dandruff was bad at times. It improved as time went by when her numbers improved and her hydration improved.
The blood test for pancreatitis is the fPLI. It’s a simple blood test and should not be expensive. You can get an in-house test done which is cheaper which will just tell you yes or no, or you can get a bit more expensive one done which will tell you how severe the pancreatitis is.
That’s great you are testing for ketones.
I clean my cats teeth each night. One cat would never let me but Harry is very cooperative and his teeth are lovely. It takes time for them to get used to it so just go slowly with it.
I’m glad you are feeling better. You will get there, sometimes it takes a while.

 

[Lisa and Witn (GA)]

If he is dehydrated, you can ask your vet for subq fluids that you can give at home. I know when my diabetic cats needed fluids they also helped lower the BG levels.

 

[CandyH & Catcat]

re dandruff -- Catcat had a lot too, change in food helped some (initially I thought wheat allergy which is why our dog had dandruff), but it didn't start to clear up until I started adding turmeric and extra virgin olive oil to his two main meals -- now I rarely see a flake unless I dig for it -- combo of Omega and the many small effects of turmeric (I take it as a cancer survivor) seem to have helped, I also use dried sardines as a treat, those have Omega 3 and 6 plus micronutrients from the bones; hydration hasn't been a problem for him, I turn his pate into sloppy gravy because he has trouble lapping liquids up, congenital tongue issue

 

[Djamila]

Hi Edy - I'm so sorry to hear your frustration and wish I could give you a hug. As we talked about when you switched insulin, dropping the dose back to 1u was not going to be helpful. You still aren't even to the dose you switched at, and it was clear that even that dose wasn't enough. You have to raise the dose back up. Even at nearly 5u on vetsulin, you weren't seeing a real curve, which means that you're going to need to go at least that high, and likely higher on prozinc as well. Is that a lot of insulin? yes. It is more than most cats need? yes. But the thing is - a cat needs what it needs. It doesn't matter how much other cats need. It matters how much Galaxy needs.

Originally you were told to increase the dose by 0.5u every third cycle. So just to be clear, there are two cycles each day. AM is one cycle, and PM is the second cycle. Because it's already been a couple of weeks, I'm going to amend that a bit and suggest you increase the dose by a full unit tomorrow. And then on Sunday morning, increase by 0.5u. That will get you to 4.5u. It still won't be enough, but it gets us into the ball park to start making more systematic increases.

Galaxy may well be a high dose cat. The good news is that you are in the UK, so may have access to the RVC - the best place in the world for high dose cats. But one step at a time. Let's work the dose for Galaxy and see if we cant' get some better numbers to appear.

 

[Galaxy (GA)]

@Djamila , thank you for your input and support. I like your voice in my head (I mean when I read your posts.) I am a bit reluctant to increase dramatically - a whole unit would be dramatic I think. It seems to me that whenever I increased, even from little doses by half or eye-ball quarter, numbers shot up like crazy. I am booking the cat in for tomorrow for a rehydration and to do the pancreatitis and IGF-1 tests. I don't trust the vet's knowledge much on the topic of feline diabetes YET, but hey, if I keep telling him stuff, he might also learn (I know, I'm only half serious.); but I want to hear what he has to say about dosing. So, I'm going to keep it 3 units b.i.d. for tonight and see what he says tomorrow. Also feeling a bit more confident as his latest +4 was down to pink! 21.5!

 

[Georgiana & Perlutz]

Hi Edy, I can't give dosing advice and such, I'm relatively new to FD and I'm asking for help myself these days but I just wanted to tell you I know exactly how you feel! We have constant reds and blacks and I go through the same feelings of despair at not being able to help out my lil guy but we just need to hang in there and keep fighting the FD, we will also get those yellows, blues and greens one day!

I think you've had a very good idea to test him for pancreatitis. you said Galaxy gets dandruff and I've been putting two and two together last night - in my pyjamas since 7 PM, eating icecream, spreadsheets on my laptop and coffee table covered in sticky notes and although I haven't come up with much, I found that when Perlutz has some sort of pancreatic flare up he has less appetite for 1 day or 2, his coat gets dull and dandruff appears. As soon as he gets better, the dandruff is gone, very few flakes left sometimes and his coat is shiny and soft again. I'm not saying he has pancreatitis but if this turns out to be the case, try to be positive, at least you know more about what could be the cause of the constant blacks and hopefully how to get rid of them.

I'm also in UK and as there's not that many of us here I'm always glad to see another UKer as we don't always get the same foods, medicine etc as in other parts of the world.

I'll be checking for your updates

 

[Lisa and Witn (GA)]

@Djamila I don't trust the vet's knowledge much on the topic of feline diabetes YET, but hey, if I keep telling him stuff, he might also learn (I know, I'm only half serious.); but I want to hear what he has to say about dosing. So, I'm going to keep it 3 units b.i.d. for tonight and see what he says tomorrow. Also feeling a bit more confident as his latest +4 was down to pink! 21.5!

There are a lot of vets that do learn new things from their pet owners. A few things I taught my vet when I had diabetic cats:

1) When the original PZI was discontinued, BCP was able to replicate a similar PZI insulin for pets and offered a sample vial free for new patients. They still do offer the sample vial in case anyone is considering trying it. https://bcpvetpharm.com/request-your-free-samples/

2). That can you can use almost every drop of insulin if Lantus pens are used instead of vials. Instead of using the needles for the pens, use syringes to withdraw the insulin.

3) Every cat and shot is different. This was for a new vet in the clinic who "tried" to tell me testing before every shot was not needed. I had two diabetic cats at the time and each was tested with their own meter. Both were on the same insulin and dose. Once a week, usually on different days, their preshot reading would drop to a non-diabetic number. I was able to download their readings directly from meters to my computer and every week provided a printed report to this vet. She eventually agreed that I knew what I was doing. Not sure if she really learned anything. She did not last very long at that clinic. But the other vets were very impressed with the amount of data I was able to provide to them.

4) FDMB is a great resource for anyone that has a diabetic cat. Their office started referring their owners to this site when their cats were diagnosed with FD.

All of this was a result of the knowledge I gained from FDMB.

 

[Galaxy (GA)]

If he is dehydrated, you can ask your vet for subq fluids that you can give at home. I know when my diabetic cats needed fluids they also helped lower the BG levels.

just been to the vet, Puss was absolutely lovely, vet is always amazed how placid he is. got the subq fluids, did 20 mls twice, then let me do a third, so now I know how to do it, YAY! got a bagful of fluids and some needles and syringe. he said to do it once a day but is that really necessary? then we settled on 40 mls every other day.

Also got him toothpaste and -brush, to do once a week.

 

[Galaxy (GA)]

Hi Edy - I'm so sorry to hear your frustration and wish I could give you a hug. As we talked about when you switched insulin, dropping the dose back to 1u was not going to be helpful. You still aren't even to the dose you switched at, and it was clear that even that dose wasn't enough. You have to raise the dose back up. Even at nearly 5u on vetsulin, you weren't seeing a real curve, which means that you're going to need to go at least that high, and likely higher on prozinc as well. Is that a lot of insulin? yes. It is more than most cats need? yes. But the thing is - a cat needs what it needs. It doesn't matter how much other cats need. It matters how much Galaxy needs.

Originally you were told to increase the dose by 0.5u every third cycle. So just to be clear, there are two cycles each day. AM is one cycle, and PM is the second cycle. Because it's already been a couple of weeks, I'm going to amend that a bit and suggest you increase the dose by a full unit tomorrow. And then on Sunday morning, increase by 0.5u. That will get you to 4.5u. It still won't be enough, but it gets us into the ball park to start making more systematic increases.

Galaxy may well be a high dose cat. The good news is that you are in the UK, so may have access to the RVC - the best place in the world for high dose cats. But one step at a time. Let's work the dose for Galaxy and see if we cant' get some better numbers to appear.

So, just popped down to the vet, Galaxy was prodded and probed and felt up, lol, got rehydrated and I have been taught how to do it at home. While I was in there, he was on the phone to, not sure, but sounded like some big guns, veterinary lab, or some kind of authority, they were asking all sorts of questions about my cat! and they advised the vet, who by then had received our SS so has access to our data, that these increases were too sudden. and that the cat needs time at least two weeks to adjust to new doses. Which makes sense, looking at the numbers. So I'm going to stick with 3 units for another week or two, then do a curve. If it takes us long, so be it. Vet also likes to say, high BG is of course not good but not as dangerous as hypo. if we can get down to mid-yellow numbers to start with, I'll be happy.

 

[Lisa and Witn (GA)]

By you doing your own curves you will know how well the dose is working. It is more accurate than the one at the vet since stress will not cause the glucose levels to be higher.

 

[CandyH & Catcat]

many years ago I had a poster in the room where I answered a crisis line -- showed a rope hanging down, kitten clinging on
"when you get to the end of your rope, tie a knot and hang on"

also thought -- if you are at the end of your tether, give it a swing and let's play tetherball --

sometimes must laugh, easier on the mind than crying ...

 

[Lisa and Witn (GA)]

many years ago I had a poster in the room where I answered a crisis line -- showed a rope hanging down, kitten clinging on
"when you get to the end of your rope, tie a knot and hang on"

also thought -- if you are at the end of your tether, give it a swing and let's play tetherball --

sometimes must laugh, easier on the mind than crying ...

Great advice. We need to remember that for all of our stressful moments.