? Dosing Help with history of DKA, vet wants to go from 2iu to 3iu

Kate & Toby

Kate & Toby

Member Since 2019
Hi All,

I have sent the specialist referral vets the data from over the weekend and this is what she has said:

"Thanks for sending this curve. I am very glad that Toby is feeling well at home although I am disappointed by his curve on Sunday. I recommend that you increase his dose to 3IU twice daily. At this degree of hyperglycaemia we run the risk of him developing DKA again and neither of us want that for him. I recommend that you don’t curve him for another 5-7 days as we need to allow that time to assess the response to the new dose but if you are able to check one or two glucose’s at around 6-8 hours after injection during the day then that is a precaution against him going too low. I imagine this might be hard with work so let me know what you are able to do."

I am really nervous about going from 2iu to 3iu in one go, but I am also super nervous about DKA, I feel stuck, could anyone offer any help on dosing please?
 
Idjit's mom said:
I have not used Prozinc, and can't advise on dosing Kate, but I would be very nervous about raising the dose by a whole unit too. Hugs!

@MrWorfMen's Mom
@Diana&Tom

Hopefully someone much wiser and more experienced than I can chime in with useful input.
Click to expand...
I'm not one of the dosing experts here either but I'm sure Linda will advise.

Personally, I'd usually say that yes, an increase of a whole unit at a time is too much. Yet you don't want to keep seeing those nasty blacks for much longer. I might be tempted to go for 2.5u and get a few tests in (not a complete curve) and see where that takes you.
 
Vet's comments are exactly what I expected.:rolleyes: I agree you need to get BG down but I don't agree with raising dose by a full unit nor do I agree that always testing between +6 and +8 post shot is going to give you the data you need.

Given BG is high you could increase the dose to 2.5u BUT you need to be able to test periodically and not just in the timeframe the vet is suggesting. Nadir (lowest point) with ProZinc occurs any time between +4 and +7 in most cats and that lowest BG is the information you need to determine a safe/best dose for Toby. I'd hold the dose for 3 days (6 cycles) barring any low BG or pre-shots too low to shoot and then increase to 2.75u if need be. The problem with increasing by a full unit is that you might skip right over the best dose or Toby's BG could go too low. Better to increase slowly and methodically.

Tests anytime are helpful so if you can only get a +2 or +3 it will give you clues as to where BG is headed.

If you are worried about the vet, just tell her you are concerned about dose going up too fast and will give 2.5u for a few days to see how that works. You hold the needle and have to be comfortable with what you are doing.

Keep testing for ketones and taking note of behaviour as you have been doing. As long as ketones stay negative and appetite/demeanour are good Toby will be fine.
 
Just a curiosity......did you provide the vet with the BG info from the 7th or just the curve on the 8th? Those cycles are two totally different pictures so if vet only saw the 8th, I'd give her the 7th data too and I would hope based on that, she'd agree an increase to 2.5u is sufficient/safer at the moment.
 
MrWorfMen's Mom said:
Just a curiosity......did you provide the vet with the BG info from the 7th or just the curve on the 8th? Those cycles are two totally different pictures so if vet only saw the 8th, I'd give her the 7th data too and I would hope based on that, she'd agree an increase to 2.5u is sufficient/safer at the moment.
Click to expand...
I send her the spreadsheet we use here, so she saw 7th too... which I was actually quite pleased with and gave me hope! Sadly I think she has just made her dosing opinion on the 8th
 
MrWorfMen's Mom said:
Vet's comments are exactly what I expected.:rolleyes: I agree you need to get BG down but I don't agree with raising dose by a full unit nor do I agree that always testing between +6 and +8 post shot is going to give you the data you need.

Given BG is high you could increase the dose to 2.5u BUT you need to be able to test periodically and not just in the timeframe the vet is suggesting. Nadir (lowest point) with ProZinc occurs any time between +4 and +7 in most cats and that lowest BG is the information you need to determine a safe/best dose for Toby. I'd hold the dose for 3 days (6 cycles) barring any low BG or pre-shots too low to shoot and then increase to 2.75u if need be. The problem with increasing by a full unit is that you might skip right over the best dose or Toby's BG could go too low. Better to increase slowly and methodically.

Tests anytime are helpful so if you can only get a +2 or +3 it will give you clues as to where BG is headed.

If you are worried about the vet, just tell her you are concerned about dose going up too fast and will give 2.5u for a few days to see how that works. You hold the needle and have to be comfortable with what you are doing.

Keep testing for ketones and taking note of behaviour as you have been doing. As long as ketones stay negative and appetite/demeanour are good Toby will be fine.
Click to expand...
Thank you, I will do his pmps in one hour and and if still high will go with 2.5 and have a long night ahead of me! Thanks again Linda x
 
Kate & Toby said:
Sadly I think she has just made her dosing opinion on the 8th
Click to expand...
Doesn't surprise me. I don't think most vets have the foggiest idea of how to read a SS. All they see are "HI" and then take a sledge hammer to it with no regard for how low a dose might be sending BG or why those highs are occurring. Bouncing is a foreign concept for most of them. :mad:
 
MrWorfMen's Mom said:
Doesn't surprise me. I don't think most vets have the foggiest idea of how to read a SS. All they see are "HI" and then take a sledge hammer to it with no regard for how low a dose might be sending BG or why those highs are occurring. Bouncing is a foreign concept for most of them. :mad:
Click to expand...
This is the specialist internal medicine vet too with a specialism in endocrine disease! So not even my normal every day vet.
 
Sadly, still not surprised. There are lots of specialists around who don't seem to have a good handle on feline diabetes. My girl had a high dose condition and I had a specialist at some well respected vet school in Texas consult on her case through my vet and got a whole bunch of ridiculous recommendations back, none of which helped in the least and some which were just plain stupid or had already been done. I figured out what the problem was and thankfully my vet worked with me as a partner not a dictator.
 
It really does beggar belief that so few vets really understand FD and its treatment... although, being kind, we might suppose that this vet is just very anxious to avoid another DKA incident and reckons that Toby's numbers are high enough to warrant more insulin... she must know the associated risks of giving too much though - has she given you any info about what to do in the event of him going too low, I wonder? Has she even discussed with you what "too low" a number is? If not it might be an idea to have a chat with her - not trying to catch her out (quite the opposite, it would be nice to see her come up with responses that we would agree with) but if she really doesn't have much of a clue then you know that you're safer listening to the experts here.

Also - I'm sounding more and more like bad cop, sorry ;) - could you try to keep your spreadsheet as up to date as possible, so if you do have any queries we can all see straightaway what's going on? It's all about numbers on this site!

Keep smiling, Kate - you're doing really well and it does get easier :)
 
Hi @MrWorfMen's Mom Linda, Toby's spreadsheet was a huge improvement overnight. His Amps was 16.4, no food. I'm out for the day should I shoot or no shoot and how much?
I need to leave soon if someone could reply that would be amazing as im way out of my depth.
 
Linda is watching 3 other kitties that seem intent on dropping to low numbers tonight, all at once! :cat:

ETA removed tag, not needed.
 
Last edited:
Hi Kate,

Wow! I thought that might happen. It's good news. I'd knock the dose back down to 2.0u and leave food out for Toby to eat in your absence.
 
Thanks everyone. You guys are literally amazing. I'll go with 2iu, leave food and send my mum in for a check on him at +6 and I have my cameras. Phew!

Thanks again, I was lost and you were there xx
 
Evening all,

I'm really confused and nervous about our numbers, he was so brilliant overnight and amps looked great, but then our pmps was SO high again, and we are back in the nasty blacks, so I went back to the vets 2.5iu.

He is happy in himself, maybe a bit quieter than usual, eating brilliantly. Is this rollercoaster normal? I feel like I live and breathe the spreadsheet and watch him constantly. X
 
Kate, I was just checking to see how Toby did today.

I see he's really high again tonight and that I believe is likely another bounce from the lower numbers on the night of the 10th and possibly also from today. He started today much lower than previously so it's not a reach to think his BG could have dropped to blue again today.

I see you increased the dose again tonight to 2.5u and while intuitively that would seem to indicate he needs more insulin, that may not be the case so it's really important to give a dose consistently and hold it for long enough to see how it is affecting BG. I'm sorry I didn't make that clear this AM and I'm sure you thought the lower dose would just be a one time thing. :(:oops:

Giving too much insulin can cause those high numbers because it causes the BG to drop either quickly or to levels Toby is no longer accustomed to. He's used to high BG and when his body perceives his BG dropping relative to what he's used to, it pumps out other hormones that make his body release sugar stores to bring his BG back to what it considers safe. Essentially, Toby's defense system is overreacting and needs to re-learn what is normal.

It looked to me like the 2u dose was actually working well to bring his BG down to much better levels but even that dose caused him to bounce. Bouncing is normal and you can't avoid it however, easing the dose up slowly and methodically can help to limit to a certain degree and it also ensures you won't skip right over the ideal dose for Toby.

For now I encourage you to stick with the 2u dose for at least 3 days and see if he settles a bit and find out how low he is going on that dose. Then if need be, you'd increase it to 2.25u. Small changes can have a big effect.

Please test Toby again tonight. While his BG may be up now, he may drop more a bit later.
 
MrWorfMen's Mom said:
Kate, I was just checking to see how Toby did today.

I see he's really high again tonight and that I believe is likely another bounce from the lower numbers on the night of the 10th and possibly also from today. He started today much lower than previously so it's not a reach to think his BG could have dropped to blue again today.

I see you increased the dose again tonight to 2.5u and while intuitively that would seem to indicate he needs more insulin, that may not be the case so it's really important to give a dose consistently and hold it for long enough to see how it is affecting BG. I'm sorry I didn't make that clear this AM and I'm sure you thought the lower dose would just be a one time thing. :(:oops:

Giving too much insulin can cause those high numbers because it causes the BG to drop either quickly or to levels Toby is no longer accustomed to. He's used to high BG and when his body perceives his BG dropping relative to what he's used to, it pumps out other hormones that make his body release sugar stores to bring his BG back to what it considers safe. Essentially, Toby's defense system is overreacting and needs to re-learn what is normal.

It looked to me like the 2u dose was actually working well to bring his BG down to much better levels but even that dose caused him to bounce. Bouncing is normal and you can't avoid it however, easing the dose up slowly and methodically can help to limit to a certain degree and it also ensures you won't skip right over the ideal dose for Toby.

For now I encourage you to stick with the 2u dose for at least 3 days and see if he settles a bit and find out how low he is going on that dose. Then if need be, you'd increase it to 2.25u. Small changes can have a big effect.

Please test Toby again tonight. While his BG may be up now, he may drop more a bit later.
Click to expand...
Thanks Linda, I understand. I'll test throughout the night again, and should be able to get a few tomorrow. I was just scared of such a high pmps, but I will go back to 2 and hold steady.

Thank you for having our backs and being there. X
 
So I did a few tests overnight, when I did the 2.30am test (+7) all the dry food I leave out had gone, although it's low carb and not a huge quantity I think it has caused a big spike, I have made the decision to remove all dry food for the time being so I know that food is having no influence.

I have got my dad popping in today to do a couple of tests and put out some wet food, tomorrow I can use the auto feeder. The trouble I have is I have a very greedy other cat who eats everything I put down, so when Toby is ready its usually all gone!!

I will update spreadsheet as I get the readings come through.
 
That's interesting. Do you know what the carb % is for the Thrive dry food? If memory serves it is definitely over 10% although it's one of the lower carb dry foods. I think you have the same situation in the UK that we have in Canada......there is no dry food available under 10% carbs. Better to get Toby onto an all wet food diet but you need to be sure Toby will have food if he needs it especially now as he continues to recover and you get his insulin needs sorted. There are feeders you can get that will only open for a specific cat that is identified through either an implanted or external microchip on a collar although they tend to be pricey.
 
Yes, Thrive dry is around the 10% mark.
If you're removing all dry food, remember that this might reduce the amount of insulin required so be specially vigilant about testing. You could also make a note of this in the remarks column of the ss.
 
@Kate & Toby My boy was dx and started ProZinc the same day 27 August. He has been on 2u and just the past few days had AMPS and PMPS in the 500-650 range. I lowered his dose to 1.5 this morning to see what that does, but I can't check his BG until I get home from work 10hrs from now...I can empathize with how you're feeling. Hang in there!
 
Morning all,
Toby has had an OK few days, he is very chipper in himself, eating and drinking plenty, and being by my side at all times.
I have tested for ketones and NOT even a trace which makes me a very happy cat mom ;-).

His levels remain high at PM/AM and whilst my data in between is limited it's enough to see he's not dropping enough. I was thinking of going to 1.25iu tonight, do you think this would be a good idea?

In other news, he has become very stroppy and grumpy about having his heart tablet, I haven't been able to get it into him for 2 days now, his normal chilled out demeanour has gone and he is feisty! Just testing him for BG is enough, and when I hold him for his tablet I can feel his heart pounding and I am terrified I am stressing him out too much. I have put it in his food this morning but I think he avoided it, such a pain and I don't know what to do.

I am having a half day at work today so will get a reading at +8, and can get some more data afterwards if I increase the dose.

Thanks in advance as always for all your words of wisdom and support.
 
Kate & Toby said:
I was thinking of going to 1.25iu tonight, do you think this would be a good idea?
Click to expand...

I assume you mean you are considering increasing to 2.25u?;) I agree. It looks like he does need a bit more insulin.

Yeah for negative ketones and the "full" cat report.

As for the pill, it never ceases to amaze me how all of a sudden cats who were previously quite co-operative about pilling, will decide they're not going to make it easy anymore. Do you happen to know if the pill is bitter? I think sometimes the problem is that if the pill doesn't go down right away one day and they suddenly taste it, they immediately start fighting it. Have you tried wrapping the pill in bit of food/treat of some sort to see if that helps?
There are also "pill guns" (not sure of technical name) that some folks find helpful.
 
MrWorfMen's Mom said:
I assume you mean you are considering increasing to 2.25u?;) I agree. It looks like he does need a bit more insulin.

Yeah for negative ketones and the "full" cat report.

As for the pill, it never ceases to amaze me how all of a sudden cats who were previously quite co-operative about pilling, will decide they're not going to make it easy anymore. Do you happen to know if the pill is bitter? I think sometimes the problem is that if the pill doesn't go down right away one day and they suddenly taste it, they immediately start fighting it. Have you tried wrapping the pill in bit of food/treat of some sort to see if that helps?
There are also "pill guns" (not sure of technical name) that some folks find helpful.
Click to expand...

Doh!! Yes 2.25iu, sorry!!

I think you have hit the nail on the head, he has tasted it and now is massively put off. I will try with some Tuna when he's really hungry tonight! It's so strange, I have never seen him like this, he is the most laid back cat ever but he is having none of it right now!!
 
3.1 at +5..... I am very worried. Have given food and re-testing in 10 mins.

Eaten well, half a pouch and 10 pieces of kibble.

15 minutes later and we are 2.8

I have glucose syrup ready. Hes not showing any signs at all, in fact seems brilliant, im scared.

So left it another 20 mins and we are rising.... 3.9... and breathe. I'll retest in another half an hour
 
Last edited:
Thanks Lou. Laptop now on, spreadsheet updated.

I've just retested and hes back down to 3.2 I've given more food and a few more pieces of kibble.

He is absolutely fine, loving the extra food!
 
Last edited:
What are you feeding him, low carb, medium carb, a mixture? He is probably approaching or at the nadir I hope.
 
Red & Rover (GA) said:
Can you get another test in? On an AlphaTrak, you want Toby above 68 (3.8).

Lou, the kibble, according to Diana (& Tom) is roughly 10%.
Click to expand...
on her ss comments she said she had taken him off kibble 10/9 but maybe is using it to bring him up.
She doesn't stay online between posts, I think she's on her phone.
You are right about the AT..but she has been down this road just a few nights ago, hopefully is repeating what she did before.
 
Hi guys sorry, yes I'm in my phone.

He did really good, numbers were low but steady all night, I've just done his Amps and its 5.1.

I gave him the biscuits to try and bring him up a bit. The food was sheeba, so low carb, I was in a panic and couldn't remember what food I had was high carb so went with any food is a good thing. I need to be more prepared for nights like this.

Hes very chipper and hungry this morning,so I've fed him. I need to leave for work in about 2 hours, so have some time to decide about whether to shoot or not.

Thank you all, that was a very long night for us.
 
OH I am so glad to hear Toby is OK. :joyful: Had us worried.

Keep in mind that low BG can make kitty a little more sensitive to insulin for a cycle or two so if you want to reduce a bit more (perhaps 1.75u) for today's cycle. Thereafter new dose should be 2u. Looks like he tricked us into thinking he needed more fuel. I think you are now seeing the results of removing the dry food from the picture.

Some folks use a marker to write the % of carbs in the canned foods on the bottom of the tin. Easier than trying to remember or rummage when Toby gets the adrenalin going! ;)

ETA I would not shoot this AM unless BG is 11 or higher.
 
Thanks Linda, he had us all on that rollercoaster! Little devil! So great to see him looking and feeling so well though. Good call on the marker.

So I still give him insulin today? Even with such a low number? This is totally new territory for us and I have no idea...apologies for all the questions.
 
MrWorfMen's Mom said:
Kate I just added another note about not shooting unless Toby is 11 or higher. Not sure if you saw it thus this echo!
Click to expand...
We crossed, yep got it.

How do I know if hes high because of his breakfast or high because he needs insulin? I'll be out for a good 8 hours today with only my spy cams to monitor him.
 
High isn't going to hurt him for a cycle. Today since you aren't going to give insulin, check his BG again after his breakfast and that should tell you roughly how much food raises his BG with that particular food choice. You'll never know for sure how much is food and how much is BG rise and with that low and no insulin he's bound to be high tonight. He'll get back on track soon enough.
 
MrWorfMen's Mom said:
High isn't going to hurt him for a cycle. Today since you aren't going to give insulin, check his BG again after his breakfast and that should tell you roughly how much food raises his BG with that particular food choice. You'll never know for sure how much is food and how much is BG rise and with that low and no insulin he's bound to be high tonight. He'll get back on track soon enough.
Click to expand...
Linda, at what would have been +2 he was 9.4 so I left him with some more food and I will keep an eye on him on the cams, my mum will pop in and check on him also later, but she can't test.

I am a bit perplexed as to why 2iu was too low but 2.25iu was too high in terms of a dose...where does this leave me?
 
There are kitties who are very sensitive to even small dose changes. It could also be that those higher numbers you saw were a bounce from some lower BGs that didn't get caught with the testing that had been done in which case the 2u may turn out to be the right dose. That's why we always suggest dose changes get done when you can monitor.

If Toby is sensitive to dose changes, the insteas of drawing insulin right on the 2u line, you would draw it up to the bottom the 2u line. We'd call that a fat 2u dose. If you wanted shave a bit off a 2u dose, you'd draw insulin to the top of the 2u line. It's finicky but it can make a difference for some kitties. :)
 
MrWorfMen's Mom said:
There are kitties who are very sensitive to even small dose changes. It could also be that those higher numbers you saw were a bounce from some lower BGs that didn't get caught with the testing that had been done in which case the 2u may turn out to be the right dose. That's why we always suggest dose changes get done when you can monitor.

If Toby is sensitive to dose changes, the insteas of drawing insulin right on the 2u line, you would draw it up to the bottom the 2u line. We'd call that a fat 2u dose. If you wanted shave a bit off a 2u dose, you'd draw insulin to the top of the 2u line. It's finicky but it can make a difference for some kitties. :)
Click to expand...
Thanks Linda. As expected, he was super high pmps, I shot 2iu, he's been eating like he's never seen food and is very happy, albeit was a bit sleepy at pmps. Just about to test +4....
 
Hello all,
Toby has had a fantastic day. I'm having laptop issues so cant update spreadsheet at the moment, it's a work in progress but today has looked like this.

AMPS 25.9
Shot fat 2iu

+6 14.9
+8 10.5
PmPS 13.4

I was worried 13.4 was too low, so I've stalled and just retest, and I got 13.2.

My question is shoot or no shoot? Fat or skinny?

Thanks in advance x
 
Looks like the bounce from those lows the other day is clearing.

I think you are fine to shoot a regular 2u dose as long as you can get a +2 and a before bed test. That way if Toby seems to be dropping quickly you can steer him with food early in the cycle.
 
I'm in all night so can test away, his ears have even learnt to bleed now and testing is going well. I also managed to do the treat trick with his tablet = treat tablet treat, worked a treat!

Thanks Linda, forever grateful.
 
You must log in or register to reply here.
Back
Top