Panter is in trouble

Panters-mom

Panters-mom

Member Since 2020
Panter didn't show up for his morning shot yesterday. He had eaten his nightfood though, at around 2-3. So up to this time everything is normal. Found him under the bed later on around 18-19, not in good shape. Don't know how long he has been there. But strangely his BS was 21.2 (+12) - like his 'normal'... He didn't want to eat or drink, just laying still. I made him a litterbox, but he didn't want to use it. He wanted to go out several times. In the end -in the middle of the night, I had to follow him out, and he disappeared in the dark...hasn't returned... and I'm soo worried... The strange thing is that I kind of thought we were on the right track with this new insulin - he is still high, but it has started to work, he is down in yellow, sometimes blue area on nadir. And he is - was - in good shape, hunting, playing, purring, friendly, very normal. I'm afraid it is something else. Organs failing or something... Any thoughts?

Best regards, Gøril.
 
He is getting his insulin very regular every 12 hour at 7am and 7pm. And he actually normally meets up everytime, ready on the table. Been taking this extremely good. The other numbers you see are just testing BS to make a curve.
 
My big worry now is, as our vet is afraid of, that it should be more than diabetes, and the condition of acromegaly. He been very well - with other words, acting very normal, but with high BG. We've been struggling to get the BG down. The reason for that we changed insulin from insulatard to PZI. And it was going in the right direction. But suddenly, yesterday, he crashed. Anybody that has experience in acromegaly?
 
Panter is home, and he is in pretty good shape and very humgry - as normal...very strange. Maybe it was something he ate... I don't know. Anyway he is home safe. BG high - 24.2, not a surprise though. Thanks for the prayers.
 
To be on the secure side for now, should I reduced the insulin back to 3u again - in case this incident had something to do with a bounce too low too fast...? He was on 3u for two weeks, but still up in red and purple area and purple and yellow mostly on nadir, then we increased to 3.2 (8u in a 100syringe) - but maybe too high? He was down in blue area on nadir - but maybe too fast...?
 
YES for sure - they know how to make you worry...puhhh... :-) Unfortunately I have never tested keytones. Don't know how, as he has never used a litterbox... I tryed to ask for this double tester (BG+keytones) at the farmacy, but he didn't know what I meant...
 
Hi Goeril, haven't seen a post from you in a while. Hope all is well with you and your husband there in Norway, and your other 2 kitties.

TempestsMum said:
Too much insulin often looks like too little. I’m very much of the start low and go slow Ilk.
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Not really. That is something that is said far too often, that too much insulin looks like too little.
If Panter does have ketones, resetting the dose to 1U is the absolutely wrong thing to do.

As too little insulin + too little food + infection/inflammation in a cat is the classic setup for DKA (diabetic ketoacidosis).

Panter is getting down into the blue range numbers (5.6 - 11.1 mmol/L; 100-199 mg/dL) with the 3U of Prozinc, so I do not think you want to reset the dose, or decrease it at this point.

TempestsMum said:
If I felt it was safe to do so, I would drop him down to 1U on the proper ProZinc syringes and allow him to stop bouncing.
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Using U100 syringes with the conversion chart, actually lets Goeril adjust the dose for Panter in finer increments. We've had a conversion chart to do that on our website for decades. Or you simply multiply the U40 dose by 2.5 to get the amount to measure in the U100 syringes. Since Prozinc insulin is a U40 insulin and is less concentrated than a U100 insulin, it's easy to use U100 syringes to measure the dose. There is even a printer friendly version of the U40 to U100 conversion chart.
http://www.felinediabetes.com/insulin-conversions.htm

Since Panter is an outdoor cat, he does not have a litter box inside and uses the outdoors to urinate. Impossible for Goeril to use a urine dipstick to test the urine.

Goeril, could you order a blood and ketone meter by mail order? Plus the test strips to go with it?

Pre-shots are the very last numbers to come down with Prozinc, and with most insulins. It's the mid-cycle numbers that we use, in conjunction with giving the pre-shot numbers a little bit of consideration, for dose adjustments.

@TempestsMum You might wish to look at the Prozinc dosing protocols sticky, that was re-written and updated in February 2020.
 
TempestsMum said:
I will bow out for a bit while I catch up I think, as I certainly don’t wish to tell someone the wrong thing..
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Please don't bow out. There are too few people here helping on the Prozinc ISG forum.

There needs to be multiple voices here, helping people out. Please keep lending your opinion. I certainly don't know everything, and never will.

Since the main advisor, @MrWorfMen's Mom left in January 2020, due to the death of one of her cats, there wasn't anyone helping. NO ONE was helping! Members were left hanging, with absolutely no help, and I said to myself, that I never wanted that to happen again. I reluctantly stepped into the breach, and tried to learn and study as much as I could to help out the Prozinc users (and the Vetsulin/Caninsulin users). Took me a while to come up to speed. But I made tons of notes, read a lot of Prozinc threads and looked at a lot of spreadsheets, and studied and studied some more.

Still don't know everything. Life is a constant learning experience.

TempestsMum said:
So much has changed its like a totally different place... it will take a bit of getting used to!
Apologies if I misdirected someone.
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Not misdirected, simply a difference of opinion here.

Panter will never be happy as an indoor only cat, and Goeril has told us that in the past, in another thread. When does curtailing his outdoor time negatively impact his quality of life is what she asked? That is up to Goeril, and she does not want to keep him locked inside, all day and night. I understand that decision. So sometimes, Panter will "go walkabout" and can't be found for mid-cycle testing. It is what it is.

He's a great hunter of mice and other rodents outside Goeril's home in Norway, they live in a rural area surrounded by nature. Which must be such a source of comfort in this time.

There was a post from long ago that I bookmarked. It was titled "Some Bad Advice for Newbies", and talked about the meme of no food = no insulin. But that can cause so many issues, like DKA, that it's something that we discourage saying.

Here is that thread, from Think Tank http://www.felinediabetes.com/FDMB/threads/some-bad-advice-for-newbies.9070/#post-1363950

Something similar holds true, for setting the dose back to 1U. I see that recommendation all the time in the various facebook groups. It's like a game of telephone. Where one person heard something, or read something or says something, then that gets passed along, and passed along to the next person and it isn't the best solution for all cats. People give very short and cryptic answers on facebook. Without the justification to back things up and explain why a certain answer is being given.

p.s. As you can see, I'm horrible at short replies. ;):joyful::p
 
Dearest Deb and Tara - thank you so much for helping out! I really appreciate it. I really appreciate the time you've used to accumulate knowledge about this issue. A fantastic resource for us concerned cat parents. And I don't feel misdirected at all, I'm listening carefully, learning more and more!
I kept Panter inside last night, he nearly ripped the cat door out, howling and complained and totally refused to use the litter box. We both stayed up more or less the whole night, me carrying him to the litter box, he bouncing back to the door... but have to be said, he was back to pretty good and normal shape. ;) After his shot this morning, after more than 15 hour no peeing I let him go. He came back til a +9 test - happy and 'healthy' :) .....and I think this just will be our way of life for a while at least til we figured out a smart plan;) But the forest is calling these days, so much activity and sounds... But I will try to get hold of that double tester for BG and ketons, maybe ebay..? And I will stick to 3u for a while and try to get more BG tests in the mid nadir area. Have a great day! Hope you are all okay where you are. We are good!
 
Hi Deb, thanks for asking. Panter is doing great! Back to his 'old self'. He is hanging around - doesn't go very far I've noticed. And been coming for his shots on time - at least almost everyday ;-) And the BG is pretty 'stable', high of course, but all over lower, purple area, in the +12. and down in yellow at nadir. The spring is here, the sun is shining, and the garden is a great place to be for us all. Hope you also are doing good in these difficult times.
 
Is Panter an outdoor cat? If so best to keep him indoors until you get a definitive diagnosis. A week of being back to his old self is not enough.
I know it's not that easy and I've had many outdoor cats over the years so I'm not preaching to you. Best of luck.
 
Goeril, I think you may want to increase the dose of insulin. I'd suggest going back up to 3.25 U. Same dose AM and PM. The 3U (units) of insulin does not look like enough. You want him to be down in the blues 5.5-11.1 mmol/L (100-199mg/dL) at the mid-cycle.

Yes Dickson, Panter is an indoor/outdoor cat that has been on insulin for months. Panter and his mom Goeril live in Norway, in a very rural area. She has decided his quality of life would be too negatively impacted by trying to keep him indoors all the time.
 
Thanks for the advices! And sorry I'm so late in responding. Lots going on the latest days. Okay, Deb - I will increase the dose from tomorrow. Panter is still good - great mood, playing and hanging around us in the garden :-)
 
Strange - we've had a couple of days where he didn't show up to his insulin on time. First day he came in +18 - got his shot, the next was at +17. For sure I thought he would be high, but surprisingly he was 'just' 21.7 - then at +8,5 down to 6.5 ! - never been this low, and then at +12 - 14.7, never been this low at +12 - so I actually didn't dare to set his insulin... waiting an hour or two... Any thoughts?
 
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I hope you went ahead and gave Panter his insulin shot. As @TempestsMum said, that pre-shot number was high enough to give the insulin.

From looking at your spreadsheet, it looks like you may have. But it's difficult to tell, since you prefill the Units cell with the dose.

You want Panter to be down in those blue color ranges 5.5-11 mmol/L (100-199 mg/dL) at mid-cycle, or even down into the high tree green BG levels >2.7 <5.5 mmol/L ( >50 <99 mg/dL).

Shoot/no shoot number can be lowered from the 11 mmol/L (200 mg/dL) if you are able to get some PM test data. I don't think you have enough test data in the evening (PM) cycle to know how Panter does during the nighttime cycle. So for now, I don't think you want to shoot much lower than that 11 mmol/L (200 mg/dL) for now.
 
Thanks for the response! Things are deffinetly happening/going differently... I gave him his shot 3.1u at +14 last night the BG 19.6. This morning at +10.5 - he was down in 9.4 - I gave him food, then 1.5 hour later at +12 his BG was 17.7. Do I understand right, that I should continue with the same dose 3.1u as long as the BG is over 11?? I'm so afraid of getting him to low... I will do some more testing in the PM cycle. But isn't it strange that he got this low number as 9.4 so late in the cycle +10.5, must mean he has been pretty low around +7 - I believe this can be the nadir....
 
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Okay...we're down i low...very low...2.9 at nadir (+7). He is surprisingly in good shape. I gave him one bag of food (100g) at +6, he was the 4.2 - one hour later, down in 2.9 - I have given him another bag of food - and he eats it with no problem.... now I'm watching closely... I'm a bit worried...
 
Hi Goeril. I'm sure Deb will be along to advise about tonight's dosing too, but it looks like you are only a couple of hours away from your PMPS.

Just in case she doesn't pop in on time and you are unsure about the dose I would refer to the STICKY: PROZINC DOSING METHODS
- Your spreadsheet indicates that you are using the SLGS method for dosing.
- When following the SLGS dosing method the protocol says "Anytime the BG drops below below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit"
- When following SLGS Panter earned a dose reduction with that (Green) 2.9 today.

If you are still unsure and as Tara just posted, Post to the Feline Health (Welcome & Main Forum) and ask for help.

And of course, before giving the dose, make sure Panter's pre-shot BG level is >=11 mmol/L
 
Shelley & Jess said:
Goeril, if you do a .25 reduction that would mean your new dose is 2.85 units.

Are you able to measure that with your U100 syringes? Have you done a 'fat' shot yet?
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At +12 he was actually up in 15.3, so first I thought to keep the regular amount 3.1, but then I didn't dare and I reduced it to 3u. On the 100u syringe I can adjust with 0.1 - like 7.75 is 3.1 and 7.50 is 3.0, 7.25 is 2.9.....
'Fat shot' I don't know much about - I just came across it on the sticky page...
 
Goeril, glad that @Shelley & Jess and @TempestsMum were both able to help you today. I was away from home almost all day.

The dosing protocol for Prozinc is written for using U40 syringes, not the U100 syringes that you use.
So when it says to reduce by 0.25U, that means 0.25U on a U40 syringe, which would be 0.625U on a U100 syringe. (0.25U times 2.5 = 0.625U reduction).

Goeril, you only reduced by 0.1U, not by 0.25U. Panter "earned" a full 0.25U reduction today, with that low of 2.9 mmol/L (52 mg/dL). Any time Panter drops below 5 mmol/L (90 mg/dL), the dose needs to be reduced.
The dose needs to be no more than 2.75U with a U40 syringe, which would be 6.875U on a U100 syringe. Round that down to 6.75 units for safety and ease of measurement.

It's ok to still use the U100 syringes to measure out the U40 dose. But the dose reductions need to be by the amount you would measure in the U40 syringe.

It can get confusing. So please let's be clear on what you need to do, ok?

p.s. Let's not get into doing a "Skinny" or a "fat" dose at this point. Lets' make sure Goeril first understands the amount to decrease the dose, when Panter gets such a low number at mid-cycle.

Fantastic job by the way Goeril, on catching that low and knowing to feed Panter to get his blood glucose levels back up.
 
Deb & Wink said:
Goeril, you only reduced by 0.1U, not by 0.25U. Panter "earned" a full 0.25U reduction today, with that low of 2.9 mmol/L (52 mg/dL). Any time Panter drops below 5 mmol/L (90 mg/dL), the dose needs to be reduced.
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Thanks Deb! Got it! And yes, I'm afraid he then (maybe) got a bit too much yesterday pm and this morning am - I gave him 7.5 (3) - went down only 0.1 as you say. But again - this morning he was up in 18.6. Hmmm... very strange. Like something new is going on. And can 0.1 (from 7.5 to 7.75) make this much difference....? And he is acting perfectly fine... strange...
 
There is nothing in his numbers that says acromegaly to me. The dose isn't super high and the numbers come down. My cat is acro. She was up to 13 units. I typically shoot about 9 units now.
 
Thanks for the update! :)

Another test or two wouldn’t hurt - if it were me I’d keep testing to make sure his BG is still rising - we don’t know when the food you fed will wear off.
More tests will also tell you if he is still on the rise when you take his PMPS.

And please keep an eye out for any replies from Deb or Bron. They may have a little more advice for you than I can give at this time.

Panters-mom said:
Going up - 5.8 at +9. I will decrease the insulin tonight - down to 6.75...
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& Just to clarify
- you are planning on giving him 2.7 units of Prozinc U40 insulin noted on your spreadsheet
- you are using U100 syringes
- so that Prozinc dose of 2.7 units is what you mean because it measures 6.75 units in a U100 syringe.
 
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Panters-mom said:
But again - this morning he was up in 18.6. Hmmm... very strange.
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He's "Bouncing" Goeril. Which means his body is trying to keep him safe by releasing hormones and stored sugars from the liver and pancreas to keep Panter at a safer number. That will often cause the BG levels to increase quite a bit, later in the cycle, and early the next cycle. Those "bounces" can last anywhere from 1 to 6 dosing cycles and can keep the BG numbers higher throughout the 12 hour cycle.

Here is a good explanation of bouncing, from another post:
"Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucagon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles)."

Panters-mom said:
And can 0.1 (from 7.5 to 7.75) make this much difference....?
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Yes, yes it can make that much of a difference in the blood glucose levels.

Something seems to have "clicked", to have made a difference, in Panter's body, to make the insulin cause these lower numbers at mid-cycle. I've got the feeling that Panter has been low before this, and you simply have not seen that, because you did not test at the time, to see those lows. It's not feasible to test all the time, but a few more tests has helped you see that Panter has been dropping low and needs a reduction is his insulin dose.

In fact, you may want to set an alarm and test Panter during his PM cycle, around the +6 to +7 time frame. He may go really low again.

I'm thinking that Panter will need another dose reduction, very soon.

The higher carb food, to bring his BG levels back up, also contributed to the higher BG levels. Both yesterday AM and PM, and again this morning.
Diane Tyler's Mom said:
I'm sorry I am not an expert on giving advice on dosing , for dome reason I can't see your spreadsheet, wishing you all the best
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Panter's mom does not have the tab with the SS as the first tab in the spreadsheet. You have to go to the right, and select the correct tab for the SS. Goeril, it would be helpful if you could move the SS tabs over to the left side of the SS. Drag the US tab to the left, and it should move for you. Then drag the World tab where you are entering the data so that tab is directly to the right of the US tab.

Would you also update your User Id "Signature", to correct the insulin you are giving now? It still says Insulatard, and you are using Prozinc. A short comment in the Signature, that you use U100 syringes would be helpful also.

So "Prozinc with U100 syringes" or something similar.
 
Thanks Deb. I updated the signature and tried to fix the spreadsheet. Please let me know if it didn't work. Up in 21.7 at pm (more exact +13), (as you know he doesn't use the litter box.) You are probably right that he is bouncing. I decreased the insulin to 6.75 tonight.

But I don't understand, when he was on 7.5 (3.0) for about 10 days, he was pretty steady moderately high - purple on the +12 and yellow on nadir - but yes, he did have some higher red numbers once in the while at am. So what is going on at night that causing this bouncing? If he eats mice, as I know he does the BG should go up or what? And he is eating his night meals every 4 hour...
And then - with an increase to 7.75 (3.1) he is doing this big dive, bouncing from purple to green...? And this is in the daytime - and I know what he eats and does at this time of day... I'm very confused now... But I will try to get his BG at around +6-7 at pm.

Thanks again Deb, and everybody, for helping. :-)
 
Signature looks better, but it should be Prozinc. Prozac is an anxiety medication or used for depression, and I don't think you meant to say that.

SS tabs are where we expect them. Thanks for doing that.
There is one more minor SS change, on the US tab, at the very very top in the pale orange colored box. It still says Insulatard. Please change that to say Prozinc and the date you changed, just like you have on the World SS tab. Thank you.

Panters-mom said:
But I don't understand, when he was on 7.5 (3.0) for about 10 days, he was pretty steady moderately high - purple on the +12 and yellow on nadir - but yes, he did have some higher red numbers once in the while at am. So what is going on at night that causing this bouncing? If he eats mice, as I know he does the BG should go up or what? And he is eating his night meals every 4 hour...
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But you don't want his BG levels to be that high. You want the BG levels to be down in the the lower ranges, in the blue and green ranges at mid-cycle. The pre-shot BG levels are the last of the BG numbers to come down to more normal numbers. So they will likely be pink, red and yellow for some time.

Panter is very active at night, as he is wandering around catching those mice. More activity needs more energy so it uses up more glucose. So he may start the PM cycle in the higher BG numbers, but then probably drops low, and he bounces in the morning, back up to the red, pink and yellow ranges.

So, what is different about the last 2 AM cycles? More active? Weather has been bad and he hasn't been going outside to hunt? Eating less food?
 
Deb & Wink said:
Signature looks better, but it should be Prozinc. Prozac is an anxiety medication or used for depression, and I don't think you meant to say that.
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Well thanks - I guess I will save that one for another time... Fixed! :-)

Deb & Wink said:
So, what is different about the last 2 AM cycles? More active? Weather has been bad and he hasn't been going outside to hunt? Eating less food?
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Well, yes - the weather has been bad the last two-three days, heavy rain, and he has stayed much inside less active, but in general he is always less active in the daytime - difference with nice days is that he has his outdoor sleeping spots... He has been eating regularly. He eats about every 4-5 hour, and eats the whole bag - and the leftovers from his brother... And no other changes...
 
PM BG numbers after reduction to 6.75 (2.7) last night: 7.4 +5, 8 +6, 10.8 +7. Little strange that it is this low at +5... And yes - he is very active at night! I kept him inside this three hours - and he was going nuts. Changing from trying to dig through his cat door to sitting next to my bed shouting... He ate at insulin time, then a mouse at +1 (that he dragged in to show me, or he tried to trade...), out again, came back to eat at +5 - I testet BG before he ate, gave him one bag regular low carb wet food, tested +6, he got a small treat l/c wet food, then tested +7 and he got 1/2 a bag again. To add, we are on a delayed schedule after a few 'no show up at time'. So our +5 last night was at peak hunting time at 2.30. With other words, very active.
 
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Puhh...to have an wild outdoor cat with diabetes is a bit complicated I have to admit... now he probably is annoyed with me as I kept him inside - he really goes bananas, so he doesn't want to come home...so insulin time has past...and more delays... I'm out there calling for him, and I honestly believe he hears me, but ignores me...
 
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