Tom & Mindy

Mesacakes

Mesacakes

Member Since 2020
Starting a new thread because the other was too long.
Tom is low tonight so I will do a token dose I guess. I don’t want to give him none and the full dose will be too much. So I’ll get him through tonight and reduce his dose back to 2.25 I guess for tomorrow.
I’m surprised/baffled as to why he randomly goes low and some days has almost no response. Ugh! He is eating well And a happy cat. Good news is he has been low the last two days so it’s working! Just not the way I want.
He will eat anything I give him but I have not specifically tested the medium and higher carb foods on him because he generally is a pig.
Toms spreadsheet: https://docs.google.com/spreadsheets/d/1N6uWa0dckCqQxw7e0qqOuka3ke2LoIj0Nk1xfOxPAYM/edit
Old thread: https://www.felinediabetes.com/FDMB/threads/rx-or-dose-help-needed.231358/
 
Oh and after reviewing your many posts/notes I am not doing a token dose but am doing a reduced dose of 2.25 tonight. I will keep my medium and high carb food handy. I do have to work tomorrow so will be gone probably 5-6 hours so hopefully nothing crazy happens on the reduced dose.
 
Oh and the cat treats & kibble Yesterday were gobbled up right away. I gave him those because they are high carb and he ate the low carb food so I thought together they would be Digested like medium carbs... as I was afraid the low carb food wasn’t quite enough.
 
Keeping paws crossed that the lower dose helps Tom to even out his BG levels.

Some cats bounce, from one low to high numbers, for cycle after cycle.

If you are concerned with Tom dropping low while you are gone, leave some MC food out for him.
"Better too high for a cycle. Or two"
 
So another low day today. 75 at +7 and 98 at +11...
I guess that earns him another dose decrease even though some days he runs high???
Tonight I will delay a while (I am leaving for an hour) until he is higher and then try 2 units instead of the 2.25? I really don’t want to give him 2 until he is over 150 probably... will see. I guess I’ll feed him a bit early and check him when I get back at +12.5...
 
So he is still only 116 after eating... I’ll test him again in two hours. Looking like no shot tonight unless he can get a token dose in two hours.
 
Looks like Tom cleared the bounce from yesterday and is giving you nice low BG numbers.
That BG of 75 did earn Tom a dose reduction of 0.25U, so the dose for next time when you can give him the full shot would be 2U.

Remember, it's the mid-cycle nadirs that determine when the dose should be adjusted, not the pre-shot levels.
Also, you have to take into account when a cat is bouncing and not increase on the bounce, unless you are ready for a very active cycle and can stay around to test.
To me, those red pre-shots say "bouncing" loud and clear.

One question I have, is did Tom have a good appetite? Sometimes a cat that is not eating as well can give you those low BG levels at mid-cycle.

Second question I have, is the shot time has been adjusted a bit earlier. Is this the new schedule for Tom? the earlier time?
 
I wondered if those were bounces...
Yes he ate all his food like normal.
Yes I’m moving him up to the 6-6:30 times so it’s better aligned with dinner time. We got off a few weeks ago when I had to delay 3 hours so I have been working my way back slowly. I did a hair over 2 units (2F) as it seems like when he was on 2 before it wasn’t enough but the 2.25 might be a smidge high...
 
So is there anything I do to help the bouncing or just continue as planned? Is it normal to bounce this much?

I got a 142 preshot tonight and a 153 preshot a few nights ago. I only did a token 0.5 dose a few nights ago and it wasn’t enough so this time did 1.5 instead of his normal 2 unit And I will keep an eye on him and I have lots of wet carby foods on hand.
I was surprised by the 142 tonight because he was so high this morning.
Does this mean I need to drop his dose again?
All food is the same. He eats two “portions” of Sheba pate every morning and evening plus gets 5 oz. Tiki twice a day which usually has a little leftover. He also will snack on the Proplan (4carbs) I feed my other cats after he eats his food. This has been his routine for a while. He seems less starving but is always hungry. Urine output is generally better.
 
Mesacakes said:
He seems less starving but is always hungry.
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If he's always hungry, then you may need to feed Tom a bit more food. Does he need to gain a bit of weight?

When you feed can make a difference.
You want to feed more in the first half of the insulin cycle, in the first 6 hours.
Mesacakes said:
So is there anything I do to help the bouncing or just continue as planned? Is it normal to bounce this much?
Click to expand...
For some cats it is perfectly normal.
Bounces happen until they don't happen any more.
"The faster the drop, the higher the bounce."

You have been getting some better mid-cycle BG numbers for Tom. With the test data to back you up, you can lower that pre-shot BG test shoot/no shoot level if you would like.

Try to get at least a +2 for each PM cycle. That number can tell you which direction the BG levels are headed.
 
No he is fat and still needs to lose weight. He has Tiki food most of the day and sometimes all day if they don’t finish it. I think some of it is Just in his mind because he was skin and bones when he showed up.
ok I was going for +3s because there didn’t seem to be much activity at +2 but that could be changing now.
 
Mesacakes said:
I was going for +3s because there didn’t seem to be much activity at +2 but that could be changing now.
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+3 BG tests are fine too.

Try substituting play time or a grooming session for the food, when Tom is begging. They've trained us pretty well, that whenever we are in the kitchen, that must mean our cats get fed too! So his attention needs to be redirected, to not expect food every time he meows and begs.

For my civie cat, it's the sound of a Ziploc bag being crumpled that gets her going. That's because I store her next meal in the fridge in one of those bags. Now, every time, every single time she hears that sound, she comes running. But other things get stored in the Ziplocs too, like my chocolate supply! So she is disappointed frequently. She was a former feral colony cat, so even though she gets fed plenty of food, she has that mindset of "when and where is my next meal coming from?"
 
So Tom has been on these higher doses of ProZinc a month now. I will probably need to order another vial sometime soon. Is it too soon to decide if the ProZinc is working well for him or if the drops are too steep & I should order Lantus instead?
 
Mesacakes said:
So Tom has been on these higher doses of ProZinc a month now. I will probably need to order another vial sometime soon. Is it too soon to decide if the ProZinc is working well for him or if the drops are too steep & I should order Lantus instead?
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The choice of deciding to switch insullns is entirely up to you.

A 2U dose really is not a large dose at all. Above 5-6 units, and we think about testing for high dose conditions like Acromegaly or IAA (Insulin Auto Antibodies).
 
I guess I’m asking more of how or when do you decide a different insulin might be better for the cat? Is it only if they don’t respond or do you base the decision off the curves.
 
Well I had a long night. I gave Tom his full dose even though he was only at 202 preshot. I did the full dose because he was over 200 and the other partial doses didn’t seem to help. So I checked at +2 & +4 and he was dropping as expected. I gave him extra food to try to slow the drop since I was sleeping. At +2 gave him 1/2 can FF 5 carb food and at +4 gave him 1/2 Sheba 11 carb food. So by +10 he was good at 214 but then two hours later was high. I’m assuming another bounce?
I reduced his dose again to 1.75 because if I hadn’t given him extra food he would have dropped below 90 for sure. Also maybe the lower dose will help the bouncing? Sigh
 
Cats can take months to regulate. A month on the higher doses of Prozinc is no time at all.
But, the flip side is that Tom has been on the Prozinc since December 2019.

There is no "magic insulin" that works for all cats the same.

Lantus is a depot type insulin. Dose changes take longer to see the full effects. Sometimes 3 days or more.
Prozinc is an in-and-out insulin. Dose changes are usually seen much quicker.

Think of it as driving a speed boat (Prozinc) vs steering a huge cruise ship (lantus).
Weigh the pros and cons. Lantus likes consistency in times more than Prozinc. Prozinc gives you a bit more leeway in the time of the dosing.

I'd suggest you go to the Lantus ISG forum here, and read through all the "Sticky" or pinned posts at the top of that forum.

Cost of lantus is higher, but you can order from Marks Marine Pharmacy to keep the cost down.
You'll need different syringes too, since lantus is a U100 insulin and Prozinc is a U40 concentration insulin.

There are no guarantees that Tom won't bounce as much on Lantus as he does on Prozinc.
Look for @Patty & Teal'c over in the Lantus forum. She switched her cat from Prozinc to Lantus.
 
Ok thank you. I will do more reading and since he earned another decrease maybe we are moving in the right direction. Thank goodness for the pandemic for Toms sake. Ugh! Normally I am gone a lot But at least I am working from home most days to deal with this. My friends think I am Pure crazy and I want to be gone a few weekends in September so my neighbor will be dosing him then... Hoping he stabilized a bit by then.
 
Hi Mesacakes. Teal'c was also very bouncy on Prozinc, however I don't think Prozinc is a bad insulin, just didn't work for Teal'c. If you look at Teal'c's SS you will see a lot of red and blacks. If Teal'c even flirted with the idea of a blue, green, or yellow he would bounce. Deb suggested I consider Lantus and I needed to try because the bounces were tearing me up inside.
I was able to outsource some Lantus while I worked at finding a vet who would prescribe Lantus for him. As you can see on his SS he would still bounce a lot. I started out SLGS because of my work schedule. On 5/3 on Lantus he hit every possible color. Started pink, then blue, green, back to blue, then red ending a 12 hour cycle with black. I didn't give up.

As you scroll on down through his SS you will notice that soon enough the reds and blacks started to become less and less. The last red I recorded was on 6/26, the last black was on 7/3.

On 7/3 is when I also decided SLGS was not working well for us, and even though it meant there are times I'm running on a wing and a prayer because of my schedule, it was a decision I had to make to switch to TR. Since that point we have seen the pink numbers all but disappear. Last pink 7/27.

He is now a kitty that runs mostly blues and greens with a sprinkling of yellow. There are 3 things at play here. The switch to Lantus, the switch to TR, and on 7/17 I opened his first Lantus pen from his own prescription, one that was not outsourced from an individual.

It wasn't like Teal'c's numbers changed right from the beginning of the switch, it still took time for his body to get accustomed to lower numbers, time and perseverance paid off.

Also, I want to mention TR with a schedule like mine is not ideal. I would not suggest it to anyone. That's a decision everyone has to make on their own.

Sorry so long.
 
Wow he was all over. Ok so I’ll give the ProZinc more time as even if I change it could take months. Bummer.

Tom is not eating as well today and really yesterday too he was a little off. His eating has been reducing over the last week and I attributed it to his sugar being lower. He usually eats all his Sheba and some Tiki but didn’t finish his Sheba this morning. He did eat about 1/2 Small can of Tiki at lunch and was 115 before eating lunch. He is purring and kneading but didn’t inhale his food. So now I’m worried. I did make a vet apt for Saturday morning to address his diarrhea that I thought I had eliminated but it’s back. He has had diarrhea most of the pandemic. I thought it was the fish foods and changing his food but he has been steady on his Chicken foods for a while and it came back.
 
Didn't mean to chase you away from Lantus. The cost difference between Prozinc and Lantus is about $40 more for Lantus from Mark's marina in Canada and what I was paying the vet for Prozinc. Got the pens. Vet called Mark's and set up his prescription for me, it was easy. Also not sure why but the pens of Lantus last way longer then the vials of Prozinc. So I'm actually saving money with Lantus.

Not even sure I could have gotten a handle on Teal'c's BG without switching to Lantus. He was on Prozinc for 5 months and still never gained control. 5 months on Lantus and it appears we now are in control of his BG.

I personally think you should consider trying Lantus, I just wanted you to know don't expect it to happen over night if you make the switch.

5 months Prozinc = no control

5 months Lantus = well controlled

Prozinc=$120 per vial thru vet

Lantus=$160 5 pens thru Mark's marina

5 Lantus pens last much longer then 1 Prozinc vial = savings.

Just some things to consider.
 
Thanks Patty, for giving your "2 cents worth". As someone I knew that had made the switch in insulins, I figured your input would be very helpful.

Hope those night shifts are treating you ok.
 
So Toms numbers are still staying low today from his shot yesterday.... I could probably do one now at +5 but he is rising so slowly I would rather wait until evening, only 4 more hours.
& Can I change his Shot time back up to 6:30 PM if he is high enough by then? Or do I need to stay with 9:30 even though I skipped this AM dose.
Then what do I do about the actual dose? Give a lower dose unless he is Really high again at shot time?
https://docs.google.com/spreadsheets/d/1N6uWa0dckCqQxw7e0qqOuka3ke2LoIj0Nk1xfOxPAYM/edit
 
So I shot my lowest number so far. He was 143 this morning just like two days ago when I skipped. So instead I reduced by 0.25 and gave him his shot. I’ll be home to check him through the day. So he got 1.5 units this morning.
 
Keep low Tom. Keep low BG levels.

Let's see some green numbers mid-cycle please Tom.That gives your pancreas time to heal and rest.
 
That 69 IS another earned dose reduction. Yes, 1U would be the correct dose going forward.

You might want to think about lowering your decision point threshold, as to when you stall, when you skip.
Think about lowering that "shoot/no shoot" BG level, what is known as your decision point threshold from 150 to 140. Or a bit lower if you are there to monitor.
You've got some good test data, to tell you how Tom reacts. So changing that threshold from the SLGS guidelines of 150 mg/dL to a lower number is something that should be considered.
 
I don’t really want to skip but I have a big meeting in the morning so need to sleep tonight. Lol
I get a little more comfortable shooting low each time and try to push it a little. I see others shoot low but it blows my mind that it isn’t sending them hypo.
Ideally I would give him a dose when he gets back up to 125-30 tonight but I’ll be sleeping. And then it would mess up my schedule too. So it will have to be a skip .
 
So a skip it was last night.

Hope your big meeting went well and you were well rested.
Good to see that reduced the dose to 1U for this AM, 8/20/20 even though Tom was high at pre-shot. He's probably bouncing from the lows yesterday.
Let's see what he gives you for a PMPS tonight.
 
Ok so to keep on schedule and not skip a shot I gave him 0.5 units. I can test him the next 2.5 hours but then will be gone 3-4 hours. I can give him carby food before I leave if needed. I’ll be gone most of the morning/day the next two days so need to stay on schedule.
 
Is 11 carbs considered medium? I have 0-25 so I’m assuming the <10 is low, 10-17? Is medium and 18+ is high? I gave him a Sheba “portion”/half package of 11 carb food so I can leave as he is 100 at +2 and I will be gone until +6 possibly.
 
Mesacakes said:
Is 11 carbs considered medium? I have 0-25 so I’m assuming the <10 is low, 10-17? Is medium and 18+ is high? I gave him a Sheba “portion”/half package of 11 carb food so I can leave as he is 100 at +2 and I will be gone until +6 possibly.
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Yes, those are close to the ranges for LC (low carb), MC (medium carb) and HC (high carb) foods.
LC < 10%
MC 11-15%
HC 16% and up

Good judgement call on the 0.5U of insulin. Tom seemed to do ok on that low dose today, 8/21/20 AM cycle.

Many cats will naturally seek out food, when they feel their blood glucose going lower than their body has been accustomed to. So leaving out some food while you are gone is a good idea. I had to put Wink in the bathroom, with his food and such. Two other cats made it impossible to leave food out for him, as the other 2 cats were vacuum cleaners and would gobble down any food in mere minutes.
 
And I just got home and +8 he is 83! I even left out a half can of Friskies just in case. I guess that is yet another dose reduction so now I will do 0.5 tonight, as long as he gets back up Higher by then.
 
So in looking at his spreadsheet how low can he be when I shoot? At this point, with all his changes, I’m hesitant to shoot anything under 140 I think. And I have to know he is rising by at least 10pts an hour... Not just 2 pts an hour...
I’m likely delaying again tonight or maybe doing a token dose as he is 87 at +10.5. I am feeding him though so hope he starts going up faster. Ugh. I’m gone for 6 hours again tomorrow morning/early afternoon.
 
I think the 140 pre-shot BG sounds reasonable for now.
He's bouncing around quite a bit in his BG numbers. He's not used to those low numbers anymore. So his body releases compensatory hormones and dumps sugars into the bloodstream to bring those BG levels back to what his body is used to.

You should try to keep the dose at the lower 0.5U dose I think.

Yes, Tom was higher last night PM cycle 8/21/20. But you don't dose on the high number. You change the dose based on the nadir or low, not the highs.

Bounces happen until they don't. And you need to be patience and wait for them to clear, before you decide to increase the dose again. OK?

"Better too high for a cycle, than too low for a moment."
 
Oh gosh I have no intention of increasing his dose.
I am hoping he will stabilize on a dose for at least a few days or go into remission.
I guess I’m wondering how low I should be dosing him so I can keep him stable. I did a 0.5 skinny even though he was only 121 tonight. I am home to test him and will check him overnight. I might offer him some 11 carb food Again before bed if his numbers are lower...
 
So Tom has been running high for 3 days now. He got a 83 on the 22nd so I reduced to a 0.5 skinny that night then 0.25 the next day and I have lost all my work!!
I even increased to a 0.5F today but still his nadirs are high and preshot is super-high for him.
I guess the 0.75 was good and I shouldn’t have reduced so close together. (?)
Now I’m trying to hold to see the If he stabilizes but I don’t know how long I should give him. He acts fine of course but I was so happy with his blues and I have never seen reds Three days in a row!
 
Mesacakes said:
He got a 83 on the 22nd so I reduced to a 0.5 skinny that night then 0.25 the next day and I have lost all my work!!
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You have NOT lost all your work. Doses get adjusted up and down all the time. A couple of days at high BG levels are only a tiny portion of time that Tom has been diabetic. You'll get him back into lower BG numbers. Give it some time please.

You asked me in a PM, if you should start a new bottle of insulin. It's always your choice, but I think that the current bottle of insulin is still good. So try increasing the dose back to the 0.75U. See if that works better for Tom.

Tom came down the insulin dosing scale pretty fast. So that probably has an impact on his higher BG levels, the last 3 days in a row as you said.

Try the dose increase first please, before you open the new bottle of insulin. Never mind, I see that you did start the new bottle of insulin with the PM cycle, 8/26/20.

Try to remember that you needed to decrease the insulin dose back after those low greens, to keep Tom safe from a hypo (hypoglycemic) episode.
 
Ok. Just got back from vet. Not enough urine to check unfortunately but he did find a strange spot under his tongue. It’s very dark red and bubbly, not smooth and pink/white like the other side. Maybe the size of a dime.
So we are trying 2 weeks of antibiotics and if it isn’t better, or if it’s still obvious, then we will do a biopsy to see if it’s squamous cell carcinoma.
The antibiotics should help if he by chance has a UTI, which he doesn’t act like but maybe, and if it’s a salivary gland infection of some sort.
 
You asked me this in a PM. Replying publicaly so others can see the response. Per the board posting rules.

Mesacakes said:
I made an apt (but my regular vet is out today) to have him checked for a UTI at 3:30 central today. If he responds by +5 to his AM shot I will cancel it. If not I’ll keep it as the newer insulin didn’t make a difference.
So if no UTI, what is the dose increase protocol? Same as before? I will be around today and tomorrow all day then gone during the days over the weekend.
Click to expand...
Yes, the dosing protocol increase is the same.

Hope the antibiotics make a difference in Tom's BG readings.
 
Just an update - pretty sure I will be putting Tom down in a few days. He seems to be having issues eating which means the spot under his tongue is bothering him now. I gave him a buffet of his high-carb canned food tonight As he didn’t eat much today. He tried to eat it all but only got down maybe half a can of pate with forti-flora and also mostly gravy From the other bowl. He then begged for chicken off my plate and it took him about 5 tries to eat the little piece I gave him. He got 2 of the 4 little pieces down. His vet apt is Friday but I might move it up to Wednesday if I can, or get him pain meds.
 
Making that decision to let our cats go, is one of the hardest things we do as pet owners.
Pain meds can help for a while.
If the spot under his tongue is aqueous cell cancer, there is not much that can be done.
Is that what the biopsy showed?

I've had 2 cats with oral cancer. Buprenorphine oral liquid, given into the mucous membranes on the sides of the mouth can help for a while. Fentanyl patch, on the leg, can be used but since it's a controlled substance, you have to go to the vet every 3 days to have the patch changed. Gabapentin can help also, with pain management.

There are no real good choices with oral cancer sometimes. Hospice care (or pawspice care as it is sometimes called) is what I choose to do.

We'll be thinking of you and Tom at this difficult time.
 
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