Continued help for Ernest's dosing

If he were my cat I would do 2.5 starting tomorrow. I think you are stuck in some glucose toxicity and won't see much movement until you hit that breakthrough dose, then it will start coming down.
 
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I think you need to "fast track" the dose increases.
1 more day is only going to leave Ernest in the pinks and reds with only the occasional yellow BG number.

My recommendation is to bump the dose up to 2.5U, ASAP.

Yes, Ernest's BG numbers are "all over the place" but still quite high most of the time. You have plenty of room to increase the dose, and still keep him safe.
You want to be seeing blues and greens, not those "Ugly" reds and pinks.

(I've never personally cared for pink, except in some flowers like the phlox that are blooming in my garden right now.)
 
Deb & Wink said:
I think you need to "fast track" the dose increases.
1 more day is only going to leave Ernest in the pinks and reds with only the occasional yellow BG number.

My recommendation is to bump the dose up to 2.5U, ASAP.

Yes, Ernest's BG numbers are "all over the place" but still quite high most of the time. You have plenty of room to increase the dose, and still keep him safe.
You want to be seeing blues and greens, not those "Ugly" reds and pinks.

(I've never personally cared for pink, except in some flowers like the phlox that are blooming in my garden right now.)
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@Deb & Wink @Panic @JanetNJ

So 2 days at 2.5 hasn't done anything really.... go up again in the morning?? 2.75 or skip to 3?
Thank you!
 
If he's so food aggressive, it may be because he isn't getting enough to eat.
How food aggressive is he? Would you give us some examples of his behavior.

You'll probably need to try some behavior modification techniques with him.
For example, if it's only when you go to the kitchen, that he is food aggressive, try to substitute some play time or a grooming session for the food.
 
Deb & Wink said:
If he's so food aggressive, it may be because he isn't getting enough to eat.
How food aggressive is he? Would you give us some examples of his behavior.

You'll probably need to try some behavior modification techniques with him.
For example, if it's only when you go to the kitchen, that he is food aggressive, try to substitute some play time or a grooming session for the food.
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Only in the kitchen.
He literally attacks me while I'm getting his food. He will bite me as I'm putting it down in front of him. He scratches my leg and has even bitten my leg.
He's currently eating 3 cans of friskies and a handful of cooked chicken cubes a day.
He was really bad in the beginning. He had gotten better but now I'm noticing he's getting worse again.
I'm hoping once we get his numbers down, he'll calm down too...
 
Ja' said:
He was really bad in the beginning. He had gotten better but now I'm noticing he's getting worse again.
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Ok, then he may need another fast track increase on the dose. He is staying in the reds and pinks most of the time. This recommendation is aggressive. Really, really aggressive. But if you are ok doing another increase, up the dose to 3U for the next cycle.

And please. Pretty please with sugar on top. Test at least once more in every PM cycle. That before bed test will help to fill in the missing data in the PM cycle.
You might even think about setting an alarm, to wake you later in the PM to get another test. Yes, it's no fun at all to get up in the middle of the night to test your cat. But you may need to do that. Be sure to get that "before bed test" every single day, around the +2 to +3 timeframe.

OK?

Have you considered getting a timed feeder, to give Ernest an extra meal overnight?
 
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Deb & Wink said:
Ok, then he may need another fast track increase on the dose. He is staying in the reds and pinks most of the time. This recommendation is aggressive. Really, really aggressive. But if you are ok doing another increase, up the dose to 3U for the next cycle.

And please. Pretty please with sugar on top. Test at least once more in every PM cycle. That before bed test will help to fill in the missing data in the PM cycle.
You might even think about setting an alarm, to wake you later in the PM to get another test. Yes, it's no fun at all to get up in the middle of the night to test your cat. But you may need to do that. Be sure to get that "before bed test" every single day, around the +2 to +3 timeframe.

OK?

Have you considered getting a timed feeder, to give Ernest an extra meal overnight?
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Okay, we increased to 3u! Doesn't seem to make a difference so far......but I'm still hopeful
We'll def do more night tests.
We bought a timed feeder and will set it up for tonight and see if that helps! Or actually maybe this weekend I'll get up and test & feed him a couple of times.
Thank you!!
ja'
 
Deb & Wink said:
Some cats just need more insulin until they find that breakthrough dose.
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3 pm tests last night.... nothing unusual that I can tell. We'll do our best to keep it up.
Please let me know when you would like for us to increase again.
Apparently Ernest doesn't understand "aggressive" insulin increases.

We're very grateful for your help!!
 
Maybe 1 more cycle on the current 3U dose. But not any longer than that.
The 3U dose is barely making an impact on his BG levels.

You need to get his BG levels down out of the pinks and reds.
If you feel like you are able to monitor, than next cycle you could try an increase.
That would be Saturday, 9/19/20 AM cycle. Or wait until Saturday PM cycle.

You know your schedule and life responsibilities much better than we ever will.
So your choice on when to increase the dose again.
But soon, since he probably doesn't feel good at those high BG levels all the time. Bet he sleeps even more than usual for a cat.

Is there any food left out, that Ernest could be getting to? Another pet's food? People food left out on the counter? Food dropped on the floor by a "helpful" small child trying to "feed the kitty"? Can he open cabinets in your kitchen and get to food?

I had Wink chew through a tough plastic bag of Hill's cat food once. It only took him about 2 minutes to get into the bag.
 
Deb & Wink said:
Maybe 1 more cycle on the current 3U dose. But not any longer than that.
The 3U dose is barely making an impact on his BG levels.

You need to get his BG levels down out of the pinks and reds.
If you feel like you are able to monitor, than next cycle you could try an increase.
That would be Saturday, 9/19/20 AM cycle. Or wait until Saturday PM cycle.

You know your schedule and life responsibilities much better than we ever will.
So your choice on when to increase the dose again.
But soon, since he probably doesn't feel good at those high BG levels all the time. Bet he sleeps even more than usual for a cat.

Is there any food left out, that Ernest could be getting to? Another pet's food? People food left out on the counter? Food dropped on the floor by a "helpful" small child trying to "feed the kitty"? Can he open cabinets in your kitchen and get to food?

I had Wink chew through a tough plastic bag of Hill's cat food once. It only took him about 2 minutes to get into the bag.
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It was driving us crazy thinking he must be getting into something. We feed our dogs & other cats in a separate room and take up their dishes when they're finished. We never let him outside. We make sure the kitchen counters are clean and nothing is in the sink...ever! We keep the pantry doors closed and all animal food/treats are keep in those vault containers in the garage. He uses the litter qwitter with no litter (he used to eat the world's best litter-it's made from corn). No children in the house, just me and my husband. My husband works from home and watches him constantly. I work 6am-6pm Mon-Thur so Fri-Sun I'm going to try to get more pm tests.
We will increase in the morning....3.5?? we can stay home tomorrow & Sunday and test frequently. Thoughts??
And, yes, Ernest lays on the kitchen rug all day long..... :-(
Thank you again for all of your time & care!
 
Ja' said:
We will increase in the morning....3.5?? we can stay home tomorrow & Sunday and test frequently. Thoughts??
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Ok. But you can likely still run a few errands during the weekend. When else do you have time to grocery shop and such?

We usually only increase by 0.25U at a time, but those smaller changes are NOT making a difference in Ernest's BG levels.

But the MPM (Modified Prozinc Method) dosing guidelines do say to increase the dose by 0.5U if the nadirs are > 200 mg/dL.
So yes, increase the dose to 3.5U for 9/19/20 AM cycle.
 
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Deb & Wink said:
Ok. But you can likely still run a few errands during the weekend. When else do you have time to grocery shop and such?

We usually only increase by 0.25U at a time, but those smaller changes are NOT making a difference in Ernest's BG levels.

But the MPM (Modified Prozinc Method) dosing guidelines do say to increase the dose by 0.5U if the nadirs are > 200 mg/dL.
So yes, increase the dose to 3.5U for 9/19/20 AM cycle.
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Deb, thank you for your confidence!
We went to the grocery store today. LOL So we'll be staying home the next 2 days.
I sure hope this jump does the trick for Ernest! Thank you!
 
JanetNJ said:
Makes me wonder if there's something else going on. Dental problems? Infection? Acromegaly? Had he had his teeth checked?
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I guess we should revisit that. He had a thorough exam the end of June when he was diagnosed. The only thing wrong in his bloodwork was his Glucose.
I'll call our vet and schedule another exam. Thanks!
 
Sometimes, when you raise the dose, the BG levels go up and not down as expected. We call it NDW (aka New Dose Wonkiness).
Try to ride it out, and see if it resolves in a few more cycles.

Tests for IAA (Insulin Auto Antibodies) and acromegaly aren't usually suggested until a cat gets to over 5-6 units for both dosing cycles.

Hopefully the vet can come up with some other ideas.
 
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Deb & Wink said:
Sometimes, when you raise the dose, the BG levels go up and not down as expected. We call it NDW (aka New Dose Wonkiness).
Try to ride it out, and see if it resolves in a few more cycles.

Tests for IAA (Insulin Auto Antibodies) and acromegaly aren't usually suggested until a cat gets to over 5-6 units for both dosing cycles.

Hopefully the vet can come up with some other ideas.
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Keep going with the 3.5? or increase?

BTW, my Vet is "old school". He only prescribes Vetsulin (dogs & cats). They did not recommend home testing or any change in food. They recommend shooting whether they eat or not and to keep karo syrup on hand for dropping too low. They want to see them every 7-10 for them to test BG and they go up in 1 unit increments.
My guess is he'll tell us to go back to Vetsulin... but maybe there's something else going on and he'll find it.

Many Thanks!!
 
@Deb & Wink @Panic @JanetNJ

With this being day 5 on 3.5 units, I'm thinking you prob don't think it's NDW.

You also mentioned glucose toxicity. I did some reading and I think it could very well be that.
Ernest had his regular annual exam in January with nothing wrong.
Then he had an abscess on his back (prob from a scuffle with his sister) and the vet put him on an antibiotic (biomox amoxicillin).
The abscess cleared up but then we noticed he started losing weight and didn't want to eat.
I think the abscess kept him from getting an earlier diagnosis of diabetes.
He probably had high BG long before his June 24th diagnosis.

My daughter came over on Saturday. She hadn't seen Ernest in a few weeks. She went on and on about how great he looked and acted compared to the last time she saw him.

Sometimes when we're around all the time, we don't see the difference like other people do.

I started thinking about it and he's much stronger and has def put on a few pounds recently. He jumps up on tall bar stools and he follows me around the house.

So is "Mr. Liver" (as I read one person tell the story) still thinking he should have a high glucose and dumping into his system? Thoughts?

Thank you for all of your time and expertise.
 
No, that is too long for NDW (New Dose Wonkiness) to be the cause for the higher BG levels still.
Much more likely to be insulin resistance.

The way to get past the insulin resistance, (aka glucose toxicity) is to keep increasing the dose.
So I'd recommend increasing the dose to 4U.

There are a couple of high dose conditions, IAA and acromegaly, but we don't suggest testing for those until the dose is > 5-6 Units.
 
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Def do 4. I'd be surprised if you saw much progress before 5 units.

He very well may wind up being acro. It's more common than once thought. My cat was diagnosed with it 18 months ago.
 
@Deb & Wink @Panic @JanetNJ

Yesterday was better, but today we're red again.
Looks like "Mr Liver" doesn't want to give up easily.
Prob should've gone to 4.5 this morning??
This is exhausting....
4.5units in the morning?
 
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You increase the dose until you don't have to increase anymore.

Yes, increase to 4.5U in the AM is my recommendation too.
 
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Ja' said:
Do we increase daily? or every 2 days?
At some point it's just going to drop fast, right?
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Every day is too fast. Giving it at least 2-3 days is better unless there's ketones. Are you checking for ketones at home? At some point you will find your breakthrough dose and then it should start dropping, yes. I'm wondering though with very little movement in numbers of there's more going on like acromegaly.
 
JanetNJ said:
Every day is too fast. Giving it at least 2-3 days is better unless there's ketones. Are you checking for ketones at home? At some point you will find your breakthrough dose and then it should start dropping, yes. I'm wondering though with very little movement in numbers of there's more going on like acromegaly.
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We are not checking for keytones, should we start? I haven't really done any reading on it......yet.
Ernest is potty trained!! So I can just find something to put in the toilet to catch it.
 

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Ja' said:
We are not checking for keytones, should we start? I haven't really done any reading on it......yet.
Ernest is potty trained!! So I can just find something to put in the toilet to catch it.
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You should since he's so high all the time. You can catch the pee and do a ketone strip, or get a ketone meter that works just like a bg meter. I use a meter because it's just easier for me. What a tricky kitty you have there. Lol
 
@Deb & Wink @Panic @JanetNJ

We opened this vial of prozinc on July 9th. It's still good right? It's about 2.75 months old. I've read all different opinions on how long they're good once opened but most people say 3 months. We'll be due to change out at about 3 months, maybe a little less.

And what happens when we start the new vial?
Do we give the amount we're on? or do we give less the first cycle?

This is terribly complicated!!
I was hoping his numbers would be coming down by now. I was just surprised by the 425 reading 3 hours after giving 4.5units!
Thankfully, Ernest is a champ. He's such a good boy and seems happy & content.
I'm worrying enough for both of us.
 
Boy, Ernest is keeping you on your toes with all those reds! Fingers crossed he's just got some major glucose toxicity but remember what Janet said ... if he hits 6u without stopping you'll want to consider testing for acro/IAA to rule it out.

I've always heard 3-4 months with vials. I kept mine for roughly 3 months. As long as there's no floaties in it it should be fine until you get the new vial. Keep the same dose.

Scritches for Ernest!
 
JanetNJ said:
You should since he's so high all the time. You can catch the pee and do a ketone strip, or get a ketone meter that works just like a bg meter. I use a meter because it's just easier for me. What a tricky kitty you have there. Lol
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I picked up a box of the ReliOn ketone test strips. Now what? LOL
I mean I know I have to collect his urine...but then what?
What number am I hoping for?
Is there a specific time of day I'm doing this?
Sorry, lots of questions!
I appreciate your patience....

Thanks!
 
Ja' said:
I picked up a box of the ReliOn ketone test strips. Now what? LOL
I mean I know I have to collect his urine...but then what?
What number am I hoping for?
Is there a specific time of day I'm doing this?
Sorry, lots of questions!
I appreciate your patience....

Thanks!
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I believe you just hold it in pee and then at 15 seconds compare it with the chart. I've never personally used the strips (I use a meter). So read the directions carefully and have a timer ready. Anything over a trace is an emergency.
 
JanetNJ said:
I believe you just hold it in pee and then at 15 seconds compare it with the chart. I've never personally used the strips (I use a meter). So read the directions carefully and have a timer ready. Anything over a trace is an emergency.
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They didn't have any meters. What kind do you have?
 
@Deb & Wink @Panic @JanetNJ

I called the vet's office today to ask if I could bring Ernest in tomorrow for bloodwork.

They asked why. I told them I wanted to see if he has any infection and check his organ function since his BG level won't come down.

She proceeded to scold me for:
1. Home testing- she said I was confusing myself with all the numbers, that an 8 hour reading every 7 days is all that's necessary.
2. That there is no correlation between infection and a rise in BG.
3. It's not a big deal that he's on 5 units twice daily and still high BG - She said we just needed to keep increasing.
4. Switching to Prozinc from Vetsulin was a mistake.
5. There's no such thing as remission. They are diabetic for the rest of their life.
6. She said to just call next Wed @ 8 hours and tell her the reading and she will check with the Dr. for how much to increase.

I asked her why next Wed. She said they don't like a big increase on Friday because you might end up at the emerg vet over the weekend. No increase on Mondays because he's not in the office on Tuesdays.....

So tomorrow I will be calling Vet's offices to find another vet..... Sad because we've been with them for about 15 years, but we've never had a serious health issue before.
We live in Orlando, Florida if anyone knows of a good Vet around here!!

Every time we increase his insulin, his BG goes up. I think we're fighting a really stubborn liver!
I really want to increase from 5 units to 6 units in the morning - give his liver a jolt!
 
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So receptionist or the vet tech was telling you this information?

Let me address these responses from your vet clinic one at a time, ok?
Ja' said:
1. Home testing- she said I was confusing myself with all the numbers, that an 8 hour reading every 7 days is all that's necessary.
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1. AAHA Diabetes Management Guidelines absolutely disagrees with what you were told. Home testing is the best way to see what is going on. Perhaps email a copy of the AAHA guidelines to the office? Drop off a copy when you go in to get your cat's vet records? Here is the link to those guidelines.
AAHA 2018 Guidelines for Managing Diabetes

2. That there is no correlation between infection and a rise in BG.
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Ah really? Partially correct, partially wrong.
The high BG levels make the "patient" (human or feline) more susceptible to infection.
Here are a couple of article links about humans and infection and BG levels.
https://www.endocrineweb.com/news/diabetes/16186-link-between-high-blood-glucose-high-infection-risk
https://www.diabeteswellness.net/sites/default/files/Illness and Diabetes.pdf

General information article on feline diabetes from Cornell University, College of Veterinary medicine.

https://www.vet.cornell.edu/departm...ormation/feline-health-topics/feline-diabetes

3. It's not a big deal that he's on 5 units twice daily and still high BG - She said we just needed to keep increasing.
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Some cats can have high dose conditions, such as IAA (Insulin Auto Antibodies) or acromegaly. Acromegaly is much more common than once thought. There are tests for both of these high dose conditions, but the only place in the US that does the blood testing for these is the University of Michigan. Special handling and shipping is required to get the blood samples there in a timely manner and in good condition. We recommend that cats get tested when the dose gets up to around 5-6 units per cycle.
4. Switching to Prozinc from Vetsulin was a mistake.
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Not in our experience. Nor in studies quoted in that AAHA article. Prozinc lasts much longer in cats than Vetsulin. Vetsulin (aka Caninsulin) was developed for DOGS. (canine=dog) These AAHA consensus guidelines came out in 2010 and were updated in 2018. Perhaps your vet clinic is not a member of the AAHA and has never seen this information?
5. There's no such thing as remission. They are diabetic for the rest of their life.
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True. But there is such a thing as being diet controlled. Wink managed that "remission" status, off the juice, no insulin, diet controlled only, for the last 4 years of his life. Plenty of other cats on here have also gone into "remission" or diet controlled status. Cat number 450 just celebrated their OTJ (off-the-juice) status yesterday, over in the Lantus ISG group. https://felinediabetes.com/FDMB/threads/otj-party-for-kittencat-today.236157/#post-2647486 Many more cats then are listed there have gone into "remission" on other insulins and before this list was being maintained. Cornell article even calls it remission.
6. She said to just call next Wed @ 8 hours and tell her the reading and she will check with the Dr. for how much to increase.
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I can see why you want to shop around for a new vet after that experience. Ideas on vets in your area may get more responses if you put a post in the Feline Health forum, specifying what you are looking for and what area.

Here are some vet interview topics for you. It's another one of the many threads to be found in the Health Links/FAQs' forum. Vet Interview/Screening Topics & Check List

Hope at least some of this helps you.

I wouldn't suggest upping the dose by a full unit. Perhaps a 0.5U increase again tomorrow? Are you up for that?
 
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Is a vet tech even allowed to be making those kind of comments? :confused:
I'd definitely be informing the vet of the person's comments while handing them a copy of the AAHA guidelines and say you're looking for someone who already knows the difference between canine and feline diabetes. :rolleyes: That's probably too snotty to say but it's what I'd be thinking!

Take a look at the thread I started over on Think Tank about canine diabetes - your secretary/vet tech/whatever seems to be confusing the two significantly. Sigh.
 
@Deb & Wink @Panic @JanetNJ

Ernest doesn't want to eat!
We finally got him to eat half a can last night and gave him his insulin.
Refused all night.
This morning I got a little cooked chicken and maybe 2 tsp of wet in him and gave him 5.5u.

This is terrible. I'm going to start calling at 9am to find a new vet.
What else can we do??
 
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