Is Duke dropping too fast...

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Teetee (UK)

Teetee (UK)

Member Since 2019
Duke been to the vets today and is starting on Prozinc in the morning with 1.5 units twice a day. He's been fairly high for a few months now, from 8.2 mmol/L glucose levels, (148mg/dL) in March to 12.9 mmol/L (232mg/dl) at the end of September, but we think the Steroid injection for his arthritic back leg he had at the end of September tipped him over because his blood glucose shot up to 19.7 mmol/L (355 mg/dl) by the 1st December. He been on a low carb diet for months now but it hasn't brought his levels down.
So we start insulin tomorrow at 8 am.
Test, feed and wait 20 mins, shoot 1.5u prozinc

Emergency kit sorted
Honey, Tate & Lyle golden syrup
Gourmet gold in gravy
Webbox Lick-e-Lix salmon
keytone strips testing daily

I will be testing his blood glucose every 2 or 3 hours with the Alphtrak for the first week or so, then as we hopefully get him stable reduce the testing to maybe 4 times daily with a human meter, we have a freestyle lite and a Gluco Navii.
If i have missed anything or there is something that i am doing is wrong please let me know.
Thanks Elizabeth and Bertie Bandit's Mom Wendy&Neko Sam-cat for your invaluable help and advice.
Tee.
 
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That's a high starting dose. If you've not already seen the information in the Prozinc forum on dosing, there is great information there. This is a link to the forum. You'll want to look over the sticky notes.
 
Thanks Sienne and Gabby (GA), have you seen his spreadsheet today, just spoken to the vet and he said drop his dose down to 1 unit twice a day, i have just fed him and will check him again in 10 minutes. His bloods are coming down really quickly and getting close to danger, hopefully they will come back up. All i am doing is following the vets advice but i will certainly be posting on the forum for advice.
 
Yes, just gave him a belly full and his reading has come up slightly to 4.0mmol/L (72 mg/dl). I will check him again in about 1 hour, god this is frightening.
I have posted a thread on the Prozinc forum for help and advice.
Thanks for your help, it's really appreciated.
Tee.
 
I would test again in 20-30 minutes.

When Lola's BG dropped rapidly (but never into the danger zone) I was advised to feed a small amount, and test in 20. We did that a few times, spacing the interval out to 30 minutes until it was clear that she was holding her BG without the aid of food.
 
On the plus side, at +8 he's likely past his nadir. And, by Forum guidelines he's earned a .25u decrease. (Although I hasten to stress that I am not qualified to give dosing advice! Please see the PROZINC DOSING METHODS)

Hold the dose for at least a week:
  • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
@JanetNJ
@Shelley & Jess
 
I saw that after I responded initially here. Since there seems to be little activity on the ProZinc forum this morning, I think this is a wise place to be.

I would suggest that you change the title of your post from "Duke's starting..." to something like "Is Duke dropping too fast.." so people know that it's not a general status post.

ETA: It was during Lola's dramatic drop into lower numbers that we both become quite better at testing :p
 
Hi, I have changed the title, just going to check him again in a few minutes, i gave him some Golden syrup to bring him up a bit.
 
I've been hoping that someone more experienced would have joined us by now, but in the meantime I've been doing some searching. I know this post (#7) is quite old (from 2015) but I don't think the guidelines will have changed much:

If she drops below 50, you give a teaspoon or 2 of the "gravy" from a Gravy Lovers type food. Don't feed a lot of the meat part. What we do is pop the top, put it back down and squeeze to get as much of just the gravy as we can out and into a bowl or tupperware dish.

You recheck every 20-30 minutes...if it climbs into the upper 60's or so, you stop giving the high carb and try only regular low carb food ...if she stays too low, (or drops back down under 50) you give more gravy and retest in 20-30 minutes (we call that "Lather, rinse, repeat"....LOL)

Once they're in the high 60's or above, you want to give one more snack of low carb food and then no more (unless they drop again) You need to continue testing until it's been about 2 hours since they had any food and they're still staying in safe numbers​
 
Hi Tee,

I've only just seen this.

Very glad you caught the 3.4 (Alphatrak).

Full disclosure: I've not used Prozinc so any help I can offer is based on general principles of treating a diabetic cat with insulin and a very basic and patchy understanding of the specifics of Prozinc. Hopefully experienced Prozinc users will be able to weigh in with much more specific information and help for you. Because it's the holiday period, it may be a little longer than usual before you get more tailored replies. (Tagging: @Deb & Wink, @JanetNJ and @Panic to alert them to this thread.)

First up, Prozinc is an in-out insulin, so you've some bit of dosing flexibility (compared to Lantus and Levemir). In this instance, if you don't hear back from an experienced user here to the contrary, I would recommend following your vet's advice to drop the dose down to 1.0IU tonight. (It can always be adjusted again should it be too low, but it's better and safer to "start low, and go slow".)


teetee (UK) said:
Thanks, Pookie unfortunately i'm in the UK and that's not available, but we have Gourmet gold in gravy a similar thing i think. Just checked him again and he's up to 5.3 mmol/L (95mg/dl). will check again in 30 mins.
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Glad to see Duke's back up to 5.3.

* * * * Don't feed. Test again 30 minutes from the time of the 5.3 test. * * * *

Questions:

* Is Duke's appetite good?

* Which varieties of Gourmet Gold do you have in the house. Please be very specific about the varieties and flavours. (I need to look them up to check the carb values.)


Mogs
.
 
Pookie said:
Since he's going up that sounds like a good plan to me.

FYI, you can enter multiple readings in one square on the SS. (Something like "xx@+8; yy@+8.5") It may look a little wonky, but it puts the information immediately at hand.
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I was wondering if i could do that, thanks.
 
Critter Mom said:
Hi Tee,

I've only just seen this.

Very glad you caught the 3.4 (Alphatrak).

Full disclosure: I've not used Prozinc so any help I can offer is based on general principles of treating a diabetic cat with insulin and a very basic and patchy understanding of the specifics of Prozinc. Hopefully experienced Prozinc users will be able to weigh in with much more specific information and help for you. Because it's the holiday period, it may be a little longer than usual before you get more tailored replies. (Tagging: @Deb & Wink, @JanetNJ and @Panic to alert them to this thread.)

First up, Prozinc is an in-out insulin, so you've some bit of dosing flexibility (compared to Lantus and Levemir). In this instance, if you don't hear back from an experienced user here to the contrary, I would recommend following your vet's advice to drop the dose down to 1.0IU tonight. (It can always be adjusted again should it be too low, but it's better and safer to "start low, and go slow".)



Glad to see Duke's back up to 5.3.

* * * * Don't feed. Test again 30 minutes from the time of the 5.3 test. * * * *

Questions:

* Is Duke's appetite good?

* Which varieties of Gourmet Gold do you have in the house. Please be very specific about the varieties and flavours. (I need to look them up to check the carb values.)


Mogs
.
Click to expand...


Thanks Critter Mom yes his appetite is good.
The food is Gourmet Gold chunks in gravy chicken and liver.
Loads of Alphatrak strips, but i have a human meter Gluco Navii if needed.
Do you think i should dose him tonight as i'm really reluctant because of what has happened on his first day on prozinc and i cannot check him during the night.
Tee.
 
@teetee (UK) -

Thanks for replying. I'm going to try to look up the food now. While I'm doing that, another question:

* Does Duke have any history of testing positive for ketones or episodes of diabetic ketoacidosis?


Mogs
.
 
We check Duke everyday for ketones and they are negative. His bloods are back down to 4.1 mmol/L (73.8 mg/dl) so i have given him some Gourmet gold chunks in gravy chicken and liver, he woofed it down. Check again in 30 minutes.
 
If you haven't already done so, Tee, please can you check Duke's BG now and let me know the reading.

As long as the result is above 3.8, please don't feed him anything. Post the result and wait to hear back from me.

If he is below 3.8, please give a teaspoon of the GG chunks and some of the gravy, then post the result.


Mogs
.
 
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We cross-posted.

The 4.1 is safe for now. Test again in 30 minutes. Please follow the recommendations in my post above (#21) when you take the next reading.

For future reference, the golden syrup you gave will have helped boost the levels when you got the 5.3. Syrup or honey can boost numbers quickly but it also wears off quickly, hence why we use higher carb foods to steer numbers when a cat's running on the low side: it helps keep numbers up for longer (but you still need to keep testing to check whether more feeding is needed).

My furchild needs edibles. Back shortly...


Mogs
.
 
Critter Mom said:
If you haven't already done so, Tee, please can you check Duke's BG now and let me know the reading.

As long as the result is above 3.8, please don't feed him anything. Post the result and wait to hear back from me.

If he is below 3.8, please give a teaspoon of the GG chunks and some of the gravy, then post the result.


Mogs
.
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Hi Mogs, his last reading about 10 minutes ago was 4.1 mmol/L (73.8 mg/dl). Sorry i have fed him a desert spool of the Gourmet gold chunks in gravy chicken and liver before i read your post, i panicked when i saw the numbers come down again.
 
teetee (UK) said:
Thanks Sienne and Gabby (GA), have you seen his spreadsheet today, just spoken to the vet and he said drop his dose down to 1 unit twice a day, i have just fed him and will check him again in 10 minutes. His bloods are coming down really quickly and getting close to danger, hopefully they will come back up. All i am doing is following the vets advice but i will certainly be posting on the forum for advice.
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Glad you are reducing to 1 unit! Good catch! I am so glad you're testing. Duke is lucky to have you. :)
 
teetee (UK) said:
Sorry i have fed him a desert spool of the Gourmet gold chunks in gravy chicken and liver before i read your post, i panicked when i saw the numbers come down again.
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That's mild! Saoirse only ever had one hypo event (when I took the vet's advice to hold a dose against my own thoughts that I should have reduced it). I shoved the contents of an entire 5.5oz can of Purina DM mixed with a spoon of honey under her nose and she wolfed down practically the whole lot. (She was only at 4.4 on an Alphatrak at the time but she was zoned out and lethargic so symptomatic, after the too high Caninsulin dose caused a massive drop in her BG levels in less than 3 hours.)

You're keeping Duke safe, Tee. You're doing grand. :)


Mogs
.
 
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JanetNJ said:
You're doing fine. He's in a safe range.
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Janet, is there any chance you could give input on the dosing, please? (Tee advised above that ketone status is checked daily and thus far has been negative.) Also, I'd be grateful if you could take over keeping an eye on Tee and Duke as well (I'm struggling with quite severe fatigue right now). Would that be OK with you?


Mogs
.
 
Critter Mom said:
Janet, is there any chance you could give input on the dosing, please? (Tee advised above that ketone status is checked daily and thus far has been negative.) Also, I'd be grateful if you could take over keeping an eye on Tee and Duke as well (I'm struggling with quite severe fatigue right now). Would that be OK with you?


Mogs
.
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Thanks Mogs you have been a fantastic help, you sit down and have a nice brew. Thank you, thank you, thank you.
Tee.
 
teetee (UK) said:
Do you think i should dose him tonight as i'm really reluctant because of what has happened on his first day on prozinc and i cannot check him during the night.
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From the Prozinc Dosing Methods sticky - Start Low, Go Slow Method:

Starting Dose:
  • 1u BID if kitty is not on a wet/canned low carb diet
  • 0.5u BID if kitty has been switched to a wet/canned low carb diet
  • If the cat was previously on another insulin, the starting dose should be increased or decreased by taking prior data into consideration
  • Generally, shots are to be given 12 hours apart.
[Emphasis mine]

As I mentioned earlier, I've not used Prozinc so can only give suggestions based on general experience of insulin treatment for diabetic cats. People with Prozinc experience are likely to give you much more specific advice.

Considerations for tonight's dosing decision:

* Duke has no history of DKA or ketosis.
* Daily checks for ketones are ongoing and all results to date have been negative.
* Duke was biochemically hypoglycaemic on 1.5IU dose today.
* You've only just started insulin treatment. Therefore you're only in the discovery stage of what Duke's response will be like, and there's only limited BG data available (obvs!).
* You're feeding Duke a low carb, wet diet.
* The Prozinc guide recommends a starting dose of 0.5IU for a cat just starting insulin treatment who's on a wet, low carb diet.
* You can't monitor tonight.
* Duke hadn't come up too high by +11 (11.5 on Alphatrak), even after the high carb food used earlier to steer his numbers.

Based on the above considerations, I'd suggest skipping tonight (less of an issue when a cat doesn't have a history of being ketone prone). If you were to choose to give insulin, I'd suggest you consider the 0.5IU dose recommended in the FDMB Prozinc guide as a maximum.

If it were my cat and I couldn't monitor, I would skip tonight. Other members may offer additional/different suggestions.


Mogs
.
 
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I'd certainly expect some kind of bounce; that may be part of what you're seeing right now.

As long as there's no history of ketones, I think you'd be safe to skip. He's definitely high enough to shoot, but you might prefer to get a good night's sleep after today's excitement and re-visit things tomorrow ;).
 
Nan & Amber (GA) said:
I'd certainly expect some kind of bounce; that may be part of what you're seeing right now.

As long as there's no history of ketones, I think you'd be safe to skip. He's definitely high enough to shoot, but you might prefer to get a good night's sleep after today's excitement and re-visit things tomorrow ;).
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Thanks Nan, i'm not going to give him anything tonight, Duke's worn out, i'm worn out and stressed. We go again in the morning.
 
Shelley & Jess said:
I wouldn't blame you for skipping either you've had a heck of a first day!

We expect Duke to bounce but a kitty can be sensitive to insulin after a low like you got today too. We just don't know what way it will go with Duke yet.

I'm leaning towards reducing to 0.5u (when you do restart) because we're at the end of 3 months after a steroid shot.
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Yes i think your right Shelly and i will reduce to 0.5u in the morning and see where we go from there, thank you for that.
Tee.
 
Shelley & Jess said:
I'm leaning towards reducing to 0.5u (when you do restart) because we're at the end of 3 months after a steroid shot.
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I'm in agreement with skipping the insulin for tonight, and starting over at a much lower dose in the morning. The 0.5U dose would be my recommendation.

A combination of Duke being 3 months post steroid shot, the low carb diet, and the lows today are saying to me that Duke needs less insulin than the 1.5U he got this morning.

He's bouncing for sure, from that low neon green 3.4 mmol/L (61 mg/dL). Duke EARNED that dose reduction. YOU earned a good night's sleep. "Nighty night, sleep tight, don't let the bedbugs bite."

p.s. Yes, Duke was dropping too fast.
 
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