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Marie & Red

Marie & Red

Member Since 2021
Hi, my kitty is Red (or Red Potato) and he was just diagnosed on 12/2. The vet put him on 2 units of ProZinc twice a day and suggested prescription diet. It took me about a week to find this site and I'm so glad I have. Red wasn't eating much at his meals so I only gave him 1 unit twice a day. I stopped all dry food, which he loved, and he is currently only on wet food. I started testing about 10 days ago and he seems to be doing well with 1 unit so I never have given the prescribed dose. My question is are we supposed to try to keep them at a certain BG level or range? Like in the green or blue on the spreadsheet?
 
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Hi, I am so glad you found this site, it was a lifesaver for me. I am not an experienced member so someone else will likely have more to add.

Glad to hear you are home testing and switched to wet food. We do like to keep our kitties in blues and greens but we would also like to nudge them towards remission and there is dosing protocol to that end. You can find more information in the link below and I am sure someone with more experience with Prozinc will come along with more advice:).

https://www.felinediabetes.com/FDMB...-the-prozinc-basics-please-start-here.164995/
 
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Welcome to FDMB!

Your instincts are very good.

Ideally, you want to get your cat into normal numbers -- between 50 - 120. With Prozinc, 90 is the point at which you give a dose reduction if you're following the Start Low Go Slow dosing method. (There's more information about dosing in the link Diane provided.) At the minimum, you want to keep your cat's numbers below renal threshold (around 220 but it varies from cat to cat.)

If I may, I'd like to offer a few suggestions.
  • This is a link to a post on helping us to help you. You've already gotten your spreadsheet up and running which is a big first step and ditto regarding home testing. In the link, there's information on adding more information to your signature (e.g., the insulin you're using, date of diagnosis) so we don't keep asking you the same questions again and again.
  • I suspect you will want to do a bit more testing. It's important to know how low a dose is taking Red's numbers. If you can test at least 4 times a day, you will get a better picture. You are already testing at pre-shot times -- and that's two of the tests. The pre-shot test tells you if it's safe to give insulin. Getting a shot somewhere around the middle of the cycle will also give you an idea of how low the dose down Red's numbers and if a dose reduction is needed.
  • Getting a PM cycle spot check test is important. We encourage getting a "before bed" test every night so you can feel reasonably reassured about where your cat's numbers are. Without any PM tests, you're missing half of your data.
You mentioned that you're feeding Red a prescription diet. Which prescription food are you using? Unfortunately, many of the prescription diabetic foods are quite high in carbohydrates. You want Red to be easing under 10% carbs (and most people here feed their kitties in the neighborhood of 5%).
 
Sienne and Gabby (GA) said:
Welcome to FDMB!

Ideally, you want to get your cat into normal numbers -- between 50 - 120. With Prozinc, 90 is the point at which you give a dose reduction if you're following the Start Low Go Slow dosing method. (There's more information about dosing in the link Diane provided.) At the minimum, you want to keep your cat's numbers below renal threshold (around 220 but it varies from cat to cat.)

If I may, I'd like to offer a few suggestions.
  • This is a link to a post on helping us to help you. You've already gotten your spreadsheet up and running which is a big first step and ditto regarding home testing. In the link, there's information on adding more information to your signature (e.g., the insulin you're using, date of diagnosis) so we don't keep asking you the same questions again and again.
  • I suspect you will want to do a bit more testing. It's important to know how low a dose is taking Red's numbers. If you can test at least 4 times a day, you will get a better picture. You are already testing at pre-shot times -- and that's two of the tests. The pre-shot test tells you if it's safe to give insulin. Getting a shot somewhere around the middle of the cycle will also give you an idea of how low the dose down Red's numbers and if a dose reduction is needed.
  • Getting a PM cycle spot check test is important. We encourage getting a "before bed" test every night so you can feel reasonably reassured about where your cat's numbers are. Without any PM tests, you're missing half of your data.
You mentioned that you're feeding Red a prescription diet. Which prescription food are you using? Unfortunately, many of the prescription diabetic foods are quite high in carbohydrates. You want Red to be easing under 10% carbs (and most people here feed their kitties in the neighborhood of 5%).
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Thank you, I will update my signature with some more info, and do some more testing. The vet suggested the Hills or Royal Canin prescription diet, and I bought a few cans of Royal Canin glycobalance food, but I'm not feeding it. I gave Red one can the first day and he didn't like it at all. I ended up throwing it away. Since I read the food chart early on, I've only been feeding pate from the chart, mostly Fancy Feast. He's a small eater, and will only eat about 1/4 to 1/2 can at once. But he will eat several times a day.

What confuses me is that I've read several places here that if the BG levels are under 120, or under 150, that a dose is not required. I've still given his dose at these numbers. I don't think his numbers are bad at all. Are you saying that if his BG is 90 or above, he should get his usual dose? And if under 90, lower it? And if so, do I lower by .25 or .50? And what level would I skip the dose...if at all? I currently have him at .75 units.
 
Marie & Red said:
What confuses me is that I've read several places here that if the BG levels are under 120, or under 150, that a dose is not required. I've still given his dose at these numbers. I don't think his numbers are bad at all. Are you saying that if his BG is 90 or above, he should get his usual dose? And if under 90, lower it? And if so, do I lower by .25 or .50? And what level would I skip the dose...if at all? I currently have him at .75 units.
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Hi and welcome.
We suggest to new members who do not have much data to not shoot under 200 or 150 depending on what insulin you are using. Once you get some data and know how your kitty handles the insulin, you can start lowering the Preshot dose.
Getting those mid cycle tests in will tell you if the dose is good or needs adjusting.

You are actually shooting lower Preshots and have adjusted the dose so there is no need to go back to 150. Read the Prozinc dosing methods and this will make things clearer.
do you have a hypo box set up in case you need it?
Yes, if you are following the SLGS method. You reduce the dose at 90. We recommend increasing and reducing the dose by 0.25 U.
I’m going to tag @JanetNJ snd @FrostD as they are Prozinc users.
 
Most members who are new to feline diabetes are a bit nervous if they are testing at pre-shot and the numbers are in the 120 - 150 range. Aside from an understandable concern that numbers are likely to drop once the insulin starts working (aka "onset"), if you don't have very much data accumulated, you won't have much of an idea how your cat responds to insulin. As a result, when you're first starting out we recommend that if you get a pre-shot test that's in a lower range, you take one of 3 options:
  • Do not feed your cat and stall for approx. 15 - 20 minutes or so. Re-test. Are the numbers rising or are they still fairly flat? You can continue to stall. You're looking to see that the insulin is wearing off and numbers are heading up.
  • Shoot a reduced dose of insulin.
  • Skip the shot. This is an option providing your cat doesn't have a recent history of diabetic ketoacidosis.
Ultimately, you will want to be able to shoot progressively lower numbers. There is an underlying message though -- if you are shooting lower numbers you have to get additional tests. It's imperative to monitor because you have no other way to know if Red's numbers are dropping and if you will need to intervene with higher carb food. For example, if Red were my cat, I would have been testing past PMPS when you're pre-shot number was 94. Even the numbers that are in the low 100s need more tests to make sure Red is in safe numbers.

If you've not yet had a chance to look over the information on Prozinc, this is a link to the Prozinc Insulin Support Group. There's a great deal of information on dosing and on Prozinc in general on the board. (It sounds like you may have looked this over -- I'm just being thorough.)

I'm also tagging a couple of our experienced Prozinc users: @JanetNJ
@FrostD
 
Hi and welcome!

Are you able to do a curve this weekend? Testing the BG every hour or every other hour after a shot?

I must admit shooting that much at these low preshots makes me nervous, especially without any other tests. Hes not bouncing which may mean it's ok, but I'd rather be safe than sorry.

Any history of ketones or DKA? Was he by chance on steroids recently?

If there's no history of ketones or DKA, I would actually reduce to 0.25U until you can get a curve in. Any preshot under 150 I would not shoot, just for the time being. 150 and over, I'd give the 0.25U.

Are your preshots fasting? Meaning no food for 2 hours before the shot.

Does your schedule allow for more midcycle tests?
 
FrostD said:
Hi and welcome!

Are you able to do a curve this weekend? Testing the BG every hour or every other hour after a shot?

I must admit shooting that much at these low preshots makes me nervous, especially without any other tests. Hes not bouncing which may mean it's ok, but I'd rather be safe than sorry.

Any history of ketones or DKA? Was he by chance on steroids recently?

If there's no history of ketones or DKA, I would actually reduce to 0.25U until you can get a curve in. Any preshot under 150 I would not shoot, just for the time being. 150 and over, I'd give the 0.25U.

Are your preshots fasting? Meaning no food for 2 hours before the shot.

Does your schedule allow for more midcycle tests?
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Doing a curve will be difficult tomorrow since I'll need to be away for several hours. Is a curve 12 or 24 hours? I and the cats will be traveling Monday (locally 2 hours). I can probably do one Tuesday or Wednesday.

He has not been on any steroids. No history of DKA, but on his first urine test on 11/25, he had 2+ ketones. I've added all of his lab work into the spreadsheet. The vet didn't seem too worried about it. I knew nothing about it until I found this site. On his follow up visit on 12/2, he was given an antibiotic injection for an infection in his tooth/jaw.

I'm a little nervous dropping down to 0.25 since he has been receiving 1.0 or .75 recently. Is that okay? Would it be better to drop to .5 to see how that works out first? I'm so confused at this point.

All of his preshots are fasting.
 
a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours.
Don't feed anything 2 hours prior to testing his AMPS
Example
For the curve let's say you give him the insulin at 5:30 AM
5:30 AM. Give insulin
7:30 AM test him
9:30 AM test him
11:30 AM test him
1:30 PM test him
3:30 PM test him
5:30 PM PMPS you test
You can continue to feed him normally
Good luck :cat:
Red is so adorable , those big eyes :cat:
 
Marie & Red said:
Doing a curve will be difficult tomorrow since I'll need to be away for several hours. Is a curve 12 or 24 hours? I and the cats will be traveling Monday (locally 2 hours). I can probably do one Tuesday or Wednesday.

He has not been on any steroids. No history of DKA, but on his first urine test on 11/25, he had 2+ ketones. I've added all of his lab work into the spreadsheet. The vet didn't seem too worried about it. I knew nothing about it until I found this site. On his follow up visit on 12/2, he was given an antibiotic injection for an infection in his tooth/jaw.

I'm a little nervous dropping down to 0.25 since he has been receiving 1.0 or .75 recently. Is that okay? Would it be better to drop to .5 to see how that works out first? I'm so confused at this point.

All of his preshots are fasting.
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Ok thanks. It's likely the diet change plus infection clearing up really brought his BGs down overall

Do you have urine ketone strips at home? Regular human ones are fine. How's his appetite and water intake?

My concern, to put it as straightforward as possible, is you are very possibly risking a hypoglycemic event with the 0.75-1U dose and these preshots. Hypoglycemic events can be very serious, resulting in permanent disabilities or even fatal. It's certainly no judgment on what you've been doing up to this point, and I'm not trying to scare you; this is just what my experience with my own cat and lots of cats on this forum is telling me. He doesn't seem to be bouncing so it is possible the dose is ok, but there is no room for error in numbers this low and no monitoring. Just because he's been ok so far does not mean he will always be - insulin is a hormone and does not work the same way day to day.

Until you can do a curve, and/or start to get more tests in, I would much rather "risk" the possibility that his BG creeps up a little bit for a few days when giving 0.25U. Slightly higher numbers are much safer than numbers that are too low.

The ketones do complicate things a little bit, which is why I asked. The ideal situation to me is reducing to 0.25U, monitoring ketones daily at home, and getting at least one extra test in each cycle (so two preshots, plus one more test each AM and PM) - ideally, it would vary from +2 to +6 so over time we can get a rough picture of the whole cycle.

We have a saying here "you hold the syringe" - if and what dose you shoot is completely your call. If you don't want to go to 0.25U that is your call, I am just making sure you are aware of the risks.
 
If you can get some additional tests today at a lower dose I think it will ease our concerns. There's no effective way to guess how low Red's numbers are going at nadir (the lowest point in the cycle). It's entirely possible that you may have missed dose reductions.

It's also possible that Red's numbers were elevated if your cat had an infection. Numbers often drop once an infection clears up.
 
Diane Tyler's Mom said:
a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours.
Don't feed anything 2 hours prior to testing his AMPS
Example
For the curve let's say you give him the insulin at 5:30 AM
5:30 AM. Give insulin
7:30 AM test him
9:30 AM test him
11:30 AM test him
1:30 PM test him
3:30 PM test him
5:30 PM PMPS you test
You can continue to feed him normally
Good luck :cat:
Red is so adorable , those big eyes :cat:
Click to expand...

Thank you! This helps immensely!
 
FrostD said:
Ok thanks. It's likely the diet change plus infection clearing up really brought his BGs down overall

Do you have urine ketone strips at home? Regular human ones are fine. How's his appetite and water intake?

My concern, to put it as straightforward as possible, is you are very possibly risking a hypoglycemic event with the 0.75-1U dose and these preshots. Hypoglycemic events can be very serious, resulting in permanent disabilities or even fatal. It's certainly no judgment on what you've been doing up to this point, and I'm not trying to scare you; this is just what my experience with my own cat and lots of cats on this forum is telling me. He doesn't seem to be bouncing so it is possible the dose is ok, but there is no room for error in numbers this low and no monitoring. Just because he's been ok so far does not mean he will always be - insulin is a hormone and does not work the same way day to day.

Until you can do a curve, and/or start to get more tests in, I would much rather "risk" the possibility that his BG creeps up a little bit for a few days when giving 0.25U. Slightly higher numbers are much safer than numbers that are too low.

The ketones do complicate things a little bit, which is why I asked. The ideal situation to me is reducing to 0.25U, monitoring ketones daily at home, and getting at least one extra test in each cycle (so two preshots, plus one more test each AM and PM) - ideally, it would vary from +2 to +6 so over time we can get a rough picture of the whole cycle.

We have a saying here "you hold the syringe" - if and what dose you shoot is completely your call. If you don't want to go to 0.25U that is your call, I am just making sure you are aware of the risks.
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Ok, I understand and agree. I do know higher numbers are safer than low. I'll start the 0.25 unit this morning.

Before insulin, he ate a lot and drank constantly. He used to eat a lot of dry food, besides wet, because I used to leave some dry out all the time. Now, dry food is gone, he eats wet food throughout the day. The vet suggested feeding only 2x per day, but he doesn't eat much at one sitting, so that didn't work out. I now feed him wet food several times per day. And I make sure not to feed 2 hours prior to testing. His water intake has reduced tremendously compared to before his DX. He does drink but not much...and spills & plays more than he drinks.

I don't have any ketone strips and have never tested for ketones before. Yikes! He has a vet appt Tuesday, and I am sure they will test for ketones also. I will definitely do some more BG testing, starting today. If his numbers shoot up because of the lower dose, do we increase the dose back up or let him stay at the higher numbers?

Thank you so much for your help!
 
Sienne and Gabby (GA) said:
If you can get some additional tests today at a lower dose I think it will ease our concerns. There's no effective way to guess how low Red's numbers are going at nadir (the lowest point in the cycle). It's entirely possible that you may have missed dose reductions.

It's also possible that Red's numbers were elevated if your cat had an infection. Numbers often drop once an infection clears up.
Click to expand...

I will do that. I'm going to do more testing starting today!
 
Don't assume the vet will test for ketones! They generally test for blood ketones but it really depends on what they include in lab tests. It looks like they tested for urinary ketones previously. If they are taking blood, it may not be a routine test but you can ask for it to be included. Otherwise, pharmacies should carry Ketostix. The purchase doesn't require a prescription.
 
Sienne and Gabby (GA) said:
Don't assume the vet will test for ketones! They generally test for blood ketones but it really depends on what they include in lab tests. It looks like they tested for urinary ketones previously. If they are taking blood, it may not be a routine test but you can ask for it to be included. Otherwise, pharmacies should carry Ketostix. The purchase doesn't require a prescription.
Click to expand...

Can I test for blood ketones? Or does it have to be urine? Seems like a urine test would be very difficult to do.
 
There are ketone meters that test for blood ketones just like you do for testing blood glucose. The strips are quite pricey -- about $1.00 each but you don't generally get lots of ketone tests unless you have a cat with a history of ketones.

Most people use urine test strips. The trick is stalking your cat to the litter box. You either put the strip into your cat's urine stream or use a spoon or ladle to catch some urine and test from there. There are some other ways (e.g., putting plastic wrap over the litter) to catch fresh urine.
 
Thank you. I don't mind paying for the blood ketone strips if it's a good test. And thank goodness Red is very good with letting me test his blood. Will the blood ketone strips be just as informative as the urine test?
 
Good about the feeding, we recommend multiple small meals a day anyway! How many times a day does he pee?

I prefer the blood ketone meter (I have NovaMax Plus) because he's a shy litterbox user, and I don't have time/ability to stalk him. Plus, when they're feeling ill, much more convenient to just get blood vs wait for urine (and good luck if they're dehydrated too). The blood test also serves as a pretty good warning system in my opinion. Anecdotally, numbers 0.4 and under seem to be pretty normal. When they start creeping up on 0.6 or 0.8 and higher, it's a pretty good sign something is coming - infection, etc. Urine strips at this point would still probably be negative.

If his BG starts creeping up still hold the 0.25U dose for a few days. If ketones start to show up then we'll figure out what to do. As long as his water intake is good (overall, between the wet food and water bowl) and he has a good appetite he'll likely be ok.
 
@FrostD thank you! Good to know about the blood meter for ketones! I agree stalking to the litter box is a bit difficult. If I even walk near the box when my kitties are in it (I have 2), they jump out. I will look today for a meter. I'm not sure how much Red pees because of having the 2. It doesn't seem excessive though.
 
@FrostD I received my ketone meter and tested Red this morning. He measured 0.2 on the meter and 181 for BG. He has a vet appt in 2 hours so they told me not to give insulin. I guess because they want to measure themselves? Should I still stall or give since I've been measuring myself all along? What can I do about his ketones?
 
Sorry I wasn't around. You've shot numbers like that plenty, I'd have shot. Sometimes vets are uncomfortable telling people to shoot anything under 200 or 250. Can't think of any other reason they'd tell you to skip... especially with those fairly recent ketones.

If you can be off schedule I'd still shoot.

That 0.2 is actually a good result! I raise an eyebrow when I see 0.6 or 0.8, but it usually isn't worrisome until over 1, usually means they're fighting something off and keep an eye out. There's a study that showed ketones over 2.5 is basically guaranteed DKA...so obviously you don't want to let it get that high. 95% of the time Mr Kitty is LO to 0.4.
 
@FrostD
I apologize for not replying. Both my husband and me have contracted covid/omicron and it's been a real challenge. I have done nothing for days. Unfortunately, today seem to be my worst day but I wanted to update you. I have continued to measure Red's BG though, but only twice a day right now, before his shot. I haven't been able to do a curve yet.

I did give Red the insulin at 181 BG. The vet told me not to give the insulin because he wanted to test Red in the office first. The odd thing is that he wanted me to feed him before I took him in, then he would test his BG - which doesn't make sense to me. He said that's how I should be testing - after he eats. He said it should be feed, test, insulin. ??

The vet also did not take it very good that I was doing my own testing and said I should not be adjusting the dose of insulin. He didn't even like me using the ReliOn - because he said it's not reliable and suggested the Alphatrack if I wanted to test. He also suggested the libre to get a reading throughout the day and gave a prescription for it. He said there was no need for me to test so much and I should just give Red the 2.0 units of insulin because he has 20+ years of experience and he has never had a cat go into hypoglycemia!

This is all confusing because he says the opposite of what I learned here. Now I am not trusting the vet. Needless to say, I am not giving Red 2.0 units. He wants us to come back next week, feed Red and then he will test his BG before giving him insulin. I don't know if I even want to go back to him, but how will I get insulin if I don't?

Good news about the ketones. Once I am feeling better and over these symptoms, I will test Red more often throughout the day.

Merry Christmas
 
Hope you guys get better soon!

Are there any other vets in your area?

I suspect he's had cats go hypo and possibly die, but because diabetics are usually senior cats they don't think twice about why.

He doesn't want you testing so much, yet wants a Libre? Doesn't make any sense.
 
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