Newbie member Alice (& kitty Evie)

[AliceL]

Hello!

I need help and guidance on how to treat my cat Evie.
She was officially diagnosed with diabetes on 4th May.

Here is a timeline of what's happened to date:

Nov 2022 - Evie and I immigrated to Portugal. She weighed 6,7kg/14,7lb when we left. For the last 2 years she has been eating Royal Canin Lightweight diet kibble with a packet of standard jelly based wet food in the evening.
Dec 2022 - Vet visit in Portugal revealed that she now weighed 6.2kg/13.6lb, we put it down to the stress of traveling.
Jan 2022 - I notice she is not really eating her kibble as vigorously as she used to. This would be very unusual except we have recently changed countries and the food is different so I think she is just being fussy.
Feb 2022 - I take her back to the vet who finds that she has a gum infection, bad gingivitis. They assign blame to a flareup of her herpes virus since we travelled recently and stress causes flareups of this usually dormant virus. Evie has had FHV since being a kitten. They issue a three month course of immunotherapy meds to try help get it under control before taking the next extreme step of getting all her teeth removed - it sometimes happens with FHV cats. She now weighs 5,5kg/12lb which I find concerning but vet said its to be expected with the gum infection. I started giving her cat porridge at most meals to help her maintain weight - basically kibble softened with warm water - and still continue her evening pouch of wet food.

28th April - I brought Evie into the vet because I just thought she was looking extra scrawny. I'm shocked to discover that she now weighs 4.1kg/9lb. I insist they double check everything else, surely this can't just be from a gum infection. They do an X-ray and blood tests, find her blood glucose is 405. They presume diabetes and want to do a fructosamine test to be sure.

Thanks to a quick google on diabetic cats I don't wait for further instruction and jump into gear going cold turkey on the kibble immediately and replace all her meals with a high quality grain-free wet food I managed to find in a speciality store. The whole food issue is another story for a different thread because it is complicated in Portugal where everything is in Portuguese and I'm still figuring out what her best options are here. But I refuse to go back to kibble.

4th May - the vet confirms her fructosamine test came back as 600 and it IS diabetes. To date she had no symptoms except the weight loss.

5th May - She has an insulin curve test. She starts on Prozinc with the lowest unit requirement for her weight which is 0.8U. Her glucose monitor levels go from starting at 262 at 9am to 210 at 6pm. I ask the vet why her glucose via monitor is now 262 to start with when her blood lab results were 405 last week, vet said that's right and it doesn't mean her sugar level improved since the change to wet food....is that correct? Is there usually such a vast difference between the two tests?

She had a sonogram yesterday to check for pancreatitis or tumours, no news yet. If all clear the vet will increase her insulin as she is still testing around 260 in the morning, I take her into the vet to have her glucose checked every 2 days or so as I don't have a monitor yet. Side note - vet doesn't want me to test myself, says it is traumatic for Evie.

The vet also wants me to feed her twice a day only but Evie won't tolerate it. She vomits if she doesn't eat for long periods so I feed her at 7am, 1pm and 7pm. She tolerates the overnight stretch because she sleeps solidly like a human from 9pm-6am. I'd like to increase to 4 feedings per day if possible. Not sure what the best is for a diabetic kitty.

Currently she is on 4 pouches of food per day which is right for her current weight but she does need to put on more weight. She is on daily anti inflammatory for her mouth issues and her voracious appetite has thankfully returned. Vet wants to start kibble again for weight gain but I'm wary of that.

Any advice and tips? I'm so overwhelmed by all the info out there plus I can't help feeling a bit suspicious of the vet's advice that seems a bit misguided.

 

[Diane Tyler's Mom GA]

Welcome Alice and Evie
I'm going to tag a Prozinc User for you @Suzanne & Darcy
I see you are not home testing yet, that you ate taking her to the vet every 2 days or so , that is probably stressing her out more.
Most of us feed our cats multiple times a day during each 12 hour cycle
The bigger meals at AMPS that's the first BG reading you take in the morning to be sure her BG is high enough to give insulin, then 2 or 3 small meals after that
Maybe @+2, @+4, @+6. +2 means 2 hours after giving insulin, @+4 etc
Same with the PMPS cycle
I'm not familiar with what a 0.8 unit is.
I assume you are the one giving her insulin to her not your vet
What syringes are you using?
The only way to keep Evie safe is for you to start testing her at home
We have a spreadsheet we use to track our cats BG to see how the insulin is working and when an increase or decrease is needed.
I'm going to give you a UK link for foods that you might be able to get in Portugal
We like to feed about 6% carbs ate lower
You will see the carbs listed
There is a lot more information here besides the food list
https://www.felinediabetes.com/FDMB...-vit-b12-and-other-need-to-know-stuff.137376/

 

[Diane Tyler's Mom GA]

I don't know if you can get this monitor but here is the link
https://www.accu-chek.co.uk/blood-glucose-meters/instant

Test strips
https://www.accu-chek.co.uk/test-strips/instant-test-strips

 

[Diane Tyler's Mom GA]

I don't know if these might work or are the correct ones that's why I'm tagging
@Elizabeth and Bertie


We use the ones with half unit markings because we adjust the doses by 0.25 units at a time
Tagging @Elizabeth and Bertie too


https://www.petdrugsonline.co.uk/ca...ulin-caninsulin-syringes-0-5ml/category/520/#

 

[Veronica & Babu-chiri]

Welcome Alice and Evie

I know that when you get the diagnose everything seems very complicated and like you are in a big mess but as you start getting the hang of it it is not so bad and Evie will start feeling better so hang in there

I take her into the vet to have her glucose checked every 2 days or so as I don't have a monitor yet. Side note - vet doesn't want me to test myself, says it is traumatic for Evie.

We've heard this one to many times, including from my vet, and that is so not true, yes it is hard when you start because you do poke his ear and get a drop of blood but it is not traumatic for them ( bit more for you though since is you who will see the drop of blood but is just a very small drop) because their ears are really not that sensitive, actually is the handling of the ear what usually bothers them more than the actual poking, and once they get used to that (usually there's some bribing with treats involved) most of the cats have no problem with that.

And as Diane mentioned you really need to test at home to keep Evie safe and to get diabetes regulated.

The vet also wants me to feed her twice a day only but Evie won't tolerate it.

Usually is ok to free feed them, you will need to withdraw the food 2 hours before you shoot insulin though to make sure the test you make before giving insulin is not food influenced and it's safe to give insulin but he can eat normally the rest of the day, some cats actually do better having small meals during the day

Currently she is on 4 pouches of food per day which is right for her current weight but she does need to put on more weight. She is on daily anti inflammatory for her mouth issues and her voracious appetite has thankfully returned. Vet wants to start kibble again for weight gain but I'm wary of that.

It's good to hear she is eating normally again, kibble is usually very high in carbs and that will raise her blood glucose numbers which is really what you want to avoid, so you want to avoid kibble if possible.

Diabetic cats tend to loose weight because the high levels of glucose in her blood do not allow her body to actually absorbe all the nutrients in the food, once she gets regulated she will start to recover weight slowly for now I do suggest you focus on getting her regulated and trying to avoid her losing more weight ( probably allow her to eat as much as she wants) and not on her putting more weight fast, you will probably won't be able to do that if her diabetes is out of control because she's eating kibble

 

[Diane Tyler's Mom GA]

Here is a link helping us to help you link. If you noticed, our members have some basic information about their cat's in their signature. This helps us to not pester you by asking the same questions (your cat's name, insulin type, date of diagnosis, etc.) repeatedly. We also have a link to our spreadsheet in our signature. We are very numbers driven. The spreadsheet is a record of your cat's progress. By linking it in your signature, we can follow along and provide feedback should you need the help.
Once you start home testing we can see what's going on with Evie
If you need help setting up our spreadsheet just ask, we have a member that will happy to do it for you
You can tap on anyone's spreadsheet to see what it looks like . It's either at the end of their posts or it might say the name of their cats name like mine does Tyler's spreadsheet, I don't test that often because Tyler is in remission since 1-24- 21
So I don't have to test that often like I did, but you can tap on any of the past years I tested on his spreadsheet ,they are at the top of the SS


Tap on this blue link and then look for post #5 , the numbers are to the right I explained in detail how the SS works and info we need about Evie
https://felinediabetes.com/FDMB/threads/new-member-salem-newly-diagnosed.271043/#post-3018593

 

[AliceL]

Thank you to everyone who answered! I have updated my signature and created a spreadsheet.

I managed to convince Evie's vet to let me test at home. She wrote me a prescription and the pharmacy gave it to me for free! That's a thing here in Portugal that I didn't know previously, diabetics are supplied monitors for free.

We tried for the first time yesterday at 4pm so see how the machine works and this morning I did my first AMPS. I was surprised at how low the reading was - 207mg/dl - compared to her readings at the vet even though I now know the level can be raised because of 'trip to the vet' stress. I notice this is close to the no shoot number of 200 - can someone explain what this is and why I shouldn't inject her at 200?

Evie absolutely hates the home testing so any tips on how to calm her down would be appreciated!

I'm not familiar with what a 0.8 unit is.
I assume you are the one giving her insulin to her not your vet
What syringes are you using?

This is definitely something I have been worrying about. Everything I read online refers to units but her vet says (in broken English) not to worry about the units, I must give her 0.02ml of insulin which is correct for her weight, and she showed me what line it is exactly on the syringe. By the way, we used Prozinc which is 40U insulin along with a 100U syringe....I have since seen some information online regarding how the values could be confusing because I am not using 40U syringes. So I pushed the vet yesterday to explain to me exactly how this works and she showed me this calculation, hopefully it will make sense to some of you because I am still confused?

Evie's weight @ 4kg = starting at 0,2U insulin per kilo = 0.8U for Evie. I assume this is 0.8U as in almost 1 unit? Then she divides that by 40 (the type of insulin) to give us 0.02ml.
Then she shows me that 0.02ml is up to the very first line of the syringe. The syringe is an orange cap, 100U=1ml type.
Honestly I still can't figure out if this is correct and worry she is not getting enough insulin but vet insists if I start looking at it from a unit perspective it will be wrong.
Perhaps someone who is more experienced with how this works can alleviate my anxiety about this by double checking if this makes sense?

It's good to hear she is eating normally again, kibble is usually very high in carbs and that will raise her blood glucose numbers which is really what you want to avoid, so you want to avoid kibble if possible.

100% going to avoid kibble. I am really struggling to find appropriate food that doesn't involve importing food. Portugal is notorious for having major delays in clearing goods from customs so I need to find options that I can buy locally or anywhere in the EU countries which are duty free. What's maddening is that most websites are in Portuguese with no English options so I have to sit with Google Translate and figure out everything step by step. Same with the physical food in the shops, all in Portuguese and some don't even include ingredients on the packets. Right now I am feeding her wet food that says it is grain free but I have no idea what the actual carb content is and that's worrying. I try to not include options that have fruit or vegetables, something that seems common in Portugal.

This is her diet currently:
Nature's Variety Original Pate No Grain - https://www.tiendanimal.pt/natures-...l-frango-saqueta-para-gatos-/NTV927788_M.html
Lidl Pure Taste Pate Cat Food (link to flyer only) - https://assets.schwarz/leaflets/pdf...67/Pure-Taste-Alimentacao-para-Animais-06.pdf
Pingo Doce ActivPet, limited info but this one seems great, comes out in a solid block with no sauce or jelly - https://www.pingodoce.pt/produtos/m...ato-pate-de-frango-grain-free-activpet-100-g/

Not 100% sure if all ok but I will start looking for more appropriate foods online this week.

Once again thank you so much for taking the time to help me, I really appreciate all the assistance I can get!

 

[Shelley & Jess]

Honestly I still can't figure out if this is correct and worry she is not getting enough

The calculation is correct and a good starting dose (don't be tempted to give more)

I'll be back in bit, just getting mobile for the day.

 

[Sienne and Gabby (GA)]

Welcome to FDMB!

One consideration with food is that not all "grain free" foods are low in carbohydrates. Like you've noted, many cat foods will contain fruit or vegetables that will raise the percentage of carbohydrates. If you Google "cat food carb calculator" there are several websites that let you enter the guaranteed analysis data from the label and will give you an approximate amount of carbs for what you're feeding your cat. (This is the calculator that I use.) We consider low carb food to be under 10% although most members feed their cat a variety that's in the 5% range. This is a link to a food list for what's available in the UK. Unfortunately, we don't have a list specific to Portugal. Many of the cat foods that have some sort of "gravy" are higher in carbs. You can always add water to your cat's food to make it soupier. In fact, adding water is good for your cat. Cats have a limited thirst drive which is why canned food is a much better diet than dry food. This is a link to a website on feline nutrition you might find interesting. The other valuable aspect of this site is that the author, Lisa Pierson, DVM, has information on a raw food diet along with a recipe for making a nutritionally complete diet. If you're having a hard time finding food that Evie will eat, a raw (or partially cooked) diet may be an alternative.

It is not unusual for a cat to have higher blood glucose (BG) numbers when at the vet's office. It's called "stress hyperglycemia." In other words, the stress of travel to the vet let alone being at the office with all of the commotion, odd smells, and being handled by strangers causes a stress reaction. Stress causes BG numbers to be higher. This is also an issue because many vets will suggest you increase the insulin dose based on the numbers at the office. As you've seen, once your cat is home, the numbers are lower. Basing a dose decision on numbers at the vet may mean you give your kitty too much insulin.

To be honest, my brain would hurt if I had to do all of the calculations to figure out a dose. Is there any way for you to get U40 syringes? You may need to search online since most human insulin is U100. This website discusses converting units to ml and references the U40 vs U100 issue.

This is our post on home testing. There's a wealth of information in the post along with one link on the psychology of testing. The major factor is treats! You'll want to find low carb treats. Usually a freeze dried protein (e.g., chicken) or any sort of human protein that you cat likes will be fine. Any time you test, regardless of whether the test is successful, means that Evie gets a treat. You want her to associate getting tested with getting a treat. It will take a little while for her to learn but she will catch on. It also takes a week or two for the capillary bed along the edge of the ear to develop so her ear bleeds more easily.

Please let us know if you have questions. The members here are very generous with their time and knowledge. We're here to help.

 

[Shelley & Jess]

I agree with Sienne, first recommendation, if able, getting U40 syringes would be best - especially if you can get .3ml (or .5ml if needed) capacity.

vet insists if I start looking at it from a unit perspective it will be wrong.

I disagree with your vet here, I think it's really important for you to understand what's going on.

You are currently giving 0.8 units of U40 insulin using a mismatched U100 syringe. There’s a conversion chart you can use for administering U40 insulin with U100 syringes (I can post a simple version here if you want to see it). It's very important to understand the conversion first though because U100 insulin is 2.5 times stronger than U40 insulin.

The other big problem I see staying with your current 1ml (large capacity) U100 syringes is that those syringes are marked in 2 unit increments for use with U100 insulin - it's going to be really difficult to measure smaller U40 doses consistently if/when Evie needs a reduction.

Syringes (U40 & U100) both come in .3ml, .5ml & 1ml capacities. The unit marker lines on a .3ml syringe are marked in increments much better suited for measuring those smaller doses & dose changes an FD kitty needs.

If after reading the links Sienne included above and anything at all is still confusing, please don't hesitate to post and ask for clarification.

 

[AliceL]

The other big problem I see staying with your current 1ml (large capacity) U100 syringes is that those syringes are marked in 2 unit increments for use with U100 insulin - it's going to be really difficult to measure smaller U40 doses consistently if/when Evie needs a reduction.

So does that mean Evie is on 2 units then? Is a unit then equal to 0.01ml? Sorry, trying to understand all this.
I do agree with you about the syringe size. The problem is the pharmacies where I live only carry the 100U syringes but I will see if I can order them online perhaps.

I notice this is close to the no shoot number of 200 - can someone explain what this is and why I shouldn't inject her at 200?

Just wondering if anyone would mind clarifying this for me? I just tested her now and she is 202 @+11. Shouldn't the insulin be virtually gone by now? Vet said it has a 12hr window. Does that mean her BG should only continue to rise from now until tomorrow morning's insulin shot? She seemed less hungry this evening but wouldn't that be normal if her blood sugar was lower than usual right?

I apologise for the incessant questions, trying to understand what's happening.

 

[AliceL]

This is a link to a food list for what's available in the UK

Great resource, thanks so much. I see some of these brands are available on one of the Portuguese websites so that's a relief.

 

[Diane Tyler's Mom GA]

So does that mean Evie is on 2 units then? Is a unit then equal to 0.01ml? Sorry, trying to understand all this.
I do agree with you about the syringe size. The problem is the pharmacies where I live only carry the 100U syringes but I will see if I can order them online perhaps.

We use the ones with half unit markings because we adjust the doses by 0.25 units at a time
Tagging
@Shelley & Jess to see if these are the correct ones and
@Elizabeth and Bertie
Just a reminder Alice lives in Portugal


https://www.petdrugsonline.co.uk/ca...ulin-caninsulin-syringes-0-5ml/category/520/#

 

[Diane Tyler's Mom GA]

Conversion Chart
http://www.felinediabetes.com/insulin-conversions.htm

 

[Diane Tyler's Mom GA]

@AliceL
Hi Alice can you add to your signature Portugal?

 

[Shelley & Jess]

So does that mean Evie is on 2 units then? Is a unit then equal to 0.01ml?

No, Evie is on 0.8 units of U40 insulin and that is equal to 0.02ml. Think in U40 - even if you use a U100 syringe with the conversion chart for administering U40 insulin you're still giving 0.8 units of U40 insulin.

Because U100 insulin is 2.5 times stronger than U40 insulin:
U100 insulin = 0.01ml is equal to 1 unit of U100 insulin
U40 insulin = 0.01ml is equal 0.4 units of U40 insulin


The link Diane inserted above is a great reference, I'll copy & paste it here too so it's handy.
Insulin Conversions: U-40 and U-100

Just wondering if anyone would mind clarifying this for me? I just tested her now and she is 202 @+11. Shouldn't the insulin be virtually gone by now? Vet said it has a 12hr window. Does that mean her BG should only continue to rise from now until tomorrow morning's insulin shot? She seemed less hungry this evening but wouldn't that be normal if her blood sugar was lower than usual right?
I apologise for the incessant questions, trying to understand what's happening.

Yes, Prozinc duration for most cats is 12 hours. Yes, if you skip a shot we expect the BG to rise before the next PS test - but looks like she handled it really well last night seeing this mornings PS test! And yes, she may feel less hungry as her blood sugar gets closer to normal.

It's very early days, keep gathering the data for us to see and keep asking those questions - I mean it! I'm hit and miss when I can be around so I'll tag @Suzanne & Darcy again for another set of Prozinc eyes & to bring her in the loop for you.

 

[AliceL]

Usually a freeze dried protein (e.g., chicken) or any sort of human protein that you cat likes will be fine. Any time you test, regardless of whether the test is successful, means that Evie gets a treat. You want her to associate getting tested with getting a treat.

Just wanted to say this is working so well, oh my gosh! Evie is very food motivated and she caught on in the first go. She is quite excited to get her little pieces of chicken at test time, even though she does still moan a little when eventually I prick her, poor thing.

looks like she handled it really well last night seeing this mornings PS test!

Really? I was devastated seeing this mornings test results, they felt so high to me. But that's good to know. I am really trying to get a handle on all this info and understand everything, I think I may even have given myself a case of information overload because I can't think 100% clearly today. It's to be expected though, I am an anxious person by nature and now my beloved baby is ill so I am just.....*gah* brained. I'm sure you get it.

Because U100 insulin is 2.5 times stronger than U40 insulin

I think I finally get it - It only appears to be 2 units because of the 100U syringe markings but she is at 0.8/0.02ml of 40U insulin. ie. same amount would look different in a 40U syringe. Hope my understanding is correct now and thanks so much for taking the time to explain it to me.

If it's ok I would like to share how I am currently of managing my spreadsheet schedule for Evie.
As mentioned previously Evie doesn't tolerate long periods without food as she starts vomiting from too much acid in the tummy. I don't want to free feed her right now while I am still figuring out how the insulin affects her BG so I thought I would rather space out the tests along with the food portions, this way food is not really influencing the result of her BG test. I'm not sure if it's ok or even correct to work this way. If not please do enlighten me!

Wake up, BG test, insulin shot, big meal (1-1.5 packets of wet food)
+3, BG test, small meal (1/2 packet of food)
+6 BG test, small meal
+9 BG test, big meal
+ 12 BG test, small meal (by now insulin should be gone, but it is interesting to me to see how the food is affecting her BG without insulin)

I think am also noticing a correlation between some of her food brands and her BG levels.
The night before last I fed her Brand A and yesterday morning's reading was quite low.
Last night I fed her Brand B and this morning her level was much higher than yesterday's.
Bearing that in mind I have only fed her Brand A today and we have just tested right now at 164 (the lowest BG registered to date)
I have a feeling Brand A is lower carb than Brand B because of the look of it (dense block with no sauce or jelly). Of course I can't prove it because Portugal doesn't include ingredients on the packet as mentioned before. But anyway, I just thought that was interesting and I am definitely going to sort out that proper low carb food this week!

 

[Diane Tyler's Mom GA]

@Shelley & Jess
Hi Shelley would these U-40 syringes be ok for Alice to use so she doesn't have to keep using the U-100 when using prozinc
Tagging
@Shelley & Jess to see if these are the correct ones and

Just a reminder Alice lives in Portugal


https://www.petdrugsonline.co.uk/ca...ulin-caninsulin-syringes-0-5ml/category/520/#

https://www.viovet.co.uk/SOL-V-Insu...u-bmMgyt3OomMGToKpkmtKE0G7ktXXvhoCklAQAvD_BwE
This place may be cheaper to get the syringes

 

[Shelley & Jess]

Hi Shelley would these U-40 syringes be ok for Alice to use so she doesn't have to keep using the U-100 when using prozinc

Yep, they would work, or, if Alice could find 0.3ml that would be even better.

@AliceL
I've read your last message, I think there's a couple things we could address.

I'm short on time this morning (I'm sorry) & have asked Suzanne to pop in and have a look

 

[Suzanne & Darcy]

Hello! Shelley asked me to stop by. I never saw any tags from last week. I see you have made a lot of progress. Let me finish reading through your entire thread and then I have a few suggestions. I’m going to switch off this phone and get to a real computer. First I will feed my heart kitty, Ginger, who is ready for her meds and supplements now.

 

[Diane Tyler's Mom GA]

Yep, they would work, or, if Alice could find 0.3ml that would be even better.

@Shelley & Jess
Hi Shelley I tried searching all over and I don't think 0.3ml is available in Portugal

 

[Suzanne & Darcy]

I don't want to free feed her right now while I am still figuring out how the insulin affects her BG so I thought I would rather space out the tests along with the food portions, this way food is not really influencing the result of her BG test.

It is true that diabetic cats do far better with smaller meals portioned out during the day. That "feed two times a day" thinking is old thinking and just not the best for your baby, as you (who know her best) can already tell.

I am wondering exactly when you made the food switch to cut out all kibble. That probably was a major influence in lowering her BG numbers (from when she first was diagnosed and when the vet did the fructosamine and some of the subsequent testing. Of course, you already know that vet stress definitely can elevate numbers -- and some cats are more sensitive to that than others.

 

[Suzanne & Darcy]

What is the reason for not giving her insulin at night? I don't see tests there but only ns in the units column. Did I miss this when reading through the thread? Sorry if I did!

 

[Suzanne & Darcy]

Anyway, you had a nice blue nadir on 5/15. That's good to see. She's been mostly flat in yellows since then. I would like to see you get evening preshot tests logged on your spreadsheet so we can see how the insulin is working for her. It would be better for her to receive insulin every 12 hours (even if that means she needs a lower dose). Getting an evening test in after the shot (perhaps a +2 or a "before bed" test) can really be important. This way you will see (based on numbers) if she will need to have a snack for the evening (I know you said she sleeps through the night, but you may need to wake her and give a snack -- just a teaspoon or two -- if possible.)

So far, with the data that we have, it looks like her nadir may be around +6. As for the feeding schedule, we don't recommend feeding food after +6 because it can shorten the duration of the insulin. We don't know the effect of that +9 large meal, because we don't have tests for PMPS yet. We do need to take into consideration that you want her to gain back weight -- so I definitely understand that. I am wondering if it would be possible to feed her meals/snacks at +2, +4 and +6, instead of feeding at +9. Or will this cause her to vomit if she has to go from +6 to +9 without food? If so, don't stress, just give her the larger meal at +6 and then a smaller very low carb one at +9... what do you thing? I know you are still trying to figure out all the carbs in your food choices.

 

[Diane Tyler's Mom GA]

@Suzanne & Darcy
Morning Suzanne I'm sure you read she is using U-100 syringes for Prozinc, I tried to find U-40 syringes with half unit markings to use
I posted some pics and they only come in 0.5ml. I assume she can use these?
As you can see she was given the conversion chart.
Maybe she should put in her signature using U-100 syringes until she can get U-40 syringes what do you think?

 

[Suzanne & Darcy]

When she vomits after going a long time without food, is it just white foamy liquid? That's usually a sign of an acid tummy. It can also be a little yellow from bile sometimes. Some people will give 1/4 of a regular strength (10 mg) Pepcid AC in the morning, but unless she has IBD you probably don't want to use that long-term (daily) but only very occasionally. Slippery Elm Bark powder can be very helpful for a excess stomach acid. I have been using it with one of my cats lately. There are many different ways to use it. I have simply taken a human Slippery Elm Bark capsule and dividing it into two #2 size empty gelatin capsules and giving it to Ginger at 5:30 in the morning. She takes a lot of meds and I have to wait about two hours after she gets the slippery elm to give her prescription meds (there is a concern that it can impede the absorption of the meds if you don't wait.) Anyway, feeding the small meals is also a fantastic way to help her, and you're already doing that! I'm very impressed with how you have gotten "up and running" with your spreadsheet and the testing. I'm really proud of you! Evie sounds like a really sweet cat.

 

[Diane Tyler's Mom GA]

@Suzanne & Darcy
I think I added this after you liked my post
As you can see she was given the conversion chart.
Maybe she should put in her signature using U-100 syringes until she can get U-40 syringes what do you think?

 

[Suzanne & Darcy]

@Suzanne & Darcy
Morning Suzanne I'm sure you read she is using U-100 syringes for Prozinc, I tried to find U-40 syringes with half unit markings to use
I posted some pics and they only come in 0.5ml. I assume she can use these?

Yep, the .5 mL capacity syringes are just fine for U-40 syringes. That's what I used to use, and I didn't have any problems with making .25 unit dose adjustments. The half unit markings are important, as you know. These would DEFINITELY better than using the U-100 syringes. I just hope she can order some U-40s. It will certainly make it easier on those of us here to help Alice, too!

 

[Diane Tyler's Mom GA]

Yep, the .5 mL capacity syringes are just fine for U-40 syringes. That's what I used to use, and I didn't have any problems with making .25 unit dose adjustments. The half unit markings are important, as you know. These would DEFINITELY better than using the U-100 syringes. I just hope she can order some U-40s. It will certainly make it easier on those of us here to help Alice, too!

Thanks so much @Suzanne & Darcy

 

[Diane Tyler's Mom GA]

@AliceL
Hi have you read about the 2 dosing methods for Prozinc, they will tell you when to adjust the dose
Here they are , when you decide which one you want to follow can you please add it to your signature and your spreadsheet up top where it asks you

 

[AliceL]

I am wondering exactly when you made the food switch to cut out all kibble. That probably was a major influence in lowering her BG numbers

I definitely thought the switch lowered her numbers before starting insulin but the vet insisted it wasn't the case. She said lab test @405 is more accurate than glucometer @262. Even though these results were 4 days apart and I switched her to wet food the same day she got the 405 reading off the first blood test. She has never had another lab blood test since the first one, and the fructosamine was done on that same blood test - that came back as 599. To reiterate, this is her timeline:
Friday 28 April - Blood lab test 405 BG / I switch to 100% wet food from this day
Tuesday 2 May - Glucometer 262 BG / Fructosamine test goes ahead using last weeks blood
Thursday 4 May - Fructosamine result is 599 / vet confirms diabetes
Friday 5 May - 1st Insulin shot + curve test (results are on Evie's spreadsheet)

What is the reason for not giving her insulin at night?

Vet wants to see how she reacts on the daytime shot before commencing night time shot. She still really wants to check Evie's urine to check the glucose reading before making any changes. I have been struggling collecting the urine because the darn cat refuses to piddle in the special litter.
Admittedly I'm a little nervous starting nighttime shot until her proper LC carb food arrives later this week. I have definitely noticed her night time spike two days ago is caused by a certain brand. I gave her that same brand today at +3 and see the same spike in BG. I will discontinue that brand immediately, clearly the carb content is still too high.
Yesterday she had great numbers and it was eating another brand. I feel like I am treating her blind because there are NO nutritional breakdowns on these food packets in Portugal so I can't work out the carbs.

As for the feeding schedule, we don't recommend feeding food after +6 because it can shorten the duration of the insulin. We don't know the effect of that +9 large meal, because we don't have tests for PMPS yet. We do need to take into consideration that you want her to gain back weight -- so I definitely understand that. I am wondering if it would be possible to feed her meals/snacks at +2, +4 and +6, instead of feeding at +9. Or will this cause her to vomit if she has to go from +6 to +9 without food? If so, don't stress, just give her the larger meal at +6 and then a smaller very low carb one at +9... what do you thing? I know you are still trying to figure out all the carbs in your food choices.

I will take all of this into consideration and see if I can adjust it and add more evening tests for better results.
I have temporarily added meals onto Evie's spreadsheet so you can have a look at how she is eating in relation to the test results - I've been recording them in the notes the last few days. I'm using SM for small meals and BM for big meals. Meals are given after test or insulin, never before. I have noticed if I do not give Evie a small meal at around the +14/+15 mark she will vomit during the night.

When she vomits after going a long time without food, is it just white foamy liquid? That's usually a sign of an acid tummy. It can also be a little yellow from bile sometimes. Some people will give 1/4 of a regular strength (10 mg) Pepcid AC in the morning, but unless she has IBD you probably don't want to use that long-term (daily) but only very occasionally.

Evie has been dealing with the vom issue for a few years. It was always foamy white/yellow but lately more brown/pink. Obviously I was hugely concerned at that but vet said its definitely from the stomach (I send her pictures). Evie actually does have some unknown allergies (coughing fits & itchy spots on some food) that can cause inflammation and she could even have IBS because the last X-ray showed the lining of her intestines is inflamed. X-ray, sonogram and blood tests showed no other issues at all, other than allergies and high glucose. Vet is reluctant to commit on IBS right now because she is nutritionally starved from the diabetes at present so she says maybe her intestine is just irritated. Evie is also a FHV cat so she often has immune flareups resulting in all sorts of inflammation issues, such as currently she has stomatitis. I will ask my vet re something to give Evie for the acid!

I'm very impressed with how you have gotten "up and running" with your spreadsheet and the testing. I'm really proud of you! Evie sounds like a really sweet cat.

Ah thank you for saying that. She is such an intelligent being with a lovely soul and we are definitely bonded. I really would do just about anything for her, and I'm 10000% committed to trying to achieve diabetic remission. I think Evie's diabetes has been caused by various steroid therapy she received in the last few months for her FHV issues, so I'm hopeful for remission. I didn't know about steroids causing feline diabetes before, if I had I would have NEVER let my cat near them. She is my baby!

I just hope she can order some U-40s.

I live in central Portugal, semi-rural, so it's a supply issue for sure. I have to go into Lisbon sometime this week so I will check at pharmacies in the big city. If not I will definitely try to order these online somehow.

Hi have you read about the 2 dosing methods for Prozinc, they will tell you when to adjust the dose
Here they are , when you decide which one you want to follow can you please add it to your signature and your spreadsheet up top where it asks you

Not 100% clear what these are all about but will read up and revert.

Thank you to everyone who has replied and taken the time to help Evie and I!

 

[Diane Tyler's Mom GA]

I definitely thought the switch lowered her numbers before starting insulin but the vet insisted it wasn't the case. She said lab test @405 is more accurate than glucometer @262. Even though these results were 4 days apart and I switched her to wet food the same day she got the 405 reading off the first blood test. She has never had another lab blood test since the first one, and the fructosamine was done on that same blood test - that came back as 599. To reiterate, this is her timeline:
Friday 28 April - Blood lab test 405 BG / I switch to 100% wet food from this day
Tuesday 2 May - Glucometer 262 BG / Fructosamine test goes ahead using last weeks blood
Thursday 4 May - Fructosamine result is 599 / vet confirms diabetes
Friday 5 May - 1st Insulin shot + curve test (results are on Evie's spreadsheet)


Vet wants to see how she reacts on the daytime shot before commencing night time shot. She still really wants to check Evie's urine to check the glucose reading before making any changes. I have been struggling collecting the urine because the darn cat refuses to piddle in the special litter.
Admittedly I'm a little nervous starting nighttime shot until her proper LC carb food arrives later this week. I have definitely noticed her night time spike two days ago is caused by a certain brand. I gave her that same brand today at +3 and see the same spike in BG. I will discontinue that brand immediately, clearly the carb content is still too high.
Yesterday she had great numbers and it was eating another brand. I feel like I am treating her blind because there are NO nutritional breakdowns on these food packets in Portugal so I can't work out the carbs.


I will take all of this into consideration and see if I can adjust it and add more evening tests for better results.
I have temporarily added meals onto Evie's spreadsheet so you can have a look at how she is eating in relation to the test results - I've been recording them in the notes the last few days. I'm using SM for small meals and BM for big meals. Meals are given after test or insulin, never before. I have noticed if I do not give Evie a small meal at around the +14/+15 mark she will vomit during the night.


Evie has been dealing with the vom issue for a few years. It was always foamy white/yellow but lately more brown/pink. Obviously I was hugely concerned at that but vet said its definitely from the stomach (I send her pictures). Evie actually does have some unknown allergies (coughing fits & itchy spots on some food) that can cause inflammation and she could even have IBS because the last X-ray showed the lining of her intestines is inflamed. X-ray, sonogram and blood tests showed no other issues at all, other than allergies and high glucose. Vet is reluctant to commit on IBS right now because she is nutritionally starved from the diabetes at present so she says maybe her intestine is just irritated. Evie is also a FHV cat so she often has immune flareups resulting in all sorts of inflammation issues, such as currently she has stomatitis. I will ask my vet re something to give Evie for the acid!


Ah thank you for saying that. She is such an intelligent being with a lovely soul and we are definitely bonded. I really would do just about anything for her, and I'm 10000% committed to trying to achieve diabetic remission. I think Evie's diabetes has been caused by various steroid therapy she received in the last few months for her FHV issues, so I'm hopeful for remission. I didn't know about steroids causing feline diabetes before, if I had I would have NEVER let my cat near them. She is my baby!


I live in central Portugal, semi-rural, so it's a supply issue for sure. I have to go into Lisbon sometime this week so I will check at pharmacies in the big city. If not I will definitely try to order these online somehow.


Not 100% clear what these are all about but will read up and revert.

Thank you to everyone who has replied and taken the time to help Evie and I!

Sorry I forgot to give you the link for the dosing methods
https://felinediabetes.com/FDMB/threads/prozinc-dosing-methods.225629/

 

[AliceL]

Sorry I forgot to give you the link for the dosing methods
https://felinediabetes.com/FDMB/threads/prozinc-dosing-methods.225629/

Had a quick read. I don't feel confident to start changing insulin doses without the correct syringes. I'm currently on the first line of the syringe, there is no line one back, and the next line is a double dose. I'm going to prioritise finding syringes this week. Will post a picture of my current syringe shortly.

 

[AliceL]

Evie's syringes. Her dose is at the 2U mark.

 

[Suzanne & Darcy]

Had a quick read. I don't feel confident to start changing insulin doses without the correct syringes. I'm currently on the first line of the syringe, there is no line one back, and the next line is a double dose. I'm going to prioritise finding syringes this week. Will post a picture of my current syringe shortly.

I am sitting here at the vet with my cat and reading your replies. I agree that you should probably not adjust the dose until you have the U-40

Had a quick read. I don't feel confident to start changing insulin doses without the correct syringes. I'm currently on the first line of the syringe, there is no line one back, and the next line is a double dose. I'm going to prioritise finding syringes this week. Will post a picture of my current syringe shortly.

I agree with you. I would not feel comfortable increasing the dose anyway, until I had the correct syringes. Now, if she earns a reduction that would be a different matter (but would be difficult to work out.)

 

[Suzanne & Darcy]

I'm not happy with that pink tonight. She would be better off with p.m. insulin!

 

[AliceL]

I'm not happy with that pink tonight. She would be better off with p.m. insulin!

Agreed. Those high numbers do worry me.

I saw on one of the information threads that changes in insulin could take 1-2 days to filter changes into the BG readings. I'm wondering if that is true of feeding schedules too.
Evie's BG was higher today than yesterday but I changed her feeding schedule yesterday to more frequent feedings than before.

If that's the case perhaps I should go back to what 'seemed' to be working before, which was a 7am+1pm+7pm feed. That would be a feed at 0, +6, +12.
She absolutely hates it and starts howling at the +9 mark but her health is more important than her feelings right now.

Or perhaps I'm just over analysing things and need to calm down a bit while I get into a rhythm / gather more data / sort out her food and syringes
Think I'm still so inexperienced at this that every higher-than-before BG number just feels like a major failure on my part.

Hope your vet visit goes well!

 

[Suzanne & Darcy]

Sorry for the chopped up messages. Vet walked in - then I replied later from home and both got sent.

Anyway, I think you may be over-analyzing things at this point. You are working on the food situation, and hopefully will figure out which foods are lower in carbs than others and/or which ones spike her BG (and you have already been discovering and tracking that.) I would not make her go that long without food if it distresses her. It may even raise her BG and she may just build up too much acid in her stomach. She’s had so many changes lately (food, shots, tests) that I would try to keep her happy. The most important time for her to not eat (at least for now) is the two hour fasting window before the preshot tests.

 

[Veronica & Babu-chiri]

Or perhaps I'm just over analysing things and need to calm down a bit while I get into a rhythm / gather more data / sort out her food and syringes
Think I'm still so inexperienced at this that every higher-than-before BG number just feels like a major failure on my part.

Take a big breath, you are doing great, a lot better than I did when Babu was diagnosed for sure, you just need to be a bit patient, handling feline diabetes needs a lot of it so hang in there , and don't beat yourself or worry to much if her numbers go up and down that's kind of normal when you start giving insulin, they usually get a bit more stable after a while ( usually although that's not always the case Babu use to like diving like a pro to very low numbers and bouncing big time from the start and till his last drop of insulin but fortunately most are not like him)

So try not to worry to much and keep asking all you want or need

 

[AliceL]

So today is Evie's first time doing a night time insulin shot and I'm a little nervous to go to sleep even though I am exhausted today!
Usually I watch her like a hawk in the first 6 hours after her day time shot - I somehow have it in my head that this is when she is at the most risk for hypo.

Her curve has been a little inconsistent today, she ate breakfast but wasn't hungry the whole morning, usually she asks for food around +3 & +6. Her BG didn't drop as expected at +3 but it was a little better at almost +6. I think she was experiencing a little pain from her stomatitis because she was breathing a little faster than usual.

I was out for a few hours this afternoon and couldn't do her routine tests as normal.
She asked my husband for food while I was out so she did eat eventually, but she won't let him test her so we skipped the +9 test.

I was really surprised to find that she was 205 at PMPS, usually she would be around high 200s. I gave her the insulin anyway, was this the right thing to do?
I just tested her for +3 and she is now 187, which is great, but her nadir is around +6 usually so I'm wondering how much further she might drop.
Do you think she'll be ok if I fall asleep? I don't think I'll last to the +6/1am, I'm quite an early sleeper and already struggling.

How does a hypo episode work exactly? I'm under the impression that she wouldn't go from 187 to 50 in a few hours as the Prozinc has a gentler curve. Am I mistaken on that?
Maybe I'm just overthinking again because she had such an unusual curve during the daytime.

Any thoughts?

 

[Suzanne & Darcy]

Let me look at her spreadsheet before replying

 

[Veronica & Babu-chiri]

I was really surprised to find that she was 205 at PMPS, usually she would be around high 200s.

That's good

I gave her the insulin anyway, was this the right thing to do?

Yes even though it was close to 200 it was still a good value not under 200

Do you think she'll be ok if I fall asleep? I don't think I'll last to the +6/1am, I'm quite an early sleeper and already struggling.

You could maybe get a bit of sleep and set an alarm for around 1 am that way you can test her at that time that way if she's ok you just go back to sleep and if by any chance she's going low you then decide what to do depending on how low she is

How does a hypo episode work exactly? I'm under the impression that she wouldn't go from 187 to 50 in a few hours as the Prozinc has a gentler curve. Am I mistaken on that?
Maybe I'm just overthinking again because she had such an unusual curve during the daytime.

It's hard to say since we haven't seen one on her and hopefully we never will, but truth is each cat is different and some go down slowly and some just dive in like pro divers in any case the important thing is to have the hypo kit at hand and give food or syrup as soon as posible

 

[Suzanne & Darcy]

Where are you in the cycle right now?

 

[Suzanne & Darcy]

Are you giving snacks?

 

[Suzanne & Darcy]

This is not a huge drop from PMPS to 187 in three hours. I would continue monitoring for at least a +4 and as long as you can stay awake to make sure she’s either dropping only slowly or is flat (or even bouncing). Can you get a +4?

 

[AliceL]

Ok, I just managed to test her at +5.5 and it's back to 235. Really unusual numbers today.

 

[Suzanne & Darcy]

Looks like she’s on her way back up. I would give a snack and go to sleep. Unless she’s only going up because you fed high carb?

 

[AliceL]

Unless she’s only going up because you fed high carb?

I've fed her nothing now.
She ate at + 3 like she usually does....at night that particular feed is about preventing her vomiting during the night from no food....in the daytime cycle the +3 feed doesn't increase her BG from starting point but I think perhaps she started out at an unusually low point 205 this evening.

 

[Veronica & Babu-chiri]

She could be bouncing a bit, sometimes it doesn't take a big drop to bounce just lower numbers than usual

 

[Suzanne & Darcy]

How does a hypo episode work exactly? I'm under the impression that she wouldn't go from 187 to 50 in a few hours as the Prozinc has a gentler curve. Am I mistaken on that?

This could happen. I’ve seen it many times. If the cat is a diver, they may drop precipitously. Then you have to “feed the curve” with snacks of varying carb percentage’s depending upon how your cat responds to carbs.