Hi, New Here, Thought I'd Intro Myself

[Mel Flagg]

Hi! I'm Mel. My cat Marair (he named himself I swear) is a 13 yr old male, neutered, and was diagnosed with DM in June after I checked his BS randomly due to him showing symptoms of DM.

I'm not new to DM, I spent 27 yrs in ophthalmology and most of my patients were diabetic, I also had gestational DM and was diagnosed prediabetic (which is now in remission), and had a diabetic dog (although I knew nothing then about DM in animals and my vet wouldn't let me check her levels. She died a year later of complications.) The irony here is, I'm now a coach for those with prediabetes. So when my cat was diagnosed, it was a face/palm moment. I have kept all of his BS readings and insulin dosages in my own spreadsheet since July.

The vet put Marair on Prozinc, and at his second checkup after a month on 2u q12hr with several skipped doses due to hypos, my vet told me to use a sliding scale. This worked until about a week ago.

Marair had a hypo of 38, and since then I cannot get his BS under control, or even below 300. After reading through everything in this forum, I feel like I need a new vet, because clearly cats don't do well on a sliding scale.

So now I'm at a loss. Yest at 7pm, his BS was 544 and I gave him a fat 1.75u. His BS didn't drop below 400. So I went back to the dose he had the best control at (it was the most common dose I gave him over the past 2 months), and his BS dropped to 261 about 5 hours later, the lowest it has been in several days. Three hours later he's back to 350. By the time 7pm rolls around, he'll be back up to over 500 at this rate.

So I'm not sure what to do. Do I go back up to his starting dose of 2u and start the Prozinc dosing method? Or do I give him 1u again, and start there? His BS has been so high the past week, and part of the problem with a background in medicine is all the worst case scenarios are running through my head.

So any thoughts would be appreciated. Thank you!

PS, he's on Wellness Core 95 pate.

 

[Ale & Bobo & Minnie (GA)]

Welcome and glad to hear you’re no stranger to diabetes!

You’re testing a lot which is great and thank you for setting up your spreadsheet. Since you only have data for one day, it’s hard to give you dosing advice. I would, however, suggest you stay with the 1 unit for a bit so we can see how he does on it. The 38 hypo on 2 units clearly means that was too high a dose. I’d stay at 1 unit for the next 7 days, more below.

I’d say the most common mistake I see beginners make is want to do dose adjustments too fast. If you read the yellow sticky notes on the prozinc forum, there’s one on the dosing methods we use here. Most use SLGS and that means you hold the dose for at least 7 days before doing a curve, unless your cat falls under 90. This is the only exception. Every time your cat’s bg falls under 90, it earns a reduction of 1/4 unit. We make dose adjustments based on the lowest the dose is taking your cat not the preshot numbers. We also adjust by 1/4 units not full units. I’m tagging out prozinc pro here @Suzanne & Darcy because you’re testing to much you could also follow the modified TR.

I know it’s nerve wrecking, but feline diabetes is a marathon, not a sprint.

I’m not familiar with the food but if it’s less than 10% carbs, it should be fine. How often are you feeding?

If you haven’t browsed it already, here’s the link to the prozinc forum: https://felinediabetes.com/FDMB/forums/prozinc-pzi.24/

 

[Mel Flagg]

Welcome and glad to hear you’re no stranger to diabetes!

You’re testing a lot which is great and thank you for setting up your spreadsheet. Since you only have days for one day, it’s hard to give you dosing advice. I would, however, suggest you stay with the 1 unit for a bit so we can see how he does on it. The 38 hypo on 2 units clearly means that was too high a dose. I’d stay at 1 units for the next 7 days, more below.

I’d say the most common mistake I see beginners make is want to do dose adjustments too fast. If you read the yellow sticky notes on the prozinc forum, there’s one on the dosing methods we use here. Most use SLGS and that means you hold the dose for at least 7 days before doing a curve, unless your cat falls under 90. This is the only exception. Every time your cat’s bg falls under 90, it earns a reduction of 1/4 unit. We make dose adjustments based on the lowest the dose is taking your cat not the preshot numbers. We also adjust by 1/4 units not full units. I’m tagging out prozinc pro here @Suzanne & Darcy because you’re testing to much you could also follow the modified TR.

I know it’s nerve wrecking, but feline diabetes is a marathon, not a sprint.

I’m not familiar with the food but if it’s less than 10% carbs, it should be fine. How often are you feeding?

Thank you!

Yes I read through the prozinc page about 3 times. LOL! I try to test him every 2 hrs. He's really good about it, so it's easy and quick to do. I did just start the spreadsheet here today, but I do have my own that I've been using (plus the app that comes with the glucometer we have). But since we've been doing sliding scale for most of the time, based on what I have read here, there's no real usable data. Over the past 2 days his average insulin dose has been about 1.5u (ranging from 1.0 to a fat 1.75) and like I said his the lowest his BS has been in that time was the 261 today. The highest was 544. The second full month on Prozinc, we had good control with an average BS of 206. But now his average BS is 291.

I feed him several smaller meals throughout the day. So today, he's eaten about 1/2 of a 5.5 can since 5am, I try to keep him at 1 can per day. He tends to sleep for a long 4 hour window from about 12 to 4pm, so he's currently "fasting" asleep.

I tried to look for Marair's food on the food chart from Dr. Pierson, Wellness is on there, but not the one he is currently eating. Based on the numbers from their "guaranteed analysis" it should be 2.5% carbs, but I'm not sure how accurate that is. So after reviewing the food chart, I'm going to be switching him to Weruva Mack and Jack which is apparently 0g carb and 78g protein.

So we'll go with the 1u tonight and see what happens in a few days... the waiting is the hard part... and I am not a patient person... I'm jus sayin... LOL

 

[Sienne and Gabby (GA)]

Welcome to FDMB!

You clearly have a good handle on diabetes management and are a good observer of your cat. With Prozinc, at one point there was an accepted sliding scale approach. (Actually, the approach was used with PZI which pre-dated Prozinc.) The methods that we now use differ in that we don't use a sliding scale.

If there's any way you can transfer a couple of weeks of Marair's blood glucose data to your spreadsheet it would be very helpful. Having a bit more to look at can help us to brainstorm what may be going on. If I had to play a hunch, the 38 caused Marair's numbers to "bounce." When numbers drop into a low range, the liver and pancreas release a stored form of glucose along with counterregulatory hormones that drive blood glucose numbers up. It can take several days for the bounce to clear. Depending on when your cat's numbers dropped, he may not have cleared the bounce.

Holding the 1.0u dose can't hurt unless the dose is way to low and Marair has a history of ketones/DKA. We tend to be more aggressive with dosing if ketones have been in the picture.

 

[Bron and Sheba (GA)]

Hi and welcome to the forum Mel and Marair.
I agree with Sienne that a couple of weeks of BG data would be helpful.
Are you testing for ketones in the urine? If not I would recommend you get a bottle of Ketostix from Walmart or a pharmacy and test 3 times a week, if the initial test is negative.

 

[Mel Flagg]

I will work on getting some additional data in the spreadsheet... I have plenty of it LOL

This am, I gave Marair his shot at 05:30, 1u. At +2 he was at 357, so coming down from 411. Just checked it again, so we're +3hrs, and he's back up to 372. Not sure what to do here. If I wait till 530pm his BS will be super high (I'm assuming).

As for ketones, I have ketone strips on the way,, should be delivered later today. When he was diagnosed 2 months ago, he did not have ketones (I filled in his lab values in the spreadsheet this am, if that's helpful). I do also use pretty litter, granted that doesn't test for ketones, but the color has not changed from his normal yellow. Theoretically, if ketones were present, his urine should be more acidic and the color should turn to blue. But theoretically, and reality are two different things. LOL