Help with growing numbers

A

Algraud

Member Since 2024
Hello,

our cat, Lelouch (age 7), was diagnosed 12/5/2023 and had was hospitalized due to DKA. After hospitalization, the ER Vet gave us Vetsulin and suggested Pro DM Purina food. Our vet (who seen Lelouch first time right before hospitalization) said he wouldn't have prescribed vetsulin, but said we should give it a try and did not object Pro DM. They also said to start giving 1u (just as ER) and if we want to test, do it once in a while (don't overdue it). A nurse also helped us pick out a Relion Platinum Meter

We started using Vetsulin and for a while didn't change anything, Lelouch seemed way better than before ER, so we were happy. On a later date (12/21) I wasn't sure if I didn't hit a blood vessel when injecting ( I panicked). We tested and my partner joined a Facebook group that strongly recommended to start monitoring the shots and testing before them. Also to make a test before night time. Based on the numbers after the shot we were advised to go to 0.5u vetsulin for now, but ask to change to a more long lasting insulin.

Note: We used to feed him dry and leave food the whole day. After switching to Pro DM we were advised to make it 2 times a day, so at first he would eat little and we would have to remove it. This might be reason for low numbers. We later (end of Vetsulin) changed this to remove food 2 hours before injection and let him eat thought out

For a few weeks preshot numbers were between 100-150. Then they started to rise to above 150 and we started giving the 1u dose again. The dose continue to be between 150-200 for a few weeks and continue to grow over 200. At which point we called vet, who said "if its around 300 its great that thats the goal (to not go over 300)". That kind of dissapointed me, especially after reading online that a lot of vets seem to not know much about feline diabetic treatment. The group informed me that the insulin age might be to old (was 46 days since puncture). That doubled down my opinion of the vet, since they said that with the current dosage, the vetsulin will last us for a few hundred days (might be miscommunication, but opinions was set).

I called the vet, saying the insulin might be too old and they agreed with me. I also asked for a more long lasting insulin, which they suggested ProZinc.

After a few day of waiting and continuing to give Vetsulin, we got ProZinc and started with 1U. The numbers stayed around 200. We were unsure if to increase it to go back to "normal numbers". We kind of decided to give 1.5u if close to 200 and 1u if less. For a few weeks it jumped around 200 but started to grow again, where we started to give 2u.

Recently it started being around 300 and he started urinating more. Facebook group explained we need to look at nadir (not pre-shot and base it on that). They also said we shouldn't switch from Pro DM to Fancy Feast classic pates (I looked up that both of them are low carb and Lelouch likes Fancy Feasts a lot more). So our current strategy is to lower back to 1.5 and feed Pro DM.

That's the current situation. We feel like the numbers just keep growing and nobody knows why. Any insight is welcome.

TLDR: Through out treatment, numbers are slowly rising and all possible answers I can find are conflicting. Need Advice.
 
Algraud said:
Hello,

our cat, Lelouch (age 7), was diagnosed 12/5/2023 and had was hospitalized due to DKA. After hospitalization, the ER Vet gave us Vetsulin and suggested Pro DM Purina food. Our vet (who seen Lelouch first time right before hospitalization) said he wouldn't have prescribed vetsulin, but said we should give it a try and did not object Pro DM. They also said to start giving 1u (just as ER) and if we want to test, do it once in a while (don't overdue it). A nurse also helped us pick out a Relion Platinum Meter

We started using Vetsulin and for a while didn't change anything, Lelouch seemed way better than before ER, so we were happy. On a later date (12/21) I wasn't sure if I didn't hit a blood vessel when injecting ( I panicked). We tested and my partner joined a Facebook group that strongly recommended to start monitoring the shots and testing before them. Also to make a test before night time. Based on the numbers after the shot we were advised to go to 0.5u vetsulin for now, but ask to change to a more long lasting insulin.

Note: We used to feed him dry and leave food the whole day. After switching to Pro DM we were advised to make it 2 times a day, so at first he would eat little and we would have to remove it. This might be reason for low numbers. We later (end of Vetsulin) changed this to remove food 2 hours before injection and let him eat thought out

For a few weeks preshot numbers were between 100-150. Then they started to rise to above 150 and we started giving the 1u dose again. The dose continue to be between 150-200 for a few weeks and continue to grow over 200. At which point we called vet, who said "if its around 300 its great that thats the goal (to not go over 300)". That kind of dissapointed me, especially after reading online that a lot of vets seem to not know much about feline diabetic treatment. The group informed me that the insulin age might be to old (was 46 days since puncture). That doubled down my opinion of the vet, since they said that with the current dosage, the vetsulin will last us for a few hundred days (might be miscommunication, but opinions was set).

I called the vet, saying the insulin might be too old and they agreed with me. I also asked for a more long lasting insulin, which they suggested ProZinc.

After a few day of waiting and continuing to give Vetsulin, we got ProZinc and started with 1U. The numbers stayed around 200. We were unsure if to increase it to go back to "normal numbers". We kind of decided to give 1.5u if close to 200 and 1u if less. For a few weeks it jumped around 200 but started to grow again, where we started to give 2u.

Recently it started being around 300 and he started urinating more. Facebook group explained we need to look at nadir (not pre-shot and base it on that). They also said we shouldn't switch from Pro DM to Fancy Feast classic pates (I looked up that both of them are low carb and Lelouch likes Fancy Feasts a lot more). So our current strategy is to lower back to 1.5 and feed Pro DM.

That's the current situation. We feel like the numbers just keep growing and nobody knows why. Any insight is welcome.

TLDR: Through out treatment, numbers are slowly rising and all possible answers I can find are conflicting. Need Advice.
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The fancy feast classic is lower carb so in not sure why they would advise to not switch. Ff classic is a popular choice here. I am glad you found this board. :) one thing that would really help us give you good advice is to share your readings with us. Do you have a Google spreadsheet you could like to?
 
Hi there! You have really been through a lot with your sweet baby. You have already learned a lot about testing and not feeding for two hours prior to the preshot tests, that we base doses on nadirs and not on preshot numbers (although we can give some consideration to the preshot number if it’s unusually low, etc.) I think you are making some progress. Looking over your spreadsheet, I would strongly recommend picking a single dose that you think you can hold for 7 days while you test as much as you can and we can see what is happening and move forward. We need more data on your spreadsheet. Tell me about your limitations on testing (your work schedule?) I think you could safely try 1.5 units and get some tests in at at least +4 and +6 if you can? It’s helpful to test at different times of day as well to fill in gaps in the data. But it’s important not to jack the dose around too much (unless a reduction is earned or you have a very low preshot.)
 
Thank you for the replies. We will stick to the 1.5u (even though the numbers scare us compared to before). Me and my partner both work at the same location and are gone from 8:30am to 5:30pm(sometimes close to 6pm). We are able to sometimes take a longer leave during lunch (to make a +4 - +6 check), but doing that too might alert the managers. On weekends we try to be free and can in most cases do a curve at least one of the days.
 
Algraud said:
Thank you for the replies. We will stick to the 1.5u (even though the numbers scare us compared to before). Me and my partner both work at the same location and are gone from 8:30am to 5:30pm(sometimes close to 6pm). We are able to sometimes take a longer leave during lunch (to make a +4 - +6 check), but doing that too might alert the managers. On weekends we try to be free and can in most cases do a curve at least one of the days.
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I honestly don't think 1.5 is enough. If it were my cat I would hold 2 for 5 -7 days then reassess if the dose needs to be raised. do a few extra mid day readings on the weekend if you are home and see how low it's going. on 2 units you were getting better numbers and it never went too low. on a human meter normal is 50- 120 If 2 proves to bring him too low, then lower it to 1.75. If it's not enough raise it to 2.25 - 2.5 (depending on the numbers)
 
I see you went back up to two units. The reason I suggested a lesser dose is simply because there are so few mid-cycle tests. We actually have almost no idea of what your cat did on the 2 unit dose except on one day, March 3 (which was a great cycle and very safe.) One day of good numbers on a certain dose (in this case 2 units) does not mean that the cat will have exactly the same kind of cycle on the same dose on a different day. However, since you did increase the dose and the weekend is coming up tomorrow- will you be able to test frequently? I already said that I thought a little more insulin would probably be required, but I wanted to work things up after you had gathered enough data for us to be sure your cat would be safe. Your call. Just get the testing in this weekend if you can. Then we will really have a better idea of how the dose is working for him.
 
So far so good today with the 2 units. Excellent job with the testing today. That is so helpful. Keep up the good work! You may see lower numbers later today. I will peek again later on today.
 
Yeah, we did panic a little when we saw 395 and with JanetNJ's message we decided to try 2u for a while. We will test both today and tomorrow. Thank you for the replies!!
 
Yes. No worries. It’s all good. I’m just very cautious about recommending doses when people don’t have enough data to support a certain dose. Don’t want a hypo and I didn’t think that there was danger necessarily of a hypo bit we wouldn’t know that without a little more data… which you are gathering today and it’s perfect because you are available to monitor today. I saw that you had long periods of time with no tests so assumed your work kept you from testing so I felt it wasn’t safe to recommend 2 units right off the bat. That was my rationale. Anyway it doesn’t matter anymore since you have two solid days to see how the 2 units does. In your case with a history of DKA (are you monitoring for ketones by the way?) then normally I would also be more aggressive about dosing, but still there has to be testing going on to keep Lelouch safe.
 
We did a ketones test yesterday evening and it was in between none and trace (not sure on color).
 
Today the number jumped a lot lower than we expected and we continued to change doses. Based on Feb 25 curve, We were worried that a 2u will be too much. Is that the correct approach in this situation? How should we decide when a lower dosage is necessary?

Edit: Seems that the morning test was bad? the difference between 8am and 10am is too big
 
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Yes, but we shot at 8:30 (so half an hour early). Thought its better to ease in by half an hour to our normal time
 
I would not have shot a reduced dose with the AMPS of 177. I do understand your anxiety though since you have not shot 2 units before with that kind of a preshot number. As you can see, it looks like the 2 units would have been fine and hopefully would have kept Lelouch from climbing so high — but it also looks like he may have started a bounce from the lower numbers that his body isn’t used to. We will be able to see that soon.

I would not doubt the morning’s test necessarily. It is possible though that you had a bad test strip. If you ever get a number that seems really wacky to you then recheck it right away if you can - to make sure the strip wasn’t faulty.
 
Algraud said:
Yes, but we shot at 8:30 (so half an hour early). Thought its better to ease in by half an hour to our normal time
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It is better to adjust shot times by no more that half an hour under most circumstances. You can do 15 minutes a day if you plan ahead. But half an hour per day is fine.
 
So shooting early may be the reason for the lower AMPS.

If you have a low AMPS or PMPS and are in doubt about shooting, if you have the time in your schedule you can just stall without feeding your cat. Then wait half an hour to see if Lelouch is rising on his own without the influence of food. Then you can have more certainty about shooting the insulin.
 
What food are you feeding now? I saw some note in your spreadsheet about going back to Purina. What food is he eating? Wet or dry food? Low carb food? When is he eating — at what hours in the cycle?
 
Dont lower the preshot for a 150. It’s doing what you want it to…. Just as this dose is wearing off and going up the next dose will be kicking in. You want to get that preshot down. Unless he gets close to 50 or below on the mid day shoot keep the dose.
 
Algraud said:
Numbers continue to grow. Preshots being so close to 400 scares us. What could we be doing wrong?
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I like that blue you saw today.
Have you had her teeth checked lately?
You aren’t giving her any dry food or treats, right?
 
Algraud said:
Numbers continue to grow. Preshots being so close to 400 scares us. What could we be doing wrong?
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You aren’t doing anything wrong. Sometimes their insulin needs just change. If it’s still high by Fri I might try an increase in dose this weekend. He is not at a high dose yet so don’t panic.

you’re doing a great job at testing!!! He’s lucky to have you.
 
No dry foods or treats. We haven't checked teeth (not even sure how, except to bring to vet?). Thank you for the help, we will look see on Friday if we need to increase (2.25 or 2.5? not sure if the normal increase is by 0.25 or the rate increases the higher you go)
 
I agree with Janet. If you don’t start to see better numbers after tomorrow, then increase to 2.25 units. Will you be able to monitor the cycle carefully on the new 2.25 unit dose? Saturday? You are not doing anything wrong. If you get lower nadirs then hopefully your preshot numbers will also start to come down. You are actually making progress. It takes time.
 
Algraud said:
No dry foods or treats. We haven't checked teeth (not even sure how, except to bring to vet?). Thank you for the help, we will look see on Friday if we need to increase (2.25 or 2.5? not sure if the normal increase is by 0.25 or the rate increases the higher you go)
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Your increase would be up to 2.25. Remember we are looking at how low the dose is taking the cat (nadir). And yes, a vet would have to check her teeth.
 
JanetNJ said:
You aren’t doing anything wrong. Sometimes their insulin needs just change. If it’s still high by Fri I might try an increase in dose this weekend. He is not at a high dose yet so don’t panic.

you’re doing a great job at testing!!! He’s lucky to have you.
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Since we have only seen one blue I am more inclined to do 2.5, but if that makes you nervous you definitely could do 2.25 for several days first and see what happens.
 
Hopefully this will help you. I have copied the section from the ProZinc dosing methods sticky note that is pinned to the top of this forum. This section tells you when to increase and by how much.

“After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit”
 
Is it possible that Lelouch is not responding favorably with ProZinc?
We talked with the vet and they suggested to do a fructosamine test, so we will also ask to do a physical checkup (teeth and similar). Anything else I should ask for?
 
I think that you are seeing a response to the ProZinc, but you just aren’t at the correct dose yet. She needs an increase in insulin. I would increase tomorrow and do a curve on Sunday. Right now, she has been going down in her BG during the cycle and you had a blue number just a couple of days ago, which shows that she can achieve lower BG with ProZinc.
 
Algraud said:
Is it possible that Lelouch is not responding favorably with ProZinc?
We talked with the vet and they suggested to do a fructosamine test, so we will also ask to do a physical checkup (teeth and similar). Anything else I should ask for?
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See my reply above, but also the only other thing I can think of is to have them run some basic bloodwork on Lelouch if you can afford to (unless you recently did a panel of blood work including a CBC and Chemistry Panel).

She is eating the Fancy Feast Classic Pates, right? I think we need to look at food. @Diane Tyler's Mom do you know how many carbs are in the Pro DM (I'm assuming this is the WET DM food, which I think is not that bad in carbs, i.e., under ten percent.)
 
Suzanne & Darcy said:
See my reply above, but also the only other thing I can think of is to have them run some basic bloodwork on Lelouch if you can afford to (unless you recently did a panel of blood work including a CBC and Chemistry Panel).

She is eating the Fancy Feast Classic Pates, right? I think we need to look at food. @Diane Tyler's Mom do you know how many carbs are in the Pro DM (I'm assuming this is the WET DM food, which I think is not that bad in carbs, i.e., under ten percent.)
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Per the members post # 21
We are feeding Purina DM wet food.
The Purina Pro Plan DM Wet is 6% carbs
 
I am glad you raised it. I wouldn't hold it too long at this though esp with trace ketones. I have a feeling you will need a few more raises before finding the right dose. Can you check ketones again please. If you have anything other then none I would do 2.5.
 
I’m glad you increased today as well. If you don’t get some blues in 3 days since the increase, I would go to 2.5. Normally, since you are new the dose would be held for 7 cycles then the numbers are reevaluated. Are you seeing ketones? Today? That makes a difference. Of course, you being able to get some tests play into the decision as well.
 
Thank you everyone for replying. We tested Ketones yesterday evening (with a urine test) and it was None. The Preshot number was the highest today morning. With that in mind, and Suzanne and vet suggesting 2.5, we decided to increase it and hold it at 2.5. It just feels demoralizing that with every increase of dose, the numbers seem to increase as well. Planning to do a vet visit, just not sure when (waiting on their reply)
 
Great about negative ketones! Janet will be pleased with the 2.5 increase as well. Sometimes it just takes a bit of tinkering to get to a good dose. It’s not really a large dose, but let’s gather data and see how he does on the 2.5 dose and then go from there, okay?
 
Algraud said:
Thank you everyone for replying. We tested Ketones yesterday evening (with a urine test) and it was None. The Preshot number was the highest today morning. With that in mind, and Suzanne and vet suggesting 2.5, we decided to increase it and hold it at 2.5. It just feels demoralizing that with every increase of dose, the numbers seem to increase as well. Planning to do a vet visit, just not sure when (waiting on their reply)
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So glad to see some yellow preshots lately. Glad there were no ketones
 
I think it is going good. We were unable to do todays mid cycle (we were lucky before to get so many midcycle, since the default would be that we cant). The vet said we need 3 weeks before getting a fructosamine test since we changed the dose, so we are waiting for that.
 
Well that is kind of silly on the vet’s part. You may actually need to increase the dose again soon, and if you hold the dose too long it’s only going to make it harder to get into better numbers. And there’s absolutely nothing really special about a Fructosamine test. It simply does what your glucometer probably already can do for you (my ReliOn does). A fructosamine test will cost you money at the vet and will give you a single number which is an average of your cat’s BG over a 2-3 week period. It’s a useful too when first diagnosing a cat with feline diabetes, but after you begin testing at home (and keeping a spreadsheet) it is pretty useless. You already have much more useful data than a Fructosamine test will provide. My meter will give me an average BG for a 7, 14, and 30 day period. I would save my money, but maybe you have to placate your vet? The part that bothers me is holding Lelouch’s dose for three weeks when this looks not to be in her best interest. I assume that you would be allowed to reduce the dose if she drops too low? That also would change the fructosamine test results (so you see the whole thing of holding the dose for 3 weeks before doing the test makes no sense.)

Also, and I am just thinking out loud as I go along here, so forgive me …. What is the purpose of doing the test? Does the vet think he’s going to make a dosing decision based on a Fructosamine test? That’s not a good or safe way to make dosing decisions. Knowing your cat’s nadir is one of the single most important factors in adjusting doses. You guys are already seeing this with the data that you’ve been gathering from your tests.
 
Algraud said:
Hello,

our cat, Lelouch (age 7), was diagnosed 12/5/2023 and had was hospitalized due to DKA. After hospitalization, the ER Vet gave us Vetsulin and suggested Pro DM Purina food. Our vet (who seen Lelouch first time right before hospitalization) said he wouldn't have prescribed vetsulin, but said we should give it a try and did not object Pro DM. They also said to start giving 1u (just as ER) and if we want to test, do it once in a while (don't overdue it). A nurse also helped us pick out a Relion Platinum Meter

We started using Vetsulin and for a while didn't change anything, Lelouch seemed way better than before ER, so we were happy. On a later date (12/21) I wasn't sure if I didn't hit a blood vessel when injecting ( I panicked). We tested and my partner joined a Facebook group that strongly recommended to start monitoring the shots and testing before them. Also to make a test before night time. Based on the numbers after the shot we were advised to go to 0.5u vetsulin for now, but ask to change to a more long lasting insulin.

Note: We used to feed him dry and leave food the whole day. After switching to Pro DM we were advised to make it 2 times a day, so at first he would eat little and we would have to remove it. This might be reason for low numbers. We later (end of Vetsulin) changed this to remove food 2 hours before injection and let him eat thought out

For a few weeks preshot numbers were between 100-150. Then they started to rise to above 150 and we started giving the 1u dose again. The dose continue to be between 150-200 for a few weeks and continue to grow over 200. At which point we called vet, who said "if its around 300 its great that thats the goal (to not go over 300)". That kind of dissapointed me, especially after reading online that a lot of vets seem to not know much about feline diabetic treatment. The group informed me that the insulin age might be to old (was 46 days since puncture). That doubled down my opinion of the vet, since they said that with the current dosage, the vetsulin will last us for a few hundred days (might be miscommunication, but opinions was set).

I called the vet, saying the insulin might be too old and they agreed with me. I also asked for a more long lasting insulin, which they suggested ProZinc.

After a few day of waiting and continuing to give Vetsulin, we got ProZinc and started with 1U. The numbers stayed around 200. We were unsure if to increase it to go back to "normal numbers". We kind of decided to give 1.5u if close to 200 and 1u if less. For a few weeks it jumped around 200 but started to grow again, where we started to give 2u.

Recently it started being around 300 and he started urinating more. Facebook group explained we need to look at nadir (not pre-shot and base it on that). They also said we shouldn't switch from Pro DM to Fancy Feast classic pates (I looked up that both of them are low carb and Lelouch likes Fancy Feasts a lot more). So our current strategy is to lower back to 1.5 and feed Pro DM.

That's the current situation. We feel like the numbers just keep growing and nobody knows why. Any insight is welcome.

TLDR: Through out treatment, numbers are slowly rising and all possible answers I can find are conflicting. Need Advice.
Click to expand...
We had the same issue with our cat. She was up to 7 unites of Prozinc twice a day and her numbers would not go down. We switched vets and found out she has hyperthyroidism. put her on meds for that and now she on gets a half unit of Prozinc once a day. Our other vet never tested the thyroid So have the thyroid tested. It has the same symptoms as diabetes. Eating and drinking a lot. We fed her Friskies wet twice a day.
 
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Would you be able to do a curve this weekend. I am wanting to see if the numbers dip into the greens at all. If not I’d push it to 3 u. You are definitely making progress.
 
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