? Please help - Dosing Assistance - Unregulated Senior Kitty

crazycatlady18

crazycatlady18

Member
Hi, all!
My Cyndi was diagnosed in November and I was working closely with my vet at first to adjust her doses. I've been checking her BG at home using the AlphaTrak 3, which is what he recommended. We started with 1U and went up to 3U, but I noticed that her PM number was going too low on 3U, so I started adjusting her doses myself based on her numbers rather than reaching out to the vet again.
I'm feeling very overwhelmed and could really use some guidance. I have some experience from my first sugar kitty, Grover, but I am still very much learning. I'm concerned that her numbers are still all over the place after 2.5 months and I feel like I'm failing her sometimes. I want to do everything that I can to get her numbers stabilized so she can feel better. I've been reading threads on here but was waiting to post until I had her SS done.
I completed her SS last night, beginning from about 2 weeks after starting ProZinc. As you'll see, we still have A LOT of high numbers. I have a 4 day weekend coming up, so I plan to test more often and get a better idea of nadir. Sometimes I think she hits nadir either early on, or much later than +6, as the 6 hour point is often not what I would expect. The numbers often don't make sense to me.
After reading some threads on here, I bought ketone urine strips and tested her last night. The color on the strip did change a bit, but it didn't match any of the colors on the bottle. I'm going with the idea that she does have some ketones, but not high because it was more like a very light purple color. I called the vet this morning and we have an appointment on Thursday to have some more testing done. I want to be sure she doesn't have DKA or any other health issues that are causing insulin resistance. She is eating and drinking (excessively), but seems to not feel great the past few days.
If someone can please review her SS, I would be so grateful. Thank you in advance for your help!
 
crazycatlady18 said:
I'm feeling very overwhelmed and could really use some guidance
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Hi Gina, you've certainly come to the right place. It can be very overwhelming and scary. :bighug: I'm new here too, but I think @Suzanne & Darcy might be able to offer some guidance.

It also might help if you put a question mark in front of your post title. At the top of your post go to Thread Tools > Edit Title > Change No Prefix to ?.

And Cyndi and beautiful!
 
Hello and Welcome to the ProZinc forum. I do wish you had posted sooner, but you are right that I would have been limited as to how much I could try to help without a spreadsheet. Let me look at her SS right now and see what I think.
 
Sorry for the delay. I have been out trapping feral cats tonight to do TNR. I just got back home. I really need more data to see what’s going on. We can’t see her nadirs from the SS data. There are too many gaps. And she appears to be very bouncy. That spate of blue AMPS you had where she had no insulin in the morning makes it appear that she had dropped low overnight, but we can’t tell how low because we don’t have any test data for those nights. Even the most recent data for the last few days is not enough to tell me much. It looks like she’s bouncing… but from what? We cannot tell. If you could get a test tonight? Maybe it’s too late. Here it’s already after 11 and I get up at four tomorrow to go out trapping again. I don’t know what your time zone is. Anyway, my advice would be to get more mid-cycle tests so we can really determine her nadir on the 2 unit dose. She’s had way too many dose changes without the numbers to substantiate them. If we can follow either the SLGS or MPM protocols and make decisions based on nadirs and then also perhaps make adjustments based on occasional lower preshots, etc. I think she would be a lot better off.
 
P.S. I am not saying stay up all night! I will check in with you again tomorrow and we can talk more. It looks like you have her on a good diet. Sorry things have been so challenging for you. I totally understand what it’s like.
 
Suzanne & Darcy said:
Sorry for the delay. I have been out trapping feral cats tonight to do TNR. I just got back home. I really need more data to see what’s going on. We can’t see her nadirs from the SS data. There are too many gaps. And she appears to be very bouncy. That spate of blue AMPS you had where she had no insulin in the morning makes it appear that she had dropped low overnight, but we can’t tell how low because we don’t have any test data for those nights. Even the most recent data for the last few days is not enough to tell me much. It looks like she’s bouncing… but from what? We cannot tell. If you could get a test tonight? Maybe it’s too late. Here it’s already after 11 and I get up at four tomorrow to go out trapping again. I don’t know what your time zone is. Anyway, my advice would be to get more mid-cycle tests so we can really determine her nadir on the 2 unit dose. She’s had way too many dose changes without the numbers to substantiate them. If we can follow either the SLGS or MPM protocols and make decisions based on nadirs and then also perhaps make adjustments based on occasional lower preshots, etc. I think she would be a lot better off.
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Hi, Suzanne!
Thank you so much for your reply. I go to bed early, but woke up to Cyndi chugging water and then vomiting so I decided to test her BG. Our numbers yesterday were AMPS 350, PMPS 420 (7pm), and my check just now at 2:45am was 500. She must be hitting nadir and bouncing
 
Laurie&Petey said:
Hi Gina, you've certainly come to the right place. It can be very overwhelming and scary. :bighug: I'm new here too, but I think @Suzanne & Darcy might be able to offer some guidance.

It also might help if you put a question mark in front of your post title. At the top of your post go to Thread Tools > Edit Title > Change No Prefix to ?.

And Cyndi and beautiful!
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Thank you, Laurie ❤️
I just updated our profile photo to Cyndi's pic. The previous one was my first sugar kitty, Grover ❤️ He passed many years ago at 17 years old. It was hard to take his picture down
 
I'm having a really bad night with Cyndi and I'm concerned. I gave her insulin at 7pm, 2U, and I injected in the flank this time to give her neck area a break. Her PMPS was 416. I checked her 3hrs later and BG was 660 Checked again at 2am and it's now 616. Im wondering if the flank area didn't absorb the insulin? I didn't feel any moisture post shot so I don't think it was a fur shot.
I tested for ketones again and got the same color. It still doesn't match any colors on the bottle. It definitely changes from the initial cream colored pad, but turns a light purple/grayish color. It's not dark at all like the high numbers on the bottle. We have a vet appt Thursday afternoon but I can tell she doesn't feel good and I'm struggling to decide if I need to miss work and take her somewhere sooner. I feel awful that she's going through this and I don't know how to help.
We're due for her next dose at 630am, in 3.5hrs. I've been holding the 2U dose for 8 cycles.
Please help I feel so defeated and worried.
 
crazycatlady18 said:
Please help I feel so defeated and worried.
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Good morning Gina, I'm sorry Cyndi still doesn't feel well. Hopefully a senior person will respond soon. If it was me, I'd go to an emergency vet. Some fluids certainly wouldn't hurt and may give you some peace of mind and what she needs. Then you can get back on track at home. :bighug::bighug:
 
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Thank you for your response, Laurie! Cyndi's AMPS number was 453, so it looks like the insulin DID work some and was absorbed. I called our regular vet on my way to work this morning and they are squeezing us in at 3:30 today instead of tomorrow. I am so relieved just knowing we're being seen today. My boyfriend offered to check her BG before he goes to work so I gave him a lesson and sent him some pics of the "sweet spot". He's diabetic himself so he's already familiar with meters, etc. but the kitty testing is something I've been managing so far. He's going to check her around 10am so I'll have another early range number to share later. I'm so grateful for this group!
 
Hi all. Thank you for your responses. I felt very discouraged and defeated and stopped coming on. Cyndi started getting lower numbers and we had a setback from anesthesia given for an abdominal ultrasound. I'm very upset about that.
She's been really high around 700 the past few days and I'm worried. Her PMPS was 707 tonight around 730 and it's now so high it's only showing HI on my Alphatrak 3 I'm considering calling the ER. She's been on 1.75u of Prozinc 2x daily.
 
Just tested again about 15 min later and she's 715 on my Alphatrak 3 and 556 on my One Touch Verio Flex human meter. I'm actually grateful to see a number and not a HI though I know it's still really high. I can't seem to find how many hours it takes for Prozinc to start working after dosing. It's been about 2 hours now. My poor baby girl
 
My Kobe was on PZI for only a short time so I am far from an expert. But I remember onset being at about 2 hours after his shot. I searched on the forum to verify this and found that @Suzanne & Darcy also said onset would be at around two hours after the shot. Hopefully you'll see Cyndi's BG start to come down soon.
 
Thank you so much ❤️ I did a live chat with VCA Vet Hospitals and the technician suggested we go to ER. I'm going to test her again in a few minutes and see if we're coming down I don't want to put her through the stress of all that but I will if needed.
 
She's down to 625 from 715 She's now up and eating her dinner. She didn't feel like eating earlier which is how I knew she didn't feel good. I'm going to keep an eye on her all night and keep rechecking BG on the hour. If she keeps coming down I will wait until tomorrow for a vet visit.
 
crazycatlady18 said:
Just tested again about 15 min later and she's 715 on my Alphatrak 3 and 556 on my One Touch Verio Flex human meter. I'm actually grateful to see a number and not a HI though I know it's still really high. I can't seem to find how many hours it takes for Prozinc to start working after dosing. It's been about 2 hours now. My poor baby girl
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2 hours is when ProZinc onsets for most cats. Let me look at your spreadsheet ….
 
She was getting some beautiful blue preshot numbers a little while back. You should not have skipped the shots. I wish you had posted here so that I could have helped you with a dose we could try for those days.
 
The blue preshot numbers are a good sign. They mean she is able to respond to the insulin and we just need to find a good dose. This is going to require more testing on your part though. We don’t have enough test data, and we absolutely must know her nadir in order to keep her safe and to make intelligent decisions about how much insulin she needs. There are almost no night tests and so we have no idea what’s going on at night. That is also very important.
 
crazycatlady18 said:
Thank you so much ❤️ I did a live chat with VCA Vet Hospitals and the technician suggested we go to ER. I'm going to test her again in a few minutes and see if we're coming down I don't want to put her through the stress of all that but I will if needed.
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I do not think you need to go to the ER unless she has high ketones (are you testing for ketones? In these high numbers you ought to be) or if she’s vomiting and can’t keep food down or if she’s quite lethargic.
 
If she were my cat, I would take her back up to 2 units right away. And I would get tests to determine her nadir. I would also make sure that …. No matter how high the preshot number or her +2 test was …. She gets small snacks of LC food at +2 and +4 and — depending on numbers, a +6 snack possibly also.
 
Suzanne & Darcy said:
(are you testing for ketones? In these high numbers you ought to be)
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crazycatlady18 said:
I also tested her urine for ketones about 30 minutes ago and it was negative. They're human strips so they may not be 100% accurate but I was happy to see that!
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Some of us also use Meters that test blood for ketones. They work much like the BG meters with the little strips. strips are pricier, but you won't use as many. I have two different ones- it's a long story- but this is the easiest to use: KetoBM Ketone Meter. replacement strips are $1 each. The other one, made by CentriVet, is a little complicated because it does BG and Ketones so you have to switch out a little chip and that's annoying. But both work great and do what they are supposed to do. If you love spending hours reading instructions, the CentriVet one might be a good fit. :p

Suzanne & Darcy said:
There are almost no night tests and so we have no idea what’s going on at night.
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Getting the midcycle numbers at night doesn't have to be as awful as it sounds. Sometimes I'd stay up a little later to get a test. Other nights I found it helpful to let myself go to bed EARLY and set an alarm or two to get up to test. It wasn't so bad that way. You can't get all the data at once.
 
Kobe (Dean and Lesley) MO said:
Some of us also use Meters that test blood for ketones. They work much like the BG meters with the little strips. strips are pricier, but you won't use as many. I have two different ones- it's a long story- but this is the easiest to use: KetoBM Ketone Meter. replacement strips are $1 each. The other one, made by CentriVet, is a little complicated because it does BG and Ketones so you have to switch out a little chip and that's annoying. But both work great and do what they are supposed to do. If you love spending hours reading instructions, the CentriVet one might be a good fit. :p


Getting the midcycle numbers at night doesn't have to be as awful as it sounds. Sometimes I'd stay up a little later to get a test. Other nights I found it helpful to let myself go to bed EARLY and set an alarm or two to get up to test. It wasn't so bad that way. You can't get all the data at once.
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Yes. I have a Nova Max Plus blood ketone meter. Expensive strips, but much less expensive than a DKA. With as many cats as I have, you could never stalk a cat to the litter box.
 
Kobe (Dean and Lesley) MO said:
Getting the midcycle numbers at night doesn't have to be as awful as it sounds. Sometimes I'd stay up a little later to get a test. Other nights I found it helpful to let myself go to bed EARLY and set an alarm or two to get up to test. It wasn't so bad that way. You can't get all the data at once.
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One of our old time members here said she used to drink a lot of water before going to bed. That way she was sure to wake up to test her cat! :woot: Personally, I just set an alarm clock to wake up and test and go back to bed. The night time tests can be around nadir time. We usually recommend a “before bed test” at about +2. If the +2 is quite a bit lower than the PMPS then it’s a good idea to set an alarm to test later.
 
Suzanne & Darcy said:
She was getting some beautiful blue preshot numbers a little while back. You should not have skipped the shots. I wish you had posted here so that I could have helped you with a dose we could try for those days.
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I am afraid of dropping her too low, and I work FT so unfortunately I can't always be around to monitor her. It's stressful not knowing what dose is best when her body often responds differently to the same dose
 
Suzanne & Darcy said:
If she were my cat, I would take her back up to 2 units right away. And I would get tests to determine her nadir. I would also make sure that …. No matter how high the preshot number or her +2 test was …. She gets small snacks of LC food at +2 and +4 and — depending on numbers, a +6 snack possibly also.
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I went up to 2u this morning and evening We saw her regular vet today and he wants us to go up to 2.5. He was glad that I tested for ketones and said that's if none are present, there's no need for ER unless she's acting really sick/lethargic.
I feed her a big meal for breakfast and she grazes on it throughout the morning/early afternoon. My boyfriend gets home around 3 and feeds her a small meal, then she gets dinner around 6 and shot around 630. I had been leaving out dry food for her while we're at work, but stopped shortly after her diagnosis.
 
Kobe (Dean and Lesley) MO said:
Some of us also use Meters that test blood for ketones. They work much like the BG meters with the little strips. strips are pricier, but you won't use as many. I have two different ones- it's a long story- but this is the easiest to use: KetoBM Ketone Meter. replacement strips are $1 each. The other one, made by CentriVet, is a little complicated because it does BG and Ketones so you have to switch out a little chip and that's annoying. But both work great and do what they are supposed to do. If you love spending hours reading instructions, the CentriVet one might be a good fit. :p


Getting the midcycle numbers at night doesn't have to be as awful as it sounds. Sometimes I'd stay up a little later to get a test. Other nights I found it helpful to let myself go to bed EARLY and set an alarm or two to get up to test. It wasn't so bad that way. You can't get all the data at once.
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Thank you. I'll start doing this. How often do you test overnight? I've really only done it in cases like this where I was worried about extremes.

Do the blood ketone meters work better than the urine strips? Doc said it was fine to use the human urine ones. I use the Alphatrak 3 for BG and money is tight right now so I need to try and save where I can I considered using a human meter but I'm so comfortable with the Alphatrak numbers that I got nervous about switching, and doing the research on which one was best for cats .
 
Suzanne & Darcy said:
One of our old time members here said she used to drink a lot of water before going to bed. That way she was sure to wake up to test her cat! :woot: Personally, I just set an alarm clock to wake up and test and go back to bed. The night time tests can be around nadir time. We usually recommend a “before bed test” at about +2. If the +2 is quite a bit lower than the PMPS then it’s a good idea to set an alarm to test later.
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Thank you! I'll start doing this. I just feel so bad poking her all the time. These poor sugar babies.
 
crazycatlady18 said:
I went up to 2u this morning and evening We saw her regular vet today and he wants us to go up to 2.5. He was glad that I tested for ketones and said that's if none are present, there's no need for ER unless she's acting really sick/lethargic.
I feed her a big meal for breakfast and she grazes on it throughout the morning/early afternoon. My boyfriend gets home around 3 and feeds her a small meal, then she gets dinner around 6 and shot around 630. I had been leaving out dry food for her while we're at work, but stopped shortly after her diagnosis.
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Feeding her three hours before her p.m. shot is going to shorten the duration of the insulin and cause her numbers to rise quite a bit as the action of the insulin is waning.

I can’t see anything on her spreadsheet past March. It’s like the whole thing disappeared (the more recent numbers. )
 
Here
 

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crazycatlady18 said:
Thank you. I'll start doing this. How often do you test overnight? I've really only done it in cases like this where I was worried about extremes.

Do the blood ketone meters work better than the urine strips? Doc said it was fine to use the human urine ones. I use the Alphatrak 3 for BG and money is tight right now so I need to try and save where I can I considered using a human meter but I'm so comfortable with the Alphatrak numbers that I got nervous about switching, and doing the research on which one was best for cats .
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Walmart ReliOn meters (which are very good) cost $17.88 for 100 strips. It is fine to use the urine strips to test for ketones as long as that’s working for you and you are able to catch her in the litter box. There’s no need to change. The urine strips will be less expensive for you.
 
crazycatlady18 said:
I went up to 2u this morning and evening We saw her regular vet today and he wants us to go up to 2.5.
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I would be very hesitant to go immediately up to 2.5. You just raised her back up to 2 units and you need to see what her nadir is on that dose. That may take more than a few days before we can see it. Cats are small creatures and insulin is a powerful hormone. Small changes in dose can make a big difference. I would gradually increase to 2.25 first (if the numbers warrant) and then increase to 2.5, but again only after gathering BG data so that we know how low the dose is taking Cyndi.
 
If your boyfriend gets home at 3 o’clock, which I assume is +9 in Cyndi’s cycle, can he test her BG at +9 (before food) to see where she is at that point in the cycle. It could give us a clue as to what went on earlier.

Since you are not home a lot and can’t always get tests on those workdays, we ask people who cannot gather test data to fill in the blank areas on their SS to run a curve where they test every 2 hours during one cycle.
 
crazycatlady18 said:
Thank you. I'll start doing this. How often do you test overnight? I've really only done it in cases like this where I was worried about extremes.
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If you look at Kobe's sheet you will see that the testing frequency varied. If something was changing in his diet or dose. I tested more frequently to see how the change would impact his BG. When he started having more active cycles (dipping istead of staying high and flat) I tested more often. But even when he was high and flat, I still tried to get some because that's how you catch the dips! @Suzanne & Darcy can maybe a more specific number or schedule. My experience with PZI is limited.
 
crazycatlady18 said:
Do the blood ketone meters work better than the urine strips?
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They did for me because Kobe had ketones and I needed to be able to test every day without waiting on a sample. I would use the same bead of blood and get a BG reading and Ketone reading in just a few extra seconds.

It sounds like your situation is different. Cyndi doesn't have Ketones and she tolerates you getting an occasional urine test; you can save your money. :D:D:D The urine strips are just fine.
 
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