Advice please? Felix update 2nd May: dropped dose from 2.5u to 0.5 in one week! Weight loss.

Astra&Purrfect

Astra&Purrfect

Member Since 2016
Hello everyone and hiya Suzanne if you’re there!

I’ve decided to post this update about Felix because this is unknown territory for us and any advice would be much appreciated from people who’ve had similar experiences with cats.

Over the last few months, we’ve had to drop Felix’s dose from 3.3u to 2.6u twice a day. But everything’s gone beserk in the last week. His numbers have been all over the place and we’ve had lower numbers on 0.5u today than 2.6u 8 days ago! He was pretty low at nadir 88 mg/dl today (human meter).

When he’s been around or under 200 mg/dl pre-shot, we’ve taking the SLGS advice of 10-25% of the dose. Coincidentally, in this last week he has had frequent loose stools and has dropped almost a pound (he’s already very underweight). His food has not changed. He doesn’t seem to be able to gain weight although he’s been eating around 250 to 300 calories of wet food every day. I’ve stopped giving pancreatic enzymes today just in case it’s too much now and is causing over-processed, over-quick transit of loose stools.

Anyway, I presume that the lower need for insulin is a sign of the pancreas starting up again? But why the worrying diarrhoea though? Any pointers or advice would be appreciated - thank you!

EDIT: He was at 137 mg/DL preshot this evening, the lowest he's ever been preshot, so decided not to inject for the first time. Some might still inject their cat a mini dose but after today we thought not. What dose to give tomorrow depending on numbers, I wonder 🤔

Astra & Felix.
Felix-2.jpg
 
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Hi Astra! I was wondering how dear Felix has been doing.

I looked at his spreadsheet last night and was a little perplexed about the criteria used for reducing the dose. I want to look again before replying. I don’t want to just say something in a second without giving due consideration. Today I am out on a family outing, but I will check in later.

It’s very good to hear from you!
 
Hello, Suzanne.
Nice to hear from you!
The criteria are the lower nadirs and lower starting numbers below 200 and caution. Yesterday, the 2nd is an example on only 0.5 units which resulted in a nadir of 88 with similar numbers to the 28th of April on a much higher dose of 1.75u. In March, we would have had to have given around 3 units to achieve the same result, ref. the 3rd of March.
His ketodiastix has also changed showing weak levels of sugar in the urine as opposed to medium or high.Today, however, we were overcautious and definitely didn't give enough Prozinc because he was too high (or flat). We'll see what happens this evening with his numbers preshot. It seems that there is intermittent function from his pancreas which is making safe dosing a bit hair-raising and unpredictable for us at the moment because 88 at nadir (and dropping) which was what was happening yesterday, despite eating well, is really too low for us to manage without worrying. Hope this answers your query.
Thank you, Suzanne, and have a really great day out! We've been having wonderful summery weather over here but today we had heavy rain and thunderstorms!
Astra & Felix.
 
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It seems like you would be comfortable following the SLGS dosing method where you take reductions of .25 units if Felix drops below 90. I see how he has had some lower preshot numbers and has had some reduced doses, but some of those doses are much too small for him (per your tests on his SS). Remind me how you measure those doses like .15 or .2. Calipers? I really think that his dose is just fluctuating around too much and that is causing some of the wacky BG.
 
Was he ever diagnosed as having Exocrine Pancreatic Insufficiency? I am asking because you had been giving pancreatic enzymes. Have you noticed a change in his BMs for the better since you stopped giving them?
 
This is from the ProZinc dosing methods sticky note— the 3-6 cycles thing applies to cats following the MPM method so would not really apply to Felix, but the other observations and recommendations about changing doses too frequently resulting in unpredictable BG is what I have observed in many cats to be true.
  • After the initial adjustment period, subsequent doses should be held for 3-6 cycles and data collected to determine next steps. Changing doses faster than that, or trying to use a sliding scale, nearly always results in bouncing and wild unpredictable variations in blood glucose, or BG getting stuck high and flat as if nothing is happening. Small steady dose changes work best.
  • PZ typically lasts 10-14 hours in most cats, and one cycle affects the next, so when changing dose, it can take a few cycles before you really see the impact of the change. It’s not uncommon for the first cycle after a dose increase to be a little higher. If this happens, try not to get discouraged. Wait a couple of cycles, collect data, and see what the BG does.
  • Conversely, if you decrease the dose when you shouldn’t, it’s not uncommon to see a good first cycle because there is still some impact from the previous higher dose. Subsequently, the following cycles may result in the numbers starting to rise. If this happens, move back up to the previous higher dose.
 
Astra&Purrfect said:
When he’s been around or under 200 mg/dl pre-shot, we’ve taking the SLGS advice of 10-25% of the dose.
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This recommendation is really for newbies who don’t have a lot of spreadsheet data on their cat. At this point, you have a lot of data on Felix. The really confusing part is that we can’t really say what Felix’s dose is right now because it’s been changed so frequently. That sounds bad, but I don’t mean it like that. I just mean, if, for example, I would recommend shooting a half dose…. I am not sure how much that would be because I don’t know half of what dose?
 
How long has it been since he’s had bloodwork and a vet visit? Has he had an abdominal ultrasound? I am worried about his weight loss and I know you are as well. Is he still having diarrhea?
 
It looks like a dose of 1 unit would be good to try when he is in the upper blue numbers like he has been recently. You tried it once and he had some decent blue numbers. Later you tried the much smaller doses like .15 and .2 so you already proved that those doses were too small for the upper blue preshot numbers. Then if you see that perhaps the 1 unit dose is not quite enough, next time try 1.25.

When you encounter these lower preshot numbers, have you tried to stall the shot and retest in about 30 minutes to see if his BG is stable or rising? You delay the feeding as well, of course.
 
Dear Suzanne,

We’d like to thank you so much for your posts and replies. We do indeed understand what you’re saying about the dose needing to be steady for a few days for stability. The mini doses of .15 and .2 don’t seem to be enough for Felix, at least for the time being. I use syringes with half-unit markers. Really mini (.15) doses are hard to do. We have tried stalling in the past but it didn’t make a huge difference. We inject him fairly late so stalling is a bit difficult.

We decided today, because he was at 289, to use the last effective dose of 0.5 units. It had taken him quite low so we did a skinny dose this time. Consequently, he had a very similar day today with lows of 128 at 4½ hours and a nadir of 92 at 6½ hours.

We were concerned though that he would go too low tonight on that dose as he started at 250 this evening and cats go lower and have less food at night. So, we did have to adjust the dose slightly downwards for safety’s sake. If we can hold a dose safely, how many cycles (12h?) should we hold it?

Felix will be going to the vet soon because we need a new prescription for Prozinc. Although I have to say that she’s pretty unaware about feline diabetes and even suggested not testing him when we first started injecting him! Rather typical me thinks. I have subsequently said to her on the telephone that we’re testing Felix at the very least before every shot and at nadir if poss just like with a human and she went very quiet.

He’s never been specifically diagnosed with pancreatitis or insufficiency. The tests alone could cost a couple of hundred Euros which is needed to buy his insulin and costly strips, syringes, etc. We were going by his symptoms of diarrhoea, malabsorption and inappetance. The inappetance has greatly subsided now over the last few weeks but he finds it difficult to put on weight and his fur is thin.

His motions have slightly improved but it occurred to us that he’s also been going outside much more with the fine weather in the past two weeks. He might be up to his old tricks of going into the field opposite to do his business but then licking cowpats at the same time. Before diagnosis he always had very healthy motions. But when the vet saw him before diagnosing diabetes, he had a slight UTI so she prescribed antibiotics. His stools have never been the same since then. His appetite was good today and no ketones in his urine.

Felix has been watching telly with us recently. This evening, it was our DVD of The Revenge of the Pink Panther (1978)!

Thank you again, Suzanne, and I hope you and yours are well and that your furry, feline family is fine too?

Astra & Felix.
 
I was going to ask if he had been licking any cowpats! I remember one time he became ill from licking that. Felix!

As I recall the Revenge of the pink Panther is funny! Peter Sellers. I believe that was his last film before his death.
 
Hello, Suzanne.
Thanks for the encouragement!
Yes, we use a capsule called Ultradiar which has some soothing ingredients + some probiotic. I've made sure to fill in the numbers in the sheet. We'll keep him at 0.4u now, if poss, and see where that gets Felix.
That's great to hear that you know the Pink Panther films too! We have all the DVDs!
 
@Suzanne & Darcy
Suzanne & Darcy said:
These are good nadirs. Well done, Felix and Astra!
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Hello, Suzanne,
Today's been a funny old day because Felix was at 180 mg/DL a.m. preshot, so we gave food (couldn't stall without feeding him he was so hungry) and waited two hours. To our surprise, he'd dropped to 159 so no shot. Now another 5 hours later, he's at 82! He been eating every 2 hours. Don't know what to think!
 
Felix! You are full of surprises! You did the right thing in skipping the dose(s). I have seen this happen before. I think he’s probably on his way up this evening, but I can’t wait to see how he does and what his BG is in the morning. How is his appetite this evening?

Edit: I was thinking this message was from today. But now I am worried because I don’t see any data on your spreadsheet since two days ago (May 7)
 
Hello, Suzanne!
Thank you very much for your message. I've just updated the spreadsheet. We are most concerned that if Felix can get to 82 by himself without insulin, even a small dose of Prozinc might be dangerous. So, we've gone 2 days without giving him insulin just to see how he's reacting. We've had 2 glorious days of his having no glucose in his urine for the first time since diagnosis in June, 2025. However, today, the strip is back at medium levels of glucose in the urine, and obviously, his numbers are too high. He has a good appetite but ongoing GI irritation and we're giving strained oat water to ease his diarrhoea - it is helping.
Suzanne, from your experience, would it be alright to try a minidose this evening, and I mean a really eensy weensy drop, such as 0.1u? This could give him a helping hand with a healing pancreas and hopefully not be hazardous.
Many thanks!
Astra & Felix.
 
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Has he ever gone from a yellow to 82 before on zero insulin? I am trying to find it so I don’t think it was any time recently. I see the recent 82 with that day with zero insulin where he began the day at 180 and eventually dropped to 82, which is a nice number.

I think it’s a mistake to not give any insulin when he is in these yellow numbers again.

I have seen this happen before where a cat will stay in some of the lower numbers for a cycle or even two on no insulin before the numbers crept up and insulin had to be resumed. I think you could try the micro dose as long as you document his BG for future dosing. I doubt it will do much to suppress his BG, but I understand how you feel because he had a green number so recently with a skipped dose.
 
Suzanne & Darcy said:
Has he ever gone from a yellow to 82 before on zero insulin? I am trying to find it so I don’t think it was any time recently. I see the recent 82 with that day with zero insulin where he began the day at 180 and eventually dropped to 82, which is a nice number.

I think it’s a mistake to not give any insulin when he is in these yellow numbers again.

I have seen this happen before where a cat will stay in some of the lower numbers for a cycle or even two on no insulin before the numbers crept up and insulin had to be resumed. I think you could try the micro dose as long as you document his BG for future dosing. I doubt it will do much to suppress his BG, but I understand how you feel because he had a green number so recently with a skipped dose.
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Thank you very much for your reply and advice, Suzanne. That's most welcome and reassuring. We will try the minidose of 0.1u and hold it for a few cycles but if his bg is looking stubborn still, we will make a minute rise up to 0.2u. How many cycles would you recommend holding a minidose of 0.1u to see if it can have an effect?
 
We call the green numbers the “healing greens” because those are the numbers that can allow the Beta cells to heal.

I really do understand your anxiety and appreciate your caution. I think if you try the tiny dose you can find out if it works or if you need more.

Because of lurkers, I will say that it would not be my recommendation to give that small of a dose, but I don’t see any harm in trying it for a cycle to see what kind of BG numbers you get. It would be better than a skipped dose. I would not recommend less than .25 units if his PMPS is in the mid-yellows. But I understand your desire to try the .1 dose first.

What is your plan if he has risen into pink by PMPS? Is he staying in the yellow numbers now during the middle of the cycle?
 
I’m sorry about the diarrhea? I haven’t heard about oat water for diarrhea. I have heard about rice water.

Have you tried S. Boulardii? That is very helpful for diarrhea. Or Slippery Elm Bark which is beneficial for both diarrhea and constipation. Sorry if I asked you about those things in the past. I was just trying to think of some natural stuff.
 
Thank you so much for your further posts. Hey, you asked about his bg now, Suzanne, so I just checked it. I was dreading a high number but it wasn't even a yellow, it was a blue - 140! Much lower than I expected - we thought it'd be in the 300s! The oat water might help stabilise bg spikes as well as the diarrhoea. 1 mug of water to 1 tablespoon of oats simmered for 12 minutes and then strained. It is a jelly like consistency. We've been giving 2 x 5ml hand syringes in his mouth every 6 to 8 hours.
Thanks very much for the suggestions about S. Boulardii and slippery elm bark. I've heard about these but never looked into the format they'd be available in here in France. I'll see if I can get some info about them. The Ultradiar which is all natural does have some yeast products in it and lactic acid bacteria. His bowel movements are improving although not yet normal. We have identified a particular range of Felix wet food we were giving him which might have been causing diarrhoea. Original and Campagne (as they call it here) are fine but Tendres Effilés don't agree with him.
The 140 number is optimistic so we'll have to see about giving insulin at all later this evening. Fingers crossed!
By the way, what are 'lurkers'?
Have a great Saturday, Suzanne!
Astra & Felix.
 
Astra&Purrfect said:
By the way, what are 'lurkers
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Lurkers are people who read the threads on this forum but don’t post to get help with or to ask questions about their specific situation with their cat. We have to be careful to specify that certain recommendations are specific to a particular cat and don’t apply in general to every cat. This is important because every cat is different and has a different situation with regard to their food, schedule, BG numbers, health conditions, whether they produce ketones or have had a DKA in the past, are prone to diving numbers, experience level of the caregiver, caregiver’s ability to test and monitor the cycle, how much BG data has been previously logged …. And on and on it goes. So it’s important for readers to understand that what is said regarding Felix won’t necessarily apply to another cat.
 
I’m pretty excited for Felix’s PMPS. If you have time, shoot me an email (by posting on this thread) with his PMPS number. I am expecting a good one considering the nice blue you just got, Astra.
 
Suzanne & Darcy said:
That is such great news about the 140! Very exciting. How long since he ate last? Is he eating well today? Go FELIX! Show us what you can do.
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Ah, I see, "lurkers"! Yes, indeed the ECID 'every cat is different concept'.
Yes, it is exciting about Felix! He ate 3/4 of a Felix sachet 2 hours before the test, and a treaty teaspoon or two of rinsed tinned tuna 1h25 before. (I keep a food log.) After the test, he's eaten a little chicken and broth and a quarter sachet of Felix. His appetite has been very good today and for quite a few days.
 
Suzanne & Darcy said:
I’m pretty excited for Felix’s PMPS. If you have time, shoot me an email (by posting on this thread) with his PMPS number. I am expecting a good one considering the nice blue you just got, Astra.
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Hi, Suzanne, Felix's PMPS is a nice blue, 166, only ever so slightly higher than earlier this evening, and much lower than yesterday's PMPS. So, we've decided not to give him any insulin!
Have a lovely Sunday, Suzanne, and thank you for your help!
Astra & Felix.
 
Astra&Purrfect said:
Hi, Suzanne, Felix's PMPS is a nice blue, 166, only ever so slightly higher than earlier this evening, and much lower than yesterday's PMPS. So, we've decided not to give him any insulin!
Have a lovely Sunday, Suzanne, and thank you for your help!
Astra & Felix.
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Awesome! But I wish you had given the token dose. He needs to get into green. But please do get some tests tonight to verify what Felix is doing. It will be very helpful. Enjoy some good British television with Felix tonight.
 
Thanks, Suzanne. Rather disappointingly, he was at 293 this morning and had medium levels of glucose in his urine, so indeed, we did go ahead with a mini dose of 0.1u just to see where his BG can go with such a low dose. I think the ongoing gut irritation is causing higher BG levels.
 
Hello, Suzanne,
Hope all's well with you.
Well, I thought I'd let you know how it went yesterday with Felix. To be honest, it was a bit hair-raising! And all because of the tiniest 0.1u mini dose of insulin. After eating and before the onset of the insulin he'd already dropped by 55 by himself and then he dropped a further 132 odd. He wasn't in danger at any point but that was because we plyed him with loads of food so he didn't plummet further and I couldn't give his oat gel because that tends to smooth out BG spikes after meals when we actually needed him to keep his BG up.
He ended up too high yesterday evening but we decided not to give insulin. For one thing, his numbers are probably artificially high due to his ongoing gut irritation. This morning, he was 40 mg DL lower than yesterday morning and with a 0.1u dose again, that would have taken him down to 66 which is really borderline dangerous and it only would take a little more natural insulin activity from Felix and it would be even lower. So, we gave no insulin and, amazingly, he dropped into the blue numbers, 141, all by himself! That seems to be the situation at the mo.
We'll see how it goes over the next few days.
One question, Suzanne, do you happen to have any info about giving capsules of s. boulardii to help cats with diarrhoea? I believe human capsules are used but how much would one give?
Thanks very much and have a lovely evening.
Astra & Felix.
 
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