09May - New Member - BG Oddities

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RD & Sissy

RD & Sissy

Member Since 2023
Hi All. Joined yesterday while researching some questions, after always finding my way to this forum’s threads over the past year of Sissy’s journey with FD. I messed up my account when setting it up - Sissy is 9 yrs old and will be 10 in August. She was diagnosed with FD 10Jun2022. It has been quite the journey so far with trying to get her regulated on ProZinc. She started with a BG of 500 and 1000 in her urine. Through multiple curves and dose changes, she is currently on 4.5 units of ProZinc 2x/day. She was still running in a curve range of around 320 to 173 at the 4.0 units with a curve done 31Mar, so we increased to 4.5 and I did a curve yesterday. (Although her first home curve on 07Oct2022 was in a range of 311 to 138 at just 3.0 units in the first 12 hours but she spiked to 400 prior to that evening dose, so we increased to 3.5 afterward and so on with each subsequent curve being just slightly off from optimal ever since.)
All I can say is that I’m baffled. Yesterday’s curve started at 328 pre-dose (just slightly higher than the 4.0 unit curve start) and never dropped below 239. Also, her nadir has always been around 5 hours but yesterday it occurred at 3 hours post dose for both the AM and PM halves of the curve. By the time she reached 5 hours post dose in the evening, she was back up to 303 and she was 388 this morning pre-dose. When checked at 5 hours post dose this afternoon, she had only dropped to 333. She used to routinely drop around 45-50 per unit dosed, but I’ve noticed with each curve that the amount of drop per unit has decreased from around 45-50 to around 18-20 since Oct 2022 to yesterday, even as her dose has increased a half unit every few months. I’m at a loss as to what is happening. Took her in for blood work and urinalysis today, and will take her back Thursday for a vet exam and a review of lab results if they have them in by then.
Sissy had an ultrasound and blood work last August where they confirmed chronic pancreatitis (although she never has visible symptoms), bilateral historic kidney damage, and bilateral slightly enlarged adrenal glands. No idea where the historic stuff started because she was a stray brought in with her litter mate back in 2013.
To the naked eye, she looks and acts like a normal cat, except for some increased drinking the last few days. Ever since her initial diagnosis, she always seems to drink more in the morning after her dose than in the afternoon/evenings. She eats well (is on Rx dry food (Purina OM) free-feed because I can’t break her of it and I have 3 other cats, and she gets Fancy Feast salmon pate half can 2x/day prior to dosing. Her weight has remained steady at 11.2 lbs for the last 4 months and including yesterday’s curve. She has never been an overweight cat even before her FD diagnosis.
There are so many variables that I’m making myself sick with worry: insulin resistance, a failing pancreas, an underlying infection, progressing kidney disease… I’m hoping my AlphaTrak2 has just gone haywire but the control solution is new and has given a solid value when checked. I’d never heard of checking ketones until reading something here, and I don’t have the supplies for that. I suppose that will be found with the urinalysis if anything’s there.
What might I be missing? Do I need to just wait for the results on Thursday? Sorry for the long post right out of the gate as a new member, but I thought we were so close to reaching Sissy’s optimal dose and now I have no idea what’s happening.
 
Hi and welcome to the forum.
If you could set up a spreadsheet and add the last few weeks data, that would be very helpful for us so we can see what is going on, and the signature which will tell us about Sissy.
How to do that is in this link Help us help you
Once we can see what is going on with the blood glucose numbers we can help you a lot more.

With the numbers bouncing around it is possible she is bouncing
Here is an explanation
  • Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
 
Sorry…it posted without me finishing what I was saying!
To test for ketones, you need a bottle of Ketostix from Walmart of a pharmacy and follow directions on the bottle.
There should be no ketones.

Once we can see the data on the spreadsheet we can look at the food you are feeding. The dry food is too high in carbs. You need to be feeding wet food that is 10% or under carbs. But we don’t want you to change anything until we can see the data and then you can change over slowly to low carb.
FOOD CHART

It is possible she has gone past the best dose. How much are you increasing each time?.
Bouncing is normal so don’t worry about it. I’m sure there is an explanation for what is happening. So get the SS and signature set up and then we can have a good look.
I’m going to tag @Suzanne & Darcy as she is a Prozinc user.
Bron
 
Sorry I haven’t gotten back. I’m trying to digest the spreadsheet instructions and find time to make it and upload it, and update my signature and all that in between my work schedule and juggling married life with 4 cats and a dog - all seniors.
I tested Sissy this morning pre-dose and she was 342 - lower than yesterday’s 388 so I was happy to see that. I had planned to test her at the 4-5 hour mark post dose, but my work meetings ran together and I missed the chance. Pre-dose this evening she was 280, which made me glad she was under 300 at almost 12 hours post-dose. She seemed to sleep more today than usual but she may have been tired from the excitement of the car ride and tech visit for the blood draw/urine collection yesterday afternoon. Because she slept more, I didn’t see her drinking as much or eating much dry food today, so that’s likely why she was lower. She still ate her wet food today and weight was normal this morning. I just checked her at around 3 hours post-dose and she was at 252 and I’m ok with that since she’s still below 300 and is not too low either. I don’t think she’s in any danger of going hypo overnight. I did dose at 4.0 units ProZinc rather than her current 4.5 unit dose just in case she somehow bounced back to her usual 40-50 drop points per unit. I would never want a hypo overnight while I’m sleeping.
The vet visit is tomorrow afternoon and I hope they have all the lab results available. I’m planning to test her pre-dose in the morning and at the 4-5 hour mark before the vet visit so I can take that information with me.
I see on the main help page that you recommend testing before every single dose. My vet has said there’s no need for us to test every day. I tested every day pre-dose for all of Nov, Dec, and Jan as we increased her dose after every curve, and my vet said only a curve is needed every month or so given Sissy’s numbers never really get below 100. She’s only ever had an 80 and 61 as her lowest numbers randomly over the last year and only those 2 times.
 
RD & Sissy said:
see on the main help page that you recommend testing before every single dose. My vet has said there’s no need for us to test every day. I tested every day pre-dose for all of Nov, Dec, and Jan as we increased her dose after every curve, and my vet said only a curve is needed every month or so given Sissy’s numbers never really get below 100. She’s only ever had an 80 and 61 as her lowest numbers randomly over the last year and only those 2 times.
Click to expand...
Yes we recommend testing before every dose to ensure it is safe to give it. You would be surprised how often the preshots are lower than expected.
If you ever get a BG below 90 you need to reduce the dose by 0.25 units with prozinc. And getting a test during the cycles will tell you how low the dose is taking Sissy. Every day can be different and I can't agree with your vet who says testing before each dose is not necessary and that a curve every month or so is needed.
 
Do you test every day then as:
Pre-eat/pre-dose AM
3-4 hours post-dose
Pre-eat/pre-dose PM
3-4 hours post-dose
Or just pre-eat/pre-dose AM/PM and midday?

Sissy tolerates the testing but she doesn’t like it. I want her to be safe though.
It also doesn’t make sense to me to make only a 0.25 unit dose reduction at a BG of 90. Sissy is on 4.5 units of ProZinc. If I saw a BG of 90, I’d be scared to give more than 1.0 unit for fear of her dropping below 50. I read that ProZinc is supposed to drop BG somewhere between 30-50 points per unit so that’s the mental calculation I make when looking at a pre-dose test. I know her BG will increase some after eating, but I don’t want her going too low. Can you explain why at a BG of 90, you’d only decrease the dose by 0.25 unit if she’s currently on 4.5 units?
 
RD & Sissy said:
Do you test every day then as:
Pre-eat/pre-dose AM
3-4 hours post-dose
Pre-eat/pre-dose PM
3-4 hours post-dose
Or just pre-eat/pre-dose AM/PM and midday?

Sissy tolerates the testing but she doesn’t like it. I want her to be safe though.
It also doesn’t make sense to me to make only a 0.25 unit dose reduction at a BG of 90. Sissy is on 4.5 units of ProZinc. If I saw a BG of 90, I’d be scared to give more than 1.0 unit for fear of her dropping below 50. I read that ProZinc is supposed to drop BG somewhere between 30-50 points per unit so that’s the mental calculation I make when looking at a pre-dose test. I know her BG will increase some after eating, but I don’t want her going too low. Can you explain why at a BG of 90, you’d only decrease the dose by 0.25 unit if she’s currently on 4.5 units?
Click to expand...
Yes the timing of the testing you have above is what is needed every day.
When I was talking about a reduction of the BG drops below 90, I was meaning the drop of 90 is usually during the cycle not the pre shot BG.
I will give you the link to the prozinc dosing.
PROZINC BASICS
PROZINC DOSING
 
Thank for the confirmation on the testing. I work from home so the timing isn’t normally a problem. However, if I need to test more, I need a different meter! The AlphaTrak2 test strips are way too expensive for me to test that often - they’re around $50 USD for 50 strips. The control solution and lancets are also expensive. I saw some human meters listed in the main health forum, so I’ll have to research what’s available near me and also how to read the numbers correctly.
I don’t mean to sound rude, but even though I’m new to this forum, I’ve been working with ProZinc and Sissy’s diabetes for almost a year with the consultation of at least 3 vets, one of which is a personal friend - and some of the information I see posted here is in direct contradiction to their advice. I’m starting to become confused and frustrated on whether I need to find another vet, if I’ve been doing things wrong, haphazardly, etc.
One piece of information that still confuses me is this:
  • IMPORTANT NOTE: Do not feed your cat within the two-hour window right before the scheduled dose time; doing this can raise your cat’s blood significantly, giving you a higher BG number based on food. This could result in your giving insulin when you should not, or giving more insulin than you should.
Am I not supposed to be feeding Sissy right before I dose, or is this referring to feeding her ahead of the pre-shot meal? As I mentioned previously, Sissy has Fancy Feast wet food 2x/day just prior to dosing (1/2 can each time) and free feeds a Rx dry food the rest of the day. I get that the dry food alone can make an impact on her BG numbers depending on how much she eats each day, but I can’t get rid of it. I tried at the start of all this and a few times since. She will not eat more wet food than the 1/2 can at one sitting no matter if I’ve removed the dry food for a day or more. I can’t let her free feed wet food because my other cats will get to it. I can’t afford to feed 4 cats 3 cans of Fancy Feast 3x/day, which is what it would take to maintain their weights. One of my cats is just a few weeks away from turning 18, and has IBD. I can’t make changes to her diet like that and my cats have suffered when I remove the dry food, i.e. they started eating carpet fibers and other things around the house, which lead to all of them vomiting and flares of both Sissy’s pancreatitis and my super-senior’s IBD.
I need to take some time to digest all the information here, but I’ve been reading it for a year before I joined the group officially. This forum has helped me immensely with learning to do ear sticks/testing, looking at foods/feeding schedules, and so many other things…but now I feel overwhelmed and lost on whether to trust my vet, this forum, etc. and how to best treat Sissy.
 
Pre-eat/dose this morning = 283
Dosed with usual 4.5 units ProZinc
At 4.5 hours post-dose = 351

Vet appt this afternoon. Hoping for some answers. I’m wondering if the insulin isn’t working with every dose, or if it’s “bouncing” like mentioned yesterday, or if it’s too much insulin and I’m seeing a spike due to an asymptomatic hypo.
 
I promise to get the spreadsheet done this weekend and uploaded. I’m interested in this forum’s interpretation of it all over the past year.

Update from today’s vet visit:

Blood work from Tuesday showed slightly elevated Urea Nitrogen, slightly elevated BUN, glucose of 338 (stress induced?), and fructosamine of 406 (don’t understand this based on the recent curve). RBC, hemoglobin, and HCT were also slightly elevated but the vet didn’t even mention these. Urinalysis was normal except for slightly high specific gravity likely due to her not urinating between 10am and when the urine was drawn. There was 3+ glucose in the urine but no ketones.
Based on all of this, the vet wanted to increase Sissy to 5.0 units of ProZinc, but I don’t feel comfortable doing it after reviewing her past curves and this week in particular. Sissy has not been eating as much Rx dry food but has been eating her wet food well. Her weight dropped 2 ounces since Monday, weighing 11 lbs. There was nothing wrong with her teeth or anything else noted upon physical exam.

Today’s BG checks have been weird:
AM Pre-eat/dose: 283 (lower than yesterday morning after dosing with less insulin last night = 4.0 units)
AM dose of 4.5 units PZI
AM +4.5 hrs = 351
AM +8.5 hrs = 359
AM +12 hrs / PM pre-eat dose = 328
She even ate the Rx dry food a half hour before this test, and yet the BG was LOWER?!
PM +3.5 hrs = 244
She ate the Rx dry food twice after dosing and the insulin produced a decent drop at least instead of an increase this time - nadir is usually at 5 hours but I can’t stay up that late tonight. I simply don’t understand, and I’ve never seen this happen with her EVER in the past year, i.e. going higher 4hrs after dosing and going lower as the insulin wears off.
At this point, I’ve dropped her back to 4.0 units for the next week or so and will curve again. When I review her curves from Oct 2022 to this week, I feel like 3.0 units was her best and we have now gone too far past it? I know I need to do the spreadsheet so you all can see the same info. I won’t post again until I can attach the spreadsheet. Thanks for being here for me.
 
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