1/27 Sid update & question on food and R insulin

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Lydia & Sid & Jake(GA)

Lydia & Sid & Jake(GA)

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I hate to jinx myself but so far Sid seems to be faring pretty well with regard to everything but his glucose levels. He has been more active the last couple of days and has wanted to spend time outside his room (my bedroom actually :smile: where he is quarantined). He comes out and talks to the other cats and they rub heads and lick each other. I have to say that Sid spend a significant amount of time in hospitals and has been to the vet all day every single day this week and when he comes home, the other cats act as if he never left. :smile:

He is getting famotidine (pepcid) 2x/day along with clavamox. He gets the leukeran 1x/week and a vitamin b12 injection 1x/week. I have cerenia on order but it hasn't arrived yet.

He has a good appetite too and is eating on his own. He will no longer touch fancy feast and only wants either w/d or friskies supreme supper. I checked Binky's food chart and the supreme supper has 7% calories from carbs - am I reading this right? But I checked the ingredients and it contains rice. I've tried other foods on him and he keeps coming back to these two.

The other question is on the R insulin. last night he finally responded to the prozinc and actually over responded because at about +4 he dropped to 26. I had to give him some karo to get him back up because he ate 1/2 can of food when he was at 55 and I checked him an hour later and the level had dropped to 26. This morning he got 1 u of Prozinc again and he was Hi until 11 am when the vet gave him a unit of R. So I now have a bottle of R at home. My plan is to give him Prozinc in the morning but then 1 unit of R a few hours later if he is still Hi. Is it correct that R only lasts 4-6 hours?

Thank you everyone for all of your support and kindness. Sid can feel your healing energy and it is what is keeping us both going :-D :YMHUG: :YMHUG:

http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=62057
 
R is a very short acting insulin. It dose last approx. 4 hours but you need to do a curve with R -- testing every hour. With Sid dropping the way he is, I would be very nervous about using R. That 26 would be terrifying if you had given R and R didn't reach nadir.

IMHO, you absolutely have to know what Sid's response to ProZinc is -- onset, nadir and duration before you even think about R without a vet's supervision. The vet giving R also means that the vet can set up a dextrose drip if Sid's numbers start to tank.
 
R is much more powerful than Lantus or Prozinc. To give you perspective, my acro cat, Jazzy, had a Lantus dose of 14u but 0.1u of R dropped her a lot (sometimes too much). She probably would have hypod on 1u of R. Weezer is using R now and her Lantus dose is 14.5u and she is getting good response from 0.25u of R. I cannot recommend using R for a low dose cat - I can't imagine what dose you could measure that would not be potentially dangerous. They can use it at the vet because they have access to IV dextrose and can bring the numbers back up quickly if the cat goes into hypo range.

Obviously I can't give dosing advice for Prozinc either, but I do know that if he hit 26 on any insulin then he needs a dose reduction. You'll just have to wait out the bounce, unless the people who are more familiar with Prozinc have a different way of handling bounces.

I think using R at home for Sid is a bad idea. If you do decide to try some R on the vet's advice, please please please don't give more than 0.1u and test every hour. You also have to be sure to not give R when the nadir might coincide with the onset or nadir of the Prozinc, and absolutely for sure do not give it when a bounce is about to clear. In other words, you'll need a lot more data on how Sid responds to Prozinc before you can consider adding R to the mix. For anyone to try to tell you what + hour would be ok to give R would be irresponsible, since we do not know his Prozinc curve.

Sorry, I know you're looking for solutions, but I believe if you will create more problems than you will solve if you start adding R to the mix. I can't see any updated numbers on his spreadsheet, but if he is high then it might be because his liver is fighting the R to keep him from going hypo.
 
Most of the time Sid has been having no response to Prozinc or any insulin except the R. Last night he did respond to the Prozinc and did his predictable drop to hypo levels which he was doing consistently on the lantus. It is very scary but I am not running him to the emergency vet every time because all they do is give him karo syrup and I can do that at home! However if he would have dropped below the 26 and not started rising within 30 minutes, I would have taken him, don't get me wrong.

The problem I'm having is that Sid is not responding to any insulin in typical ways. The R is not even bringing him down below 240 except one day he received R at 11 am and at 5 he was 70, but that was an exception. I'm just trying to keep him low enough to prevent ketones and high enough to prevent hypo. And I'm testing him ALOT. I think I am going through 50 strips/week!! I feel that and the specialist also feels that we won't get his glucose under control until the disease is under control.

It lifts my spirits to see Sid eating on his own and being alert and active (or at least more active). Tonight he actually walked out from under the bed to say hi to me. I do know for a fact that the next bed I buy is going to rest on the floor so no more of this kitties hiding under the bed business. That's the hardest part of this is trying to drag him out. Well one of the hardest parts anyway.
 
On the FAF site we recommend blocking off the hiding spaces so you have easy access. Boxes under the bed work.

So glad to hear Sid is perking up. It helps to refill my heart to hear this.
 
do you have any recent numbers you can add to your SS? Maybe you can post in the prozinc forum for dosing advice.

His Lantus response doesn't really look all that atypical to me at the time the spreadsheet ends. He dropped, bounced for 3-4 cycles, then dropped again. Yes, he was bouncing high, but you can learn to cushion those drops with food and that will eventually lessen the bounces. It takes time, though.

I appreciate your comment about not needing to rush to the vet for low numbers. I want to caution you, though, that your experience is with Lantus. Lantus is gentle enough that cats can usually get into low numbers without hypo symptoms, and they can be fairly easy to bring up. An R hypo would probably be fatal before you could even get to the ER.
 
Lydia,

I have no experience at all w/R so cannot help you there, and I have never used anything but Lantus so can't help w/the ProZinc either. But if you look @ Tawny's SS from about the 6th of November thru about 12/16, when she was so ill and back & forth to the ER, you can see her #s were all over the place. The ER did give her R via IV but like Libby says this was in a drip, constantly monitored, and she was getting dextrose too. She did not get the R with her Lantus at all I don't think of if she did it wasn't for very long. They pulled her completely off her Lantus and just gave her R most of the time when she was critical, then as she showed improvement they would put her back on her Lantus and take her off the R.

I am so glad Sid is active and talking, that means he's feeling better. You are taking such good care of him. I literally know how hard this is and my heart goes out to you.

With Tawny it was those little tiny signs that always gave me hope. Just one little grooming lick, one little soft meow, one little flick of an ear when I called her name, a day when her eyes were brighter than the day before. Small signs, but big at the time. Just like Sid right now.

One of my greatest joys right now is running my hand across Tawny's back and not feeling a bony spine anymore. It's amazing what little things can bring us so much joy.

Hang in there, we'll all keep hanging in there with you and pulling for Sweet Sid. Tawny is pulling extra specially hard for him.

Desi & Tawny
 
I do have numbers but have not updated the SS yet. Thank you for the warnings about R. I had no idea it was that drastic. The vet gave no indication of that. I will not be giving him R without close supervision but I do not think supplementing with R is the answer.
 
Lydia --

I'm very relieved that you had a change of heart re. using R. I couldn't agree with Libby more -- Sid's numbers are just too unpredictable at the moment to use R without him being at the vet's office where IV dextrose is on hand. R is lifesaving when used in the ER or hospital by a vet or can be very helpful with a high dose cat. For a cat that may land in low numbers unexpectedly, you could have a true crisis on your hands.

I know the bounces are hard to see when you know Sid isn't feeling well. Hang in there.
 
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