10/10. PMPS HI (over 750), ate very little, no ketones

Nancy S

Nancy S

Member
I posted yesterday and was awaiting another opinion from a tagged member. Please look at KittyLou's spreadsheet. Her values are critically high tonight, she is lethargic and has been for a week. She has neuropathy which worsened this week. She ate only a few morsels today. Not only is the value high, but she has been doing swings (she did that once before in July when I tried to change her to Dr Elseys chicken).
I do not know what to do. I called the Emergency Vet and they are full. That is not an option.
My main concern is how much insulin should I shoot tonight. If I shoot the 4.5U, she may do a swing and go too low. She has never been this high before. I am afraid and I would so love to see her regulated. Can someone help me?
The reason the vet is raising her insulin dose is because he thinks that since her thyroid level went from 8.8 to 2.3 during the month of September, that it raised her insulin requirement. (unless something else is going on).
KittyLou was the picture of health in May. A DepoMedrol shot started this whole process.
PLEASE ADVISE. Can I get a mentor from this group?
How much insulin can I shoot tonite (Basaglar).
 
Kitty Lou is nothing eating today. She is drinking and laying next to the food. She seems nauseous. Shot time is now.
how much should I give?
 
Nancy S said:
Kitty Lou is nothing eating today. She is drinking and laying next to the food. She seems nauseous. Shot time is now.
how much should I give?
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Poor baby. Is there anything she really likes that isn't the best for her, just to get her to eat?
Or juice from a can of tuna, some cheese? Maybe moisten her Glycobalance?
I can't advise on what to do, hopefully people will be on soon, it's kind of the dead time on a Sunday evening :)
 
Are you able to stay up and test?

Definitely a sign of nausea, I do wonder about pancreatitis. Do you have any anti nausea meds and appetite stimulant? Sometimes a little tuna water helps entice them.

Otherwise, get her to eat what you can.

If you can catch some middle of the night readings I'd give full dose.

Edit: I'd start with a +2 and go from there. At minimum every other hour, but if seeing big drop that may change. I don't see her hitting green but you never know, especially with dry in the picture. This high she definitely needs insulin.
 
I am wondering if she is having a pancreatitis episode. It’s very common with fd. I think if she is she’s likely nauseous. I would call your vet tomorrow as she might need to be seen and will need cerenia or ondansetron for nausea.

She needs insulin with numbers this high.
 
tiffmaxee said:
I am wondering if she is having a pancreatitis episode. It’s very common with fd. I think if she is she’s likely nauseous. I would call your vet tomorrow as she might need to be seen and will need cerenia or ondansetron for nausea.

She needs insulin with numbers this high.
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Thank you all for your responses. I measured her food and she actually ate about 1/8 cup today. Better than nothing. I shot the full amount of insulin. 4.5 units. I emailed the vet. Hopefully I can get her in tomorrow morning.
Doesn’t sustained high BG levels make the cat more insulin resistant? I’m trying to get her on wet food.
I’ve had a lifetime of cats and KittyLou is the ONLY one who ONLY ate dry. I wish I could just tube feed her for awhile. I’d make sure she got good nutrition.
 
FrostD said:
Are you able to stay up and test?

Definitely a sign of nausea, I do wonder about pancreatitis. Do you have any anti nausea meds and appetite stimulant? Sometimes a little tuna water helps entice them.

Otherwise, get her to eat what you can.

If you can catch some middle of the night readings I'd give full dose.

Edit: I'd start with a +2 and go from there. At minimum every other hour, but if seeing big drop that may change. I don't see her hitting green but you never know, especially with dry in the picture. This high she definitely needs insulin.
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I’ll try to stay up and test. I’ve stayed up the past two nights testing.
Has any cat ever been somewhat successful on dry food? I’m trying to switch her. She is the only cat I ever had who only ate dry. I got her when she was about 2 and she was very set in her ways.
 
FrostD said:
Are you able to stay up and test?

Definitely a sign of nausea, I do wonder about pancreatitis. Do you have any anti nausea meds and appetite stimulant? Sometimes a little tuna water helps entice them.

Otherwise, get her to eat what you can.

If you can catch some middle of the night readings I'd give full dose.

Edit: I'd start with a +2 and go from there. At minimum every other hour, but if seeing big drop that may change. I don't see her hitting green but you never know, especially with dry in the picture. This high she definitely needs insulin.
Click to expand...
 
Nancy S said:
Thank you all for your responses. I measured her food and she actually ate about 1/8 cup today. Better than nothing. I shot the full amount of insulin. 4.5 units. I emailed the vet. Hopefully I can get her in tomorrow morning.
Doesn’t sustained high BG levels make the cat more insulin resistant? I’m trying to get her on wet food.
I’ve had a lifetime of cats and KittyLou is the ONLY one who ONLY ate dry. I wish I could just tube feed her for awhile. I’d make sure she got good nutrition.
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Sustained high BGs can cause a number of things, but yes what you're referring to is glucose toxicity. You have to chase the dose upward until you start to hit a breakthrough, then the insulin needs usually come back down.

Getting her to wet food will make a big difference. Just be sure to do it slowly because it can really drop BGs; be sure to note any transitions/progress in the spreadsheet too.

Please take down the 911 when you get a chance.
 
Nancy S said:
I’ll try to stay up and test. I’ve stayed up the past two nights testing.
Has any cat ever been somewhat successful on dry food? I’m trying to switch her. She is the only cat I ever had who only ate dry. I got her when she was about 2 and she was very set in her ways.
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I personally have not seen it happen on the medium or high carb dry food, but I've only been around about 2 years
 
I’ll get some test numbers. If she goes hypo, I can only do hone remedies. The Emergency vet locally is not seeing any more patients tonite. They opened at 8pm and were full for the night by 9pm. The next closest is 2 hours away in Pittsburgh, or Akron. That’s not do able.
 
I always keep Gerber baby food and syringes on hand for easy syringing (assist feeding) when things like this happen. If she'll let you do that, I'd give it a shot... can wet her dry food down and blend it too. Though sometimes they develop aversions to food that's syringed.
 
Nancy S said:
I’ll get some test numbers. If she goes hypo, I can only do hone remedies. The Emergency vet locally is not seeing any more patients tonite. They opened at 8pm and were full for the night by 9pm. The next closest is 2 hours away in Pittsburgh, or Akron. That’s not do able.
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Ah I'm Cleveland area!

I really do not see her going hypo from this high. Just keep trying to feed her what you can, water too. Test ketones whenever you get a chance.

I'd ask the vet to run a SnapfPl, they can also run a SpecfPl for pancreatitis. If it is pancreatitis, you'll want the following:
  • Ondansetron Rx for nausea (can get at human pharmacy)
  • Cerenia for nausea. These two meds work on different pathways and can use both at same time, but sometimes one works better than the other. Cerenia generally better if there's vomiting
  • SubQ fluids, have them show you how to do it too
  • Appetite stimulant like Mirataz. You have to give the nausea meds time to kick in first, then give the appetite stimulant. I start with about half the recommended dose of app stim
  • Pain medication, pancreatitis can be very painful. My vet likes buprenorphine, but some give gabapentin.
  • Do not discontinue meds too soon, better to keep them going for a bit after you think she's better
If you look at my spreadsheet from March and July, there were pancreatitis or suspected pancreatitis flares in there. You can see how I did meds and food.
 
I don’t think she will go into hypo numbers starting out this high but it is best that she eat and don’t worry about what right now.

The SNAP just gives a positive or negative so if in the gray area will come out negative. Best to get the Specfpl. You will get results in a day.

Please remove the 911 so that if you need immediate help again we will know. Don’t hesitate to put it back if she gets into dangerous territory with her bg. I don’t expect that but we never know for sure. Can you syringe feed if necessary?
 
FrostD said:
Ah I'm Cleveland area!

I really do not see her going hypo from this high. Just keep trying to feed her what you can, water too. Test ketones whenever you get a chance.

I'd ask the vet to run a SnapfPl, they can also run a SpecfPl for pancreatitis. If it is pancreatitis, you'll want the following:
  • Ondansetron Rx for nausea (can get at human pharmacy)
  • Cerenia for nausea. These two meds work on different pathways and can use both at same time, but sometimes one works better than the other. Cerenia generally better if there's vomiting
  • SubQ fluids, have them show you how to do it too
  • Appetite stimulant like Mirataz. You have to give the nausea meds time to kick in first, then give the appetite stimulant. I start with about half the recommended dose of app stim
  • Pain medication, pancreatitis can be very painful. My vet likes buprenorphine, but some give gabapentin.
  • Do not discontinue meds too soon, better to keep them going for a bit after you think she's better
If you look at my spreadsheet from March and July, there were pancreatitis or suspected pancreatitis flares in there. You can see how I did meds and food.
Click to expand...
 
I just tested her at +2 and she was “down” to 625. At least it registers on the meter. She actually just voluntarily ate a little bit.
My previous hyperthyroid (but non diabetic) cat had several bouts of pancreatitis. She had “triaditis”. Unfortunately it was managed with prednisolone. I learned to give subQ fluids with her.
KittyLou’s diabetes was most likely caused by a DepoMedrol injection in May for a skin condition. So no prednisone for her ever again, says the vet.
Is there a support group on here for hard to regulate cats? I need a checklist of reasons to investigate on why she is so hard to regulate.
 
FrostD said:
Are you able to stay up and test?

Definitely a sign of nausea, I do wonder about pancreatitis. Do you have any anti nausea meds and appetite stimulant? Sometimes a little tuna water helps entice them.

Otherwise, get her to eat what you can.

If you can catch some middle of the night readings I'd give full dose.

Edit: I'd start with a +2 and go from there. At minimum every other hour, but if seeing big drop that may change. I don't see her hitting green but you never know, especially with dry in the picture. This high she definitely needs insulin.
Click to expand...
 
FrostD said:
Are you able to stay up and test?

Definitely a sign of nausea, I do wonder about pancreatitis. Do you have any anti nausea meds and appetite stimulant? Sometimes a little tuna water helps entice them.

Otherwise, get her to eat what you can.

If you can catch some middle of the night readings I'd give full dose.

Edit: I'd start with a +2 and go from there. At minimum every other hour, but if seeing big drop that may change. I don't see her hitting green but you never know, especially with dry in the picture. This high she definitely needs insulin.
Click to expand...
 
FrostD said:
Ah I'm Cleveland area!

I really do not see her going hypo from this high. Just keep trying to feed her what you can, water too. Test ketones whenever you get a chance.

I'd ask the vet to run a SnapfPl, they can also run a SpecfPl for pancreatitis. If it is pancreatitis, you'll want the following:
  • Ondansetron Rx for nausea (can get at human pharmacy)
  • Cerenia for nausea. These two meds work on different pathways and can use both at same time, but sometimes one works better than the other. Cerenia generally better if there's vomiting
  • SubQ fluids, have them show you how to do it too
  • Appetite stimulant like Mirataz. You have to give the nausea meds time to kick in first, then give the appetite stimulant. I start with about half the recommended dose of app stim
  • Pain medication, pancreatitis can be very painful. My vet likes buprenorphine, but some give gabapentin.
  • Do not discontinue meds too soon, better to keep them going for a bit after you think she's better
If you look at my spreadsheet from March and July, there were pancreatitis or suspected pancreatitis flares in there. You can see how I did meds and food.
Click to expand...
FrostD said:
I always keep Gerber baby food and syringes on hand for easy syringing (assist feeding) when things like this happen. If she'll let you do that, I'd give it a shot... can wet her dry food down and blend it too. Though sometimes they develop aversions to food that's syringed.
Click to expand...
 
Hi Nancy,

There is no "list" for why a cat is hard to regulate. There are many possible reasons, concurrent disease being one, and your cat has not been on insulin for very long, and it can take a long time to get to the right dose to achieve regulation. You should take a look at other cats' spreadsheets to get an idea.

It's been pointed out to you that you're feeding high carb food that is not appropriate for a diabetic cat. That is one very important place to start, but only after she gets her appetite back. There are many options and a list was provided to you, did you take a look at that?

The hyperthyroidism could be another reason. @Sue and Luci has a kitty with hyperT and her Luci is also unregulated, though she doesn't bounce as high as KittyLou but that 29% carb food could be the culprit.
 
Your spreadsheet is very impressive! Do you have a good vet in Cleveland? Anyone you would recommend? I am about 20 minutes east of Conneaut Ohio. Did you figure that dosing out for yourself? I can’t believe how high you took the insulin dosages. It looks like I have been doing it all wrong.
Will these swings eventually stop? Do you think my dose will need to go higher?
 
Can you be sure to keep the spreadsheet updated? I don't see these recent tests or the dose in there. That's a good drop, good thing. I would catch some sleep and check again at +4.

It can take awhile for cats to get better regulated, but really I think getting her to low carb canned wet food will be the tipping point. High carb food, especially dry, exacerbates nearly everything...how high the "baseline" BG is, how high they shoot when bouncing, it can affect several cycles beyond the meal itself...the list goes on.

I'd be persistent with getting her switched over ...but for now we just need her eating.
 
Nancy S said:
Your spreadsheet is very impressive! Do you have a good vet in Cleveland? Anyone you would recommend? I am about 20 minutes east of Conneaut Ohio. Did you figure that dosing out for yourself? I can’t believe how high you took the insulin dosages. It looks like I have been doing it all wrong.
Will these swings eventually stop? Do you think my dose will need to go higher?
Click to expand...
My dad is out that way. Unfortunately I'm west side, so would be long drive for you! If you're on Facebook, you can ask local moms groups or city groups, that's how I found my vet. He wasn't super well versed in tight regulation, but was at least willing to work with me.

Once I switched to Lantus in January, I followed the guidance found here, minimal input from my vet. I had been following guidance here while on other insulins as well, but my other vet at the time had me doing things in hindsight that were bad ideas. As I learned more, I dumped him for a new vet.

Mr Kitty has acromegaly and IAA so please know his situation is a little unique in how high I had to take his dose, and the way he came down into remission.

The swings do eventually stop for most cats, but really the diet change is what will help you there. I'd just continue to follow the guidance in the dosing sticky for SLGS.
 
tiffmaxee said:
I don’t think she will go into hypo numbers starting out this high but it is best that she eat and don’t worry about what right now.

The SNAP just gives a positive or negative so if in the gray area will come out negative. Best to get the Specfpl. You will get results in a day.

Please remove the 911 so that if you need immediate help again we will know. Don’t hesitate to put it back if she gets into dangerous territory with her bg. I don’t expect that but we never know for sure. Can you syringe feed if necessary?
Click to expand...
I do not know how to syringe feed. I’ll have to look into that.
 
For what it’s worth, my cat was given Glycobalance after dx and he wouldn’t touch canned wet food at the time. He transitioned over just fine, so don’t give up. But trying/switching to wet slowly cannot be emphasized enough. If you look at our SS, you’ll see that once he was off the dry (even just a handful a day) his insulin needs dropped dramatically.
 
We are at the Vet now. We are switching from Basaglar to Prozinc. He thinks she is resistant to Basaglar. I am just thankful to totally start over. I think the Basaglar was dosed too quickly and incorrectly.
Vet doesn’t want to test for Acro at this point.
 
Nancy S said:
We are at the Vet now. We are switching from Basaglar to Prozinc. He thinks she is resistant to Basaglar. I am just thankful to totally start over. I think the Basaglar was dosed too quickly and incorrectly.
Vet doesn’t want to test for Acro at this point.
Click to expand...
Well, I respectfully but strongly disagree with your vet. Just know this can potentially be dangerous, when you make the switch please please test often and check ketones.

Edit: take a look at my SS for all of 2020. You'll see my old vet had me do same thing, thinking various insulins weren't working, trying a dose reset. You'll see the only thing that worked was this year methodically raising the dose til we hit a breakthrough. I fear you'll find this an exercise in futility and lost time, especially without a diet change.
 
Last edited:
Nancy S said:
We are at the Vet now. We are switching from Basaglar to Prozinc. He thinks she is resistant to Basaglar. I am just thankful to totally start over. I think the Basaglar was dosed too quickly and incorrectly.
Vet doesn’t want to test for Acro at this point.
Click to expand...
I see you switched to Prozinc , can you please note that in your signature that your cat was on Basaglar first then switched to Prozinc and on the top of your spreadsheet, I don't think the members will see that in your remarks column. Can you add the meter you are using also to your signature

It would be even better is you wrote that in on the line for 10-11 on your SS
I see on your SS you wrote insulin reset 1 unit twice a day

Looking at your SS it looks like you were not following SLGS correctly
different doses most of the time , that could be why you didn't see an improvement using Basaglar. You really need to start testing during the night cycle after PMPS, you are only seeing half the picture.

I'm not a prozinc user I can tag a few members and see what they thinks about the reset
Just want the best for your kitty :cat:
@JanetNJ



Hi Janet her kitty was on Basaglar and just switched to prozinc



Nancy can you read the dosing methods for Prozinc please
https://felinediabetes.com/FDMB/threads/prozinc-dosing-methods.225629/

@JanetNJ

@Wendy&Neko

@Sienne and Gabby (GA)

Thank you ladies
 
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Diane Tyler's Mom said:
I see you switched to Prozinc , can you please note that in your signature that your cat was on Basaglar first then switched to Prozinc and on the top of your spreadsheet, I don't think the members will see that in your remarks column. Can you add the meter you are using also to your signature

It would be even better is you wrote that in on the line for 10-11 on your SS
I see on your SS you wrote insulin reset 1 unit twice a day

Looking at your SS it looks like you were not following SLGS correctly
different doses most of the time , that could be why you didn't see an improvement using Basaglar. You really need to start testing during the night cycle after PMPS, you are only seeing half the picture.

I'm not a prozinc user I can tag a few members and see what they thinks about the reset
Just want the best for your kitty :cat:
@JanetNJ

@Wendy&Neko

@Sienne and Gabby (GA)

Hi Janet her kitty was on Basaglar and just switched to prozinc



Nanct can you read the dosing methods for Prozinc please
https://felinediabetes.com/FDMB/threads/prozinc-dosing-methods.225629/
Click to expand...
My vet called today to tell me the results of yesterday’s extensive bloodwork. He thinks I should bet kittyLou tested for acromegaly because he says she is a “difficult case”. He also said he has never treated a cat with acro. I think he wants an opt out.
He is the reason I am jumping around with the dosing. It is at his direction, and kitty is a mess.
Regarding my SS, the vet told me it would be difficult to regulate her because she has hyperthyroid and diabetes (diagnosed the same day). He focused more on the thyroid, and my cat felt and acted well up until about 2 weeks after the I-131 (on 8/31). Her metabolism slowed down markedly this past month and her thyroid is perfectly normal. Everything I read says that if the thyroid normalizes, the insulin need should be reduced. We raised it. She has spent so long in the 500’s that she has pretty significant neuropathy, sleeps all day, and only gets up to eat and go to the litter box. Surprisingly her blood work is all excellent except for slight BUN increase.
Aside from the first few weeks of my spread sheet, my experience with Basaglar has been awful.
Since we switched to Prozinc, I tested last night at +9 269.
I figured I would get a “bounce” day and I did. AMPS today was 502, +1 699, +6 552 and +8 549 PMPS just now 638. Looks like it’s going to be another week bad week.
You have no idea how despondent I am. I feel totally alone in this. My vet is not helpful. I spent over $500 there yesterday and have no answers or advice. He ran the same bloodwork that he ran two weeks ago, and nothing has changed. What tests should I get run? What vet should I go to? Should she get the acro test?
In June 22, her first curve, AMPS 428, +3 348, +5 187, and +9 199. That was when her T4 was high on 1.5U of Basaglar and dry diabetic cat food. (I know I should do wet). The vet has no answers.
Could experienced people look at my data and help me chart a path? Maybe she has cancer or something. What could be wrong?
 
Diane Tyler's Mom said:
I see you switched to Prozinc , can you please note that in your signature that your cat was on Basaglar first then switched to Prozinc and on the top of your spreadsheet, I don't think the members will see that in your remarks column. Can you add the meter you are using also to your signature

It would be even better is you wrote that in on the line for 10-11 on your SS
I see on your SS you wrote insulin reset 1 unit twice a day

Looking at your SS it looks like you were not following SLGS correctly
different doses most of the time , that could be why you didn't see an improvement using Basaglar. You really need to start testing during the night cycle after PMPS, you are only seeing half the picture.

I'm not a prozinc user I can tag a few members and see what they thinks about the reset
Just want the best for your kitty :cat:
@JanetNJ

i printed out the link for Prozinc. Thank you. I was following the advice of the vet who wants me to keep upping the dose. He wanted me to do 5 U. He ups the dosages in 1 U intervals. Finally, at yesterdays visit, he decided to switch insulins. Today he called with the bloodwork results which were all good, except glucose at 431 and BUN a little high (47). Since her metabolism has slowed down, and her neuropathy kicked in, she basically sleeps all day at home. I noticed that she gets excited when she goes to the vet, and her blood sugar goes DOWN on vet day and is better the entire day. Could all this laying around at home be causing higher numbers? Plus it seems that after every "decent" reading in the 100's or 200's causes a big swing that lasts for days. Do I still hold the Prozinc dose for a week even with her numbers this high?



Hi Janet her kitty was on Basaglar and just switched to prozinc



Nancy can you read the dosing methods for Prozinc please
https://felinediabetes.com/FDMB/threads/prozinc-dosing-methods.225629/

@JanetNJ

@Wendy&Neko

@Sienne and Gabby (GA)

Thank you ladies
Click to expand...
 
Hi Nancy -

Since you’ve switched insulins, you might want to create a new thread in the Main/Welcome forum asking for advice. Since this is the Lantus forum, most of the people who will see this thread are not used to ProZinc. It’s also a good idea to copy the link from this thread so you don’t have to rewrite your story.

I know this is a very hard time. I was so stressed for the first 2 months of this, and there were so many tears… it can get better. It’s great that you are testing at home!

You say your girl will only eat dry. While not as good as wet, there are 3 brands of dry food that are lower carb and none need a prescription:
Wysong Epigen 90
Dr. Elsey’s Clean Protein
Young Again

These companies will also send samples, though I’ve heard it can take a while to arrive with COVID delays. But it might help bring some of these numbers down. Another thing to consider with wet food is that they come in a variety of textures. My girl will NOT eat shredded chicken, but if it’s in chunks, it’s fine. Some pates are good, others are too wet or too dry for her. Since she can’t tell me what she likes, we went through a lot of experimentation before we found a rotation of flavors and textures she likes.

I’m not a dosing expert - new to this forum in May. But the reset is probably not what your cat needs. If she’s been at high numbers for a while it can take a good amount of insulin to crack through. I know you want to get there faster, but so little progress with feline diabetes happens quickly. The pace at which doses are increased with these protocols have been developed so they are safe for your cat and yield results. However, once that insulin DOES break through and your cat’s body gets used to lower numbers, doses can be reduced and Kitty Lou can still achieve remission. Some newly diagnosed cats reach it in a few months. Other cats are diabetic for years until their pancreas is healed enough not to need insulin.

It felt weird to me at first not consulting my vet about Chloe’s diabetes. Now it’s rarely discussed. My vet does not have the expertise on this specific subject that the members here do. At this point, I’ve probably done more reading the subject than she has. You will get good guidance here, even if it doesn’t match what your vet says.
 
Sorry I'm just catching up - yes Luci was hyperthyroid and underwent the I-131 treatment. I'll look on the Main Health Forum or the Prozinc forum to see if you're posting there.

Your cat definitely needs more insulin. Your vet is uninformed about feline diabetes - and from what I've read above perhaps other things related to cats...
 
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