10/13 Captain, 100 AMPS, No Shot, 101 +4

R

rem87062597

New Member
Captain got diagnosed on 10/6 with a BG of 323. He had trace ketones, 2+ protein, and 3+ glucose in the urinalysis. He was perscribed Prozinc at 3 units twice per day.

He won't eat exclusively canned, but at each of his two meals we give him half a can of Fancy Feast Classics Pate and about two or three tbsp of his old dry food while we're waiting for better dry to ship (I know we shouldn't have him on dry, we're working on it). Before he was almost exclusively on dry free fed (Science Diet Sensitive Stomach Dry). He's never acted anything but healthy.

Here's my spreadsheet

Basically, he got a 68 at +5 yesterday. Today, AMPS, he was at 100. We didn't shoot, then at +2 he's at 94 and +4 he's at 101. We're getting a Freestyle Libre put on tomorrow. Just wanted to hear some thoughts on the spreadsheet and get some input on what people think is going on. I have the weird feeling that we've been shooting 3 units at low glucose numbers without realizing it since we just got our monitor yesteday, so I think we're probably pretty lucky.
 
Yes, 3U is a large starting dose, especially with that starting BG.

Have you tested ketones at home in the last day or two? That largely determines how we'd move forward.

Which dry did you order?

Does he have any other conditions? Infection at diagnosis? Bad teeth?

Symptoms at diagnosis?

Did they do a fructosamine?

Today's cycle tells me his pancreas is actually still working pretty well, and I always like to rule out potential misdiagnoses. The ketones are a little concerning but can be caused by a number of things.
 
Have you tested ketones at home in the last day or two? That largely determines how we'd move forward.
  • No, but he'll be at the vet tomorrow for the Freestyle Libre and I'll see if they can do a urinalysis.

Which dry did you order?
  • Royal Canin Glycobalance. We already tried Pro Plan DM dry and he wouldn't touch it.

Does he have any other conditions? Infection at diagnosis? Bad teeth?
  • His nose was a bit runny but that's about it. Maybe a pound overweight, good teeth, no health issues.

Symptoms at diagnosis?
  • No symptoms whatsoever at any point in this process. We just took him in for some shots and routine bloodwork/urinalysis. It's an hour drive to the vet and he hates cars/new things so he was probably very stressed out.

Did they do a fructosamine?
  • No, my wife is going to see if they still can do that though (she's a receptionist at the vet's office).
 
Ok. A one time reading at the office isn't exactly the standard for diagnosing, a fructosamine would be. But those can be falsely elevated if there was an infection, inflammation, etc inflating the BG, not necessarily diabetes. 300+ is a little more than we'd expect for stress though.

Did they find the cause of proteinuria?

The prescription food isn't really necessary, it's still technically high carb. Some cats do ok because it's lower than what they were eating before. The 3 truly low carb dry ones we recommend are Dr Elsey's Clean Protein, Young Again Zero, and Wysong Epigen 90.

See where he's at tonight.
This next part assumes you can test again at +3 ish - and possibly after if needed -

If he's above 200 - our recommended starting dose for a cat still eating dry food is 1U twice a day. But, this is a bit of an unusual pattern today, so 0.5U might be the better option.

If he's 150-199 I would try 0.25U (eyeball as best you can), under that skip.

If you cannot monitor, you can skip under 200 or stall without feeding to see if he comes up.

That said, the recipe for DKA is infection/inflammation + not enough insulin + inappetence/not enough food. So, when making these decisions knowing ketones were present at diagnosis, you have to weigh the hypo risk against DKA risk.
 
Ok. Please be very careful moving forward. I am suspecting some sort of misdiagnosis, perhaps something transient that was elevating BG. Other possibility is the diet change alone was enough to do it (it was for my cat at first).

So glad you picked up a meter and started testing! Could have gone very badly
 
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