7-15 Bella BG 646 (+4) after 1st week on Prozinc Help!

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Alicia2022

Alicia2022

Member Since 2022
We took Bella to the vet today (4 hours after the injection) and her BG is 646. :(
It was 560 at the previous visit in late June. We started 0.5 units Prozinc a week ago, and from now on will increase to 1 unit.
The vet suggests we go slow, and she also mentioned that it is possible for BG numbers to increase before they decrease. Is this true? She also said that sometimes it can be just a bad bottle of insulin :eek: She is not opposed to switch to a different brand but still suggests that Prozinc needs time to work. So we bought another bottle of Prozinc just in case. C

I've ordered testing supplies (including ketone sticks) from Walmart and will try my best to test at home.
A big problem is that I have to go abroad for an important work-related trip in a week or two and have to make my travel arrangements today. My husband stays home and I believe he can handle injections alone (don't know about tests because we haven't done them yet). Our vet will be on vacation around the same time. We live in a small town and don't have a car, and the nearest ER is 45 min drive away.
I'm trying to figure out just how bad our situation is.
 
Previous post intro post
https://felinediabetes.com/FDMB/thr...-and-insurance-questions.265643/#post-2975621
I think you should start testing as soon as you get your meter from Walmart
What meter did you get?
Your husband should also be testing while you're away , its the only way to keep your kitty safe
We increase by 0.25 units at a time not by half units

I would change your title to 7-15 Bella BG 646 four hours after injection after 1st week in prozinc Help! Look to the right you will see the word Thread Tools tap on that then tap on Edit Thread and change it then tap Save

On your previous post which I have linked to this one in blue I gave you the diagram on how to test I can tag Melissa @FrostD for you who familiar with Prozinc but without any testing yet I don't know if she can give you any advice
@FrostD

Just a reminder about what Bella is eating per Alicia's intro post she said
She's been on RC Gastrointestinal dry food since we got her, and this was the only food that worked for her. Two years ago, we started introducing wet food as well because it’s easier on her teeth (not so many left!) and also makes easier to give her joint supplements. Now, her main dish is RC Renal support E, and from time to time also RC Aging. Both have around 20% carbs. She has a small amount of her dry gastrointestinal food always available for grazing.
After learning about her diabetes but before finding this forum, I decided to try and switch her from dry gastrointestinal food to the canned one (our vet advised that but didn’t go into any details regarding carbs, brands, etc.) Well, after finishing the first can she vomited, had loose stool, and refused to eat today before the injection. Luckily, we’re able to feed her the renal wet food after that. So…as much as I want to try other brands like FF (and they are so much cheaper!), I’m also super hesitant to change Bella’s current diet.
 
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I'll post it again for you :cat:
Always aim for the sweet spot warm the ears up first, you can put rice in a sock and put it in the microwave, test it on the inside of your wrist to be sure it's not to hot, like you would test a babies bottle. You can fill a pill bottle with warm water and roll it on the ears also.Just keep rubbing the ears with your fingers to warm them up
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6. As the ears get used to bleeding and grow more capilares, it gets easier to get the amount of blood you need on the first try. If he won’t stand still, you can get the blood onto a clean finger nail and test from there.
When you do get some blood you can try milking the ear.
Get you finger and gently push up toward the blood , more will appear
You will put the cotton round behind his ear in case you poke your finger, after you are done testing you will fold the cotton round over his ear to stop the bleeding , press gently for about 20 seconds until it stops
Get 26 or 28 gauge lancets
Take a look at the lancets ,you will see one side points up, that's the side you want to poke with
A lot of us use the lancets to test freehand
I find it better to see where I'm aiming
You can also put a thin layer of vaseline on the ear ,to help the blood bead up
A video one of our members posted
VIDEO: How to test your cat's blood sugar
 
You need to set up our spreadsheet to track Bella's BG numbers t
So members here can follow along in case you need help
I will give you the link , if you have trouble setting it up just ask, I can ask a member here to set it up for you
Take a look at any members spreadsheet to get an idea of what it looks like it will be at the end of their signatures. You can look at mine , but look at my 2020 test , they are at the too of my spreadsheet tap in it. Tyler is in remission now so not so many tests on my 2022 sheet

Spreadsheet link it will also explain how it works under Understanding the spreadsheet

https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/

Just a quuck explanation
AMPS means the first test in the morning , withhold feeding 2 hours prior to testing so it's not food influenced You would put that number in the AMPS cell that means AM pre shot
If you test him 2 hours later after giving insulin that BG number goes in the +2 cell
and so on

Same thing with PMPS withold feeding 2 hours before that test then test and put that BG # in the PMPS cell if you test 3 hours after giving insulin that goes in the +3 cell and so on

The U column means how many units of insulin you are giving
 
Thank you, Diane. The spreadsheet looks very complicated.
So when should I test and how many times a day? And when to withhold the food? The vet told us not to withhold the food because with such BG numbers our cat needs food constantly.
I just received the meter Relion Premier Classic and tried it on myself.
 
Alicia2022 said:
Thank you, Diane. The spreadsheet looks very complicated.
So when should I test and how many times a day? And when to withhold the food? The vet told us not to withhold the food because with such BG numbers our cat needs food constantly.
I just received the meter Relion Premier Classic and tried it on myself.
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I will tag Bhooma
@Bandit's Mom to set it up for you, when she sees the tag she will post here telling you to look for her message up time where it says inbox

You have to withhold food only 2 hours prior to the first test in the AM and the PM because you don't want the number to be influenced by food

You can feed Bella then maybe around +2 and +4 a smaller snack
The bigger meal is after you test in the AM and PM
You can give her a couple of tablespoons for the small snacks
About when to test be right back

Nadir on ProZinc is about 4-6 hours after the shot. So if you can start getting some tests in that window, that will tell us a lot.

I'm not a prozinc user that's why I tagged Melissa
@FrostD for you
She may tell you to test sooner
You definitely need to test AMPS and PMPS and at least 2 more tests after that I would say
I will give you the Prozinc link to read about it

https://felinediabetes.com/FDMB/threads/prozinc-dosing-methods.225629/
 
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Alicia2022 said:
We took Bella to the vet today (4 hours after the injection) and her BG is 646. :(
It was 560 at the previous visit in late June. We started 0.5 units Prozinc a week ago, and from now on will increase to 1 unit.
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What do you mean by from now on will increase to 1 unit?
Part of that process is getting a feel for basic concepts:
  • Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
  • Peak/Nadir - the lowest point in the cycle
  • Duration - the length of time insulin continues to lower blood glucose
 
Alicia2022 said:
Our vet told us to increase Bella's dose of Prozinc from 0.5 units to 1 unit (every 12 h).
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OK since you are still feeding the dry food I think that will be ok

Did you ever order the shorter syringes you said she felt the shot with the longer ones
These are shorter needles U-40 with half unit markings
I copied what one of the reviews said , they are half unit markings even though I don't see it on the box ,you can always call to be sure
https://shoppettest.com/advocate-pe...MInfTou_Xv-AIVkfLjBx0yOA4DEAQYASABEgKfMPD_BwE

Here is the review

My dog was diagnosed less than a month ago and I was given 29g 1/2 syringes. She is a small toy poodle with Cushing's disease and her skin is very thin and delicate. I'm new to injections so I know I was causing her more discomfort than necessary. These make SUCH a difference. She no longer squirms and the ordeal is over much faster. The 1/2 unit markings are great as well.

On your previous post a member said

The starting dose is 1.0u providing your cat is NOT on a low carb canned food diet.
 
Alicia2022 said:
Yes I did , they should arrive next week. Thank you. But I switched to injecting near Bella's flanks instead of the scruff and that really helped!
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So are you planing to test tonight with the Relion Premier?
If so go to your signature and add Relion Premier as of 7-15
Tap on your name then tap on signature and add it then tap save
 
Alicia2022 said:
I just gave her an injection at 8:30 pm so I don't think we'll test tonight. So tomorrow I have to test before feeding? Test, then feed, then give insulin?
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Yes
The proper sequence for dosing insulin is: Test/Feed/Shoot.

Look for Bhooma's message in your inbox about setting up your spreadsheet

For your reading pleasure :p here is the link for the basics about prozinc
https://felinediabetes.com/FDMB/thr...-the-prozinc-basics-please-start-here.164995/

Also if you are still feeding the dry food you will have to follow SLGS Dosing Method for Prozinc
You can read about it here
https://felinediabetes.com/FDMB/threads/prozinc-dosing-methods.225629/

@Alicia2022
 
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Those numbers aren't too surprising given that she's newly diagnosed and on the high carb food. I never like to increase insulin based on a single days worth of data because she could have just been bouncing when the test was done, but in all likelihood 0.5U truly isn't enough.

Go ahead up to 1U. When the spreadsheet is up and running that'll give us good info. Prioritize testing at preshot, and again 4-6 hours after the shot. Do try to get some nighttime ones in as well, maybe 2-3 times a week, as they often go lower at night.

I wouldn't say the numbers get worse before they get better...so far it's all within meter variance (they're allowed up to 20% variance assuming it was handheld meter). You might get a few good days or a few good numbers here and there, but the overall trend is still high. What typically happens is the trend stays high until you start to get closer to the right dose, then they slowly come down.

Not to belabor the food point, but another challenge with high carb food + ProZinc is: ProZinc tends to hit a little harder with high carb food (drop them lower and faster) which can lead to a bounce, but also wear out sooner. It usually takes mich longer to many any progress.

In your previous post I said keep her food as-is for now, because I'm not liking parts of her lab work that possibly point to infection and inflammation. Also, the concern around the unknown GI issue. So that's two boxes for DKA checked, the food and fluids are what will help keep it at bay. If you can find a low carb food she'll eat reliably and doesn't make her sick then great, we'd want to get her switched over- but slowly. Have you considered raw feeding?

The "average" dose for a cat on low carb is usually 2.5U and under. On high carb food, that goes up to more like 4.5U and under (varies significantly between cats, I'm just giving you anecdotally).
 
No way I can do the testing. Pocked Bella's ear twice, both time got "insufficient sample" error. I'm sorry, this is just not for me (or for her).
 
Alicia2022 said:
No way I can do the testing. Pocked Bella's ear twice, both time got "insufficient sample" error. I'm sorry, this is just not for me (or for her).
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Sorry you feel that way, I see you increased the dose to 1 unit and on your SS you have not currently testing at home.
Try and not give up on home testing you will never know what Bella's BG is and if it's a safe number to give her insulin or when a decrease or increase is needed
If you aren't going to be home testing I would definitely go and add that to your signature so if anyone looks at your SS they won't wonder why . I'm just worried about your kitty
Tap on your name then tap on signature and add that you're not home testing
@Alicia2022

@FrostD
 
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Diane Tyler's Mom said:
Try and not give up on home testing you will never know what Bella's BG is and if it's a safe number to give her insulin or when a decrease or increase is needed
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I tried her paw yesterday and after I finally managed to pock I dropped the damn strip because Bella was so uncomfortable and wanted to free herself. I don't honestly know how people are doing this. Multiple times per day??? All those videos with cats barely noticing what's going on...
We'll test her +4 at the vet later this week.
 
Alicia2022 said:
I tried her paw yesterday and after I finally managed to pock I dropped the damn strip because Bella was so uncomfortable and wanted to free herself. I don't honestly know how people are doing this. Multiple times per day??? All those videos with cats barely noticing what's going on...
We'll test her +4 at the vet later this week.
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I know it's stressful but keep trying. I thought I would never be able to test my boy. Now I tell him it's test time & I put his chewy box on the table & he gets in it & waits patiently for me to get everything ready & test him. He does claw my hands some but I started using disposable gloves & that has helped. I also give him boiled chicken for a treat when we are done & pet him & tell him good boy. You can do it, try not to be to stressed because your kitty can tell & that makes them stressed as well. Good luck you can do this!
 
Still have no luck testing. Used vaseline and it was even worse, as if all blood disappeared from her ear (can't see it and not enough for the test).
Yesterday, we got Bella's SDMA result: 30 which means CKD and, according to our vet, can't be treated.
 
There are always things that can be done to manage CKD, but yes that would be roughly Stage 3.

Any other labs you have would be helpful. Has she had blood pressure checked?

Here's a site a lot of us use as our "CKD bible", link specifically to info about SDMA - https://felinecrf.org/early_detection.htm#sdma_test

I will tag @Suzanne & Darcy , @Bandit's Mom. Bhoomas cat Bandit is also stage 3. These ladies would know more about treatment that I do, but you'll probably be looking at pain management, fluid therapy, dietary management (including appetite). https://felinecrf.org/treatments_essential.htm

With CKD many vets say treat the diabetes first and foremost, as that continues to wear on the kidneys.
 
Alicia2022 said:
Still have no luck testing. Used vaseline and it was even worse, as if all blood disappeared from her ear (can't see it and not enough for the test).
Yesterday, we got Bella's SDMA result: 30 which means CKD and, according to our vet, can't be treated.
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Hi. I just want to say that your vet is wrong if he/she said that CKD cannot be treated. It is true that it cannot be cured, but it definitely can be treated. I have had quite a few CKD cats in my time. The main treatments are for you to learn to give subcutaneous fluids at home (I can give you a lot of tips on that) and usually anti-nausea medications are required like Cerenia and/or Ondansetron. Frequently appetite stimulants like Mirataz or Cyproheptadine (and there is another one called Entyce) are very helpful. More in a second... got to run
 
I'm back. Phosphorus control is also very important because high phosphorus levels are very damaging to the kidneys. This means either prescription renal foods or phosphorus binders that are added to kitty's food.

Supplementing B-12 is also very important and adding B-Complex into the diet are very important because CKD kitties tend to suffer from anemia at some point and this helps a lot. At some point, if anemia becomes severe, there are drugs called ESAs that can really help to raise the red blood cell counts and make your cat feel better. But let's don't put the cart before the horse. Do you have any labs that you can share here. I would very much like to see them.

I am concerned about your vet. What is the vet's attitude toward this situation? Are they just saying "well, there's nothing you can do about it?" Because if that's the attitude, then I would find another vet that you are not going to have to fight, tooth and nail, for every single treatment that your cat needs to have a good quality of life. These treatments that I have mentioned are all about making your cat feel better, and the CAN really do that. Fluids will help bring the uremic toxins (BUN) down are really the first line of treatment for CKD. The other things are really important too. It's all about maintaining quality of life and making them happy and comfortable and keeping them eating so they can enjoy the remainder of their lives. I have had CKD cats who lived on for years with a very good quality of life.

Another thing to watch out for with CKD cats is constipation. CKD cats get dehydrated and their body does such an excellent job of conserving water that it will draw on every source of water that it can get, including drawing water from the stool in the colon -- so you get constipation. There are many ways to handle constipation depending on the severity. Miralax, and Lactulose are number one on my list. Adding fiber can be beneficial. There is just soooo much more we could talk about. I hope I have not overwhelmed you, but I hope that I have given YOU some hope for the kidney disease.

My most urgent suggestion would be to go to the felinecrf.org site. This is the most well-researched, comprehensive site on feline kidney disease. And to help you on your journey, I would DEFINITELY join the tanyackd support group that is associated with this site. The people on there are very helpful and knowledgeable and will support you and help you every step of the way. They are just great -- have known them for quite a few years now. I hope this all helps! Hugs to you. I know how depressing the diagnosis can be. And you have got this on top of diabetes. I think you would have a better chance at getting the numbers down if you would switch to a different insulin like Lantus... and it's really important now to keep the numbers below your cat's kidney threshold. But that's another subject entirely.
 
Suzanne & Darcy said:
I'm back. Phosphorus control is also very important because high phosphorus levels are very damaging to the kidneys. This means either prescription renal foods or phosphorus binders that are added to kitty's food.

Supplementing B-12 is also very important and adding B-Complex into the diet are very important because CKD kitties tend to suffer from anemia at some point and this helps a lot. At some point, if anemia becomes severe, there are drugs called ESAs that can really help to raise the red blood cell counts and make your cat feel better. But let's don't put the cart before the horse. Do you have any labs that you can share here. I would very much like to see them.

I am concerned about your vet. What is the vet's attitude toward this situation? Are they just saying "well, there's nothing you can do about it?" Because if that's the attitude, then I would find another vet that you are not going to have to fight, tooth and nail, for every single treatment that your cat needs to have a good quality of life. These treatments that I have mentioned are all about making your cat feel better, and the CAN really do that. Fluids will help bring the uremic toxins (BUN) down are really the first line of treatment for CKD. The other things are really important too. It's all about maintaining quality of life and making them happy and comfortable and keeping them eating so they can enjoy the remainder of their lives. I have had CKD cats who lived on for years with a very good quality of life.

Another thing to watch out for with CKD cats is constipation. CKD cats get dehydrated and their body does such an excellent job of conserving water that it will draw on every source of water that it can get, including drawing water from the stool in the colon -- so you get constipation. There are many ways to handle constipation depending on the severity. Miralax, and Lactulose are number one on my list. Adding fiber can be beneficial. There is just soooo much more we could talk about. I hope I have not overwhelmed you, but I hope that I have given YOU some hope for the kidney disease.

My most urgent suggestion would be to go to the felinecrf.org site. This is the most well-researched, comprehensive site on feline kidney disease. And to help you on your journey, I would DEFINITELY join the tanyackd support group that is associated with this site. The people on there are very helpful and knowledgeable and will support you and help you every step of the way. They are just great -- have known them for quite a few years now. I hope this all helps! Hugs to you. I know how depressing the diagnosis can be. And you have got this on top of diabetes. I think you would have a better chance at getting the numbers down if you would switch to a different insulin like Lantus... and it's really important now to keep the numbers below your cat's kidney threshold. But that's another subject entirely.
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You are an angel thank you :)
 
Alicia2022 said:
I have her labs in my first topic, here (Post #12): https://felinediabetes.com/FDMB/thr...-and-insurance-questions.265643/#post-2976495
Thank you for all the information. Yes, its's overwhelming right now. And I'm about to leave for a 2-3 weeks work trip. Will she survive till I come back? Not sure what to do.
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Can you get a Libre Sensor put on to Bella. This would help your husband while you are away. He can use the time to learn how to test. Can he post here for assistance while you are away. Can your vet show him or you how to do sub-q fluids at home while you are away. Now, with sub-q fluids, you do need to be careful as some vets will overhydrate a cat, which can cause fluid buildup around the heart and other places. If Bella has not got heart problems then it should be safe to give.
 
Suzanne, thank you here as well :) Bella does have some heart murmur but she doesn't have typical Maine Coon heart problems as far as I know. I mean, she hasn't have them before. I'm no longer sure of anything.
Where can I buy the sensor and do I need a prescription? Can I put it on Bella myself or does it require a visit to the vet? I can shave her but her skin is soo thin, I'm afraid I can damage it by putting the sensor on. We're going to the vet on Thursday and I have to leave on Saturday.
 
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Alicia2022 said:
Was able to test her today for the 1st time. AMPS 393.
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That’s great news! Congratulations. I guess I would hesitate to het that sensor? Not sure. I think you do need a prescription for them, yes. Maybe you won’t end up needing it after all since you have had that first successful test. I’m trying to think who the really experienced Libre users are to tag them. @babyg and @John & Henry are two that are coming to mind. RJ puts them on her kitty by herself. I have heard of people having problems with the adhesive hurting the cat’s skin but that was when the vet did it.
 
Alicia2022 said:
I have her labs in my first topic, here (Post #12): https://felinediabetes.com/FDMB/thr...-and-insurance-questions.265643/#post-2976495
Thank you for all the information. Yes, its's overwhelming right now. And I'm about to leave for a 2-3 weeks work trip. Will she survive till I come back? Not sure what to do.
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Yes. I saw these yesterday and commented on them. I hope you saw all of my lengthy (sorry) comments. There’s a lot to be relieved about in those labs such as her phosphorus level not being high. When you go to the vet tomorrow, can you at least get them to run some in house bloodwork to check her CBC so we can see if her white count has returned to within the normal range? I understand about the chin sore. Usually they will respond well to Antirobe (clindamycin) - probably feline acne that became infected. I just want to make sure that nothing else infectious is going on.

I completely understand about the teeth and vet not wanting to do anesthesia. I think that’s fine. I have been in the same boat with a cat with kidney disease and bad tooth. What we did for her was to give one week of the clindamycin and then three weeks off - so pulsed antibiotics. It worked very well. After a few cycles, I was able to extend that to four weeks between the one week on the clindamycin.
 
Alicia2022 said:
Where can I buy the sensor and do I need a prescription? Can I put it on Bella myself or does it require a visit to the vet? I can shave her but her skin is soo thin, I'm afraid I can damage it by putting the sensor on. We're going to the vet on Thursday and I have to leave on Saturday.
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Hi! Yes, you do need a prescription from your vet, and you should be able to fill it at any normal pharmacy like Walmart, for instance. I was also initially afraid to do it myself, but it's really not that hard at all. I think a lot of it depends on how good of a patient your cat is. Its true their skin is delicate, but that's why when I shave, I pull the skin taught. Havent had any issues thus far. I also dont use the glue the vets usually use, but I use Skin Tac wipes. My cat has had zero skin irritation. When I get back from work today, I can give more details, if you'd like. :)
 
Just to add, I haven't placed the sensor myself, but I've read and watched videos on how to do it. It doesn't look that difficult to do, it seems the shaving may be the hardest part, but if you make a mistaken then you're out the $35 for the sensor. I've read it also requires you use a #40 pet clipper blade (it trims to 1/100 of an inch). I don't think using an actual razor is recommended since their skin is so delicate.

Also, about the price of the sensor. The price can vary widely depending on what pharmacy you get it from. I've been getting mine from Fred Meyer but that is a regional chain (they're the same company as Ralphs, Kroger and many others). I've read that costco has the sensors for about $35 as well so that is probably your best bet if you have one near you. If not I'd call around and ask the price because some places will charge up to $200 for a single sensor. I'm not sure what walmart charges.

I think most vets apply the sensors around the scruff of the neck so you're kitty can't claw it off. My vet wasn't sure if the subQ fluids he gets would affect the sensor or not so she put it on his hinds (he pays no mind to it at all):

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She alternates sides for each new sensor so it gives one side time to heal from any possible irritation, but his skin shows no sign of irritation what-so-ever. I don't know what additional adhesive she may be using. Probably vet glue. Keep in mind you need to scan the sensor with your phone at least once every 8 hours if you want to get all the data.

Let me know if you have any additional questions, and good luck on caring for your kitty.

Dealing with everything you are can be really overwhelming at first, but it get easier with time. Especially the ear pokes. It took me a few days to get the hang of it, but now he just lays in my lap purring while I do it. He doesn't even flinch or make any reactions at all. I've only been doing it for 2 months, so you (and kitty) will adjust.
 

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547 AMPS today. We're going to the vet to test +6. I imagine the vet will suggest increasing the dose. Bella's current dose is 1 unit Prozinc BID (the initial dose was 0.5). The vet will most likely tell us to increase up do 1.5 units. Would that be okay? My understanding is the usual increase recommended here on FDMB is 0.25? I am sorry that I'm asking questions without figuring out the consistent testing first.
Ketone strip yesterday was negative. Should I test ketones every day?
 
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