Advice about PZI time lapse effect

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Cesar the Burmese

Cesar the Burmese

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Hello Folks,

I'm doing a blood sugar 12 hours test today and so far, numbers are showing me that nadir happened 4 hours after shot instead of 6.

Numbers also are outrageous (started on hi, lowest is 24.4 mmol/L and climbing back up).

https://docs.google.com/spreadsheet...8-I2b85ShLPAnbu3UJs/pubhtml?gid=5&single=true

You can take a look of Cesar's spreadsheet above.
My next step is to have an huge conversation with Cesar's vet and put back Cesar to Lantus.
Feel free to comment.
 
Did you have a chance to read over the Prozinc guidelines @Sue and Oliver (GA) put together in a sticky at the top of this forum? While there is no depot, holding the same dose for 3 shots (3 cycles) gives the body a chance to acclimate to changes.

And it would be helpful if you would actually skip lines when you aren't recording data, so we don't visually see a continuous set of numbers displayed which are not continuous at all when one checks the dates carefully.
ex. 8/26 and 8/27 are missing, which makes me wonder what happened that gave you an AMPS of 2.9 mmol/L (52.2 mg/dL) which all of us would have told you not to give insulin, it was too low (you don't shoot low to stay low on ProZinc, the way you can on Lantus). And what may have happened after that is called bouncing. Bouncing is the body's response to 1) rapid glucose drops, 2) drops to unfamiliar glucose levels or 3) drops to actual hypoglycemia. The hormones in the body release stored glucose (glycogen) to prevent the cat from dying.

Insulin doses are adjusted based on the nadir, the lowest glucose post-shot. With ProZinc, once you have systematically collected data, you may be able to develop a sliding scale.

At this point, I'm concerned you may be overdosing your cat and at some point, the glycogen is going to be exhausted, leaving your cat at extreme risk of fatal hypoglycemia.
 
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Hello BJM,

Cesar came back from vet 8/22 and started Prozinc on 8/23. He started his day on 23rd with his first shot of PZI. Vet asked me to keep an eye on his value before meal (as introduction to new insulin).
Cesar was used to eat 100% of his meal until he got fed up of canned Purina DM with all the supplements in it.

Things went worse about the fact that type of insulin does his job but in less than 12 hours instead of 12 hours sharp.
He climbed stairs slowly everyday until he reached the outerlimits of my blood sugar monitor (HI).
I didn't have such results with Lantus before moving to PZI (as requested by my vet to have a higher margin of manoeuver

BJM said:
which makes me wonder what happened that gave you an AMPS of 2.9 mmol/L (52.2 mg/dL)
Click to expand...
I didn't gave insulin after his meal (given shortly after this result), i gave insulin after reading 31.3 mmol/L (564 mg/dL) at 8:30 AM ( 2 hours after first result of 2.9 mmol/L) wich is a perfect Somogyi effect or hypoglycemia rebound. Cesar ate 75% of his meal the whole day, wich is quite considerably lower than normal and having also a hypoglycemia rebound during same day. Having him ate 100% of his meal (wich was already fed up of canned Purina DM), this event would probably not happen.


(Note : I've joined the forum like 2 weeks ago and i didn't have the knowledge of the forum to write up properly in SS and to take proper action with PZI)
 
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It is hard to tell what exactly is going on.

I wonder about the rapid rise in dose from .5 to 2.5 in the very beginning. Now, with continuous flat high levels, it does look like it is possible he is getting too much insulin.

Some they drop very low with too much insulin; sometimes they just have continually high numbers. Normally I might suggest a restart of one unit, hold it for 3 cycles and see if the numbers are in lower ranges. But, when reading through your last posts on Health, it looks like he has been DKA twice, so a reduction is always a risk.

Is he eating Hills MD/WD? If so, you are counteracting insulin with very high carb food. It is certainly important that he eat, but you have to increase the insulin to compensate (like a human diabetic eating donuts and needing extra insulin). If the high carb food is the issue, then a reduction would not be a good idea; more insulin would.

It is possible that Lantus is a better insulin for him. But as long as he will only eat high carb dry, IMHO, he is going to be difficult to regulate.

The protocol we put together is in my signature in blue.

I am not sure we have been of much help. You do have your hands full with previous DKA and high carb food. I wish I had a more definitive answer for you, but it seems to me you are working with two possible variables and I don't know how much each could be contributing to his issues.
 
Thanks for your help Sue. I know Purina DM dry was an optional choice but i cannot see how could i do better with prescribed wet (even tried other prescribed brand of food). The major point is : he must eat.
Hill's MD was used for about a week until chronic constipation was revealed by Cesar.
Hill's WD was used for about couple months to help deconstipation (high fiber values). Verdict was not helping to maintain his blood sugar level due to high carbs in food.

This was already discussed on other topic of my own :
http://www.felinediabetes.com/FDMB/...a-gravy-what-should-i-do.144018/#post-1494659
 
I am still not clear what he is eating right now. Hills or Purina Dry?

You got lots of advice on that food thread so I assume you've tried Fancy Feast and Friskies pates - with water and without, dressed with a favorite treat like PureBites or FortiFlora (which might also help with his possible constipation issues. Often if cats liked Purina DM wet and tried of the liver taste, they'll transition to the other wet low carb choices.

But he may not be one of those kitties....
 
For only being here 2 weeks, you're doing pretty well.

So there is more than just diabetes is going on - issues with constipation and with food preferences. That can make anyone want to tear his/her hair out. My GA Spitzer had IBD, possible lymphoma, and the would/would not eat/keep it down/run it through in 2 hours kept me hopping and driving home every day at lunch to check on him.

For really good constipation info, in case that turns out to be an on(not)going problem, pop over to Feline Constipation where you'll find tons of info on how the feline GI tract works, what happens when it doesn't, and options to treat and to prevent further constipation issues.

I don't know if you've tried these at all. The only 2 over the counter dry foods in the US which are low carb are Young Again 0 Carb and Evo Cat and Kitten.Young Again is internet only, and they have a couple of formulas. Evo may be found online and at specialty pet stores
 
I've put for tonight meal 1/4 teaspoon of Restoralax with water and his dry nuggets (Purina DM). He ate it without problems, he was licking his bowl.
My vet gave me a list of laxatives that i could use on my cat (Restoralax, Laxaday, etc...). Let's see if this works.
 
Don't know if calorie intake is an issue with Cesar, but my cat is on Royal Canin glycobalance now - it only has ~ 390 calories/cup and some fiber
I think Purina DM is high in calories - I tried Evo dry but it seemed to raise his blood sugar levels (plus it has about 600 calories/cup as does Young Again) that would limit my cat to only 1/3 cup of food a day, which he would not tolerate. 1/4 tsp miralax added to canned pumpkin is helping with Murphy's bowel habits.
 
Update about Cesar :
After the birth of my son (end of September), i've bring back Purina DM canned to Cesar progressively (a week 50/50, another at 75/25 then 100 since couple days ago with dosage reduction every week since 3 weeks in a row).
So far so good, i've caught in time an hypoglycemia episode wich result that insulin dosage is too high for his amount of food consumed.

Cesar is more joyful than ever, teasing up other cats in house and wake me up earlier everyday for food.
I sse some light at the end of tunnel and no, it's not a train coming up.
 
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