Advice needed on dosage - dealing with lethargy

Princethecat

Princethecat

Member
Hello I am kindly requesting some advice on Prince’s current levels and insulin dosage.

For context, for the last couple of weeks Prince has gone through a series of events that has effected his blood sugar levels overall. This is my post in the forum for context.
https://felinediabetes.com/FDMB/threads/please-help-lethargy-and-yellow-stools.294927/#post-3215602

Essentially he was lethargic and was having bouts of diarrhea and throwing up and even stopped eating at one point (very unlike him). Thankfully better now energy wise.

At the time, I was giving him 2.5u of Prozinc insulin twice a day. However since the 14th, he has been consistently testing lower numbers than usual. (I only unfortunately started reusing the spreadsheet template recently, but have been tracking on my personal sheet. His levels prior to this have consistently been in the 250-360 mg/dl range pre shot and then 125-200 mgl/dl range post - essentially never dropping below 125 mg.dl even with 2.5 u / twice a day.)

Currently I am giving him 1.5 u for his AM shot and then 1 u for the PM shot IF he tests above 320~ prior to shooting. And my sheet has been updated with his levels from that.

My worry presently is that he will drop too low at night because even with 1u he can drop to 110. Although I know that is a normal range, I can tell that he is a little uncomfortable. Thankfully he is eating again. But I think also with the stress of the last two weeks and just getting him to eat anything has changed his eating habits/times and so I’m struggling to find an ideal process.

Previously (when I was giving a dose of 2.5u) - he was eating ~ 4 times (morning, afternoon, evening, night) day. Not 4 whole meals of course but split. I found that he is more content that way than if I give just a morning and a night meal.

Due to him not feeling well over the last two weeks, that has now been switched to 6~ times a day (smaller meals as that was at the time the most he wanted) but im wondering the effects of that on his daily levels.

My worry comes with the upcoming holidays Nov/Dec. I will be out of town a couple of days here and there. And while my family are comfortable with dosing and even testing him, they are not as acutely aware of how he is feeling. They are aware of hypo levels/giving karo when needed - but with his potential IBD (context in linked post above). I am a tad bit more worried.

Apologies if this is very convoluted, happy to provide more clarity and deeply appreciate any advice.
 
Hello. I am looking at the spreadsheet now. I will come back this afternoon/early evening to give some detailed comments and suggestions. In order for me to be able to really help you, I will need as much data on the spreadsheet as you have. The skipped shots are not helping him. We can work out a better plan than that and can work our way down to shooting lower numbers (adjusting the dose if necessary as you gather the test data so we can seehow Prince responds.)

Also, it’s not unusual for cats who have been diabetic for a while to behave strangely when they are in normal BG numbers. Some act sick. Some will hide. They will become accustomed to normal numbers again and will feel MUCH better. Their bodies have become used to the high BG and they feel strange in normal, healthy numbers. More later… I must go out now…. I will check back in.
 
Can you give me an update on Prince’s health status ? What’s going on with him and what kind of diagnosis has he received (other than diabetes?)
 
So you say you are struggling with his eating? Ideally, he would be eating low carb wet food (looks like he’s eating FF pate so that’s fine) and he will eat at shot time and again a small amount at about +2, +4 and maybe even +6. The whole feeding schedule can be flexed a little bot based on his needs. Is he underweight? Are you trying to get him to gain weight? Are you testing for ketones? Os the lethargy and vomiting gone?
 
Princethecat said:
Currently I am giving him 1.5 u for his AM shot and then 1 u for the PM shot IF he tests above 320~ prior to shooting. And my sheet has been updated with his levels from that.
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We need to find a dose where he can receive the same amount of insulin both a.m. and p.m. on a regular basis. It’s hard to tell what he’s doing at night since there are few tests and some nights no tests. He’s had far too many skipped shots it looks like from the SS.
 
Hi @Suzanne & Darcy thank you so much for your response.

As an update on his health: he has been doing significantly better than 1-1.5 weeks ago. He was previously lethargic/not eating/ loosing weight. As for diagnosis: he has gotten an ultrasound last Friday as they believed it was Pancreatitis. It actually was not pancreatitis but they found some thickening on his intestinal walls, so it could be IBD or SCL but they are not sure. My next vet appointment will be with an internal medicine doctor but they do not have availability until Nov. He has been struggling with some congestion/sniffling but its slowly getting better too

He is currently not struggling with eating but his feeding times have significantly changed - around 2, +4 and +6 as you suggested is around when he eats.

Yes over the last 1.5 weeks he has lost weight. He is a bigger cat as it is. Around 1 month ago (when he was a bit more stable) he was around 17.5-17.9~ lbs (down from his highest of 18.1 lbs). At his lowest last week he was at 16.4 lbs. Now he fluctuates between 16.9-17.0 lbs. So definitely lost but it is slowly creeping back up. I am trying at the very least to make sure his weight doesn’t decline more.

At the emergency vet he visited twice last week they had tested for ketones - and thankfully there were none. The doctor has prescribed Mirataz for appetite and Cerenia to give if he throws up but I have not had to use it since last Friday as he thankfully hasn’t thrown up since and his lethargy has improved over the week.

To give some additional context from 10/16 - 10/18 he was that the vet and emergency vet numerous times they had tested his levels there but notably consistently low. Maybe I can find the numbers from test results they did - but this was mostly told to me verbally after being in and out of the vet all week - so I can’t remember well :(.

The low levels were maybe contributed to the fact that he was not eating and at the vet for long stretches of time. As recommended by the vet at the time they mentioned maybe not giving his night dose.

Appreciate the input!
 
It would be helpful to know what his levels were at the vet, but not essential. I would be more interested to know what they are calling “low” numbers. They may not be low at all? But it’s more important that you personally keep up with testing before every shot and getting some mid-cycle tests so we can see his nadir and see how his cycles typically go.

You’ve been through a lot with Prince. What a relief that he’s doing better now (and eating— he must eat and get his insulin.) I assume they checked his electrolytes? Did you get copies of his bloodwork? If they suspected pancreatitis, they should have run a blood test called Spec fPL to test for it. Did you get a copy of the ultrasound report with the intestinal measurements? I have had a few cats with IBD and SCL. I currently have two cats with IBD (one was diagnosed via intestinal biopsy just a few weeks ago.). He’s doing great, but if you can, I would go with an endoscopic biopsy (although whether they can do this depends upon the location of the thickening and they will tell you they can’t get full thickness biopsies this way.)

As for ketones, I would encourage you to either test his urine using keto stix or to get a blood ketone meter to test them. It works just like a regular glucometer except with different test strips. I bought a Nova Max Plus blood ketone meter from ADW Diabetes Supply. Let me take a look at his spreadsheet again and see what is going on with his BG.
 
The spreadsheet isn’t up to date unfortunately. He’s been getting some pretty decent blue numbers during the daytime cycle. That’s good. I can’t say much about what is happening at night. It’s not recommended to shoot a lower dose at night (exception would be if he had a very low preshot number and you had no data to support giving the full dose at that time- then a temporary dose reduction could be done.)

We want to try to at least keep him out of all pink and yellow numbers as much as possible. Those are just going to be hard on his kidneys.

let me know when you get a chance to update his spreadsheet.
 
HI @Suzanne & Darcy
Yes I will try to get the reports from the emergency vet and the vet - the emergency vet is not the best at sending things over - but ill work on chasing that down. When I was at the emergency vet they had had stated was 104 mg/dl when they had suggested not dosing him with insulin. That was on the 14th I believe around +11 after his AM shot. I have updated the sheet. When I got him home he was still pretty bad that week so I refrained from testing him.

Ill have to follow up on all reports since their a combo from both places. But thanks for the insight on IBD, im glad your cat is doing well!:)

Actually I have discussed this with the family vet and went over the options for biopsy endoscopy versus surgical and I am leaning more towards the endoscopy as surgical seems a significantly more intense thing to put him through at the moment. Ill have to discuss more with the internal medicine doc in Nov.

Noted on the ketones I have heard that before and am going to look into purchasing supplies. The emergency vet did test for it and noted that there was none so that’s good.

I have updated my sheet thus far and will aim to test him more frequently. It’s always such an uphill battle testing him. :banghead:

As for ranges - trying to understand the optimal or just generally more ideal range for him to be in? The vet says that him being in the 200s range isn’t bad but I know he feels worse closer to 300+ and if it drops lower than 70.

About two years ago, he dropped to about 12 mg/dl actually and suffered a seizure. It was a very traumatic experience and so I’ve just been fearful of his numbers being in that lower range even 100-110
 
Princethecat said:
Yes I will try to get the reports from the emergency vet and the vet - the emergency vet is not the best at sending things over - but ill work on chasing that down. When I was at the emergency vet they had had stated was 104 mg/dl when they had suggested not dosing him with insulin. That was on the 14th I believe around +11 after his AM shot. I have updated the sheet. When I got him home he was still pretty bad that week so I refrained from testing him.

Ill have to follow up on all reports since their a combo from both places. But thanks for the insight on IBD, im glad your cat is doing well!:)

Actually I have discussed this with the family vet and went over the options for biopsy endoscopy versus surgical and I am leaning more towards the endoscopy as surgical seems a significantly more intense thing to put him through at the moment. Ill have to discuss more with the internal medicine doc in Nov.

Noted on the ketones I have heard that before and am going to look into purchasing supplies. The emergency vet did test for it and noted that there was none so that’s good.

I have updated my sheet thus far and will aim to test him more frequently. It’s always such an uphill battle testing him. :banghead:

As for ranges - trying to understand the optimal or just generally more ideal range for him to be in? The vet says that him being in the 200s range isn’t bad but I know he feels worse closer to 300+ and if it drops lower than 70.

About two years ago, he dropped to about 12 mg/dl actually and suffered a seizure. It was a very traumatic experience and so I’ve just been fearful of his numbers being in that lower range even 100-110
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Oh wow. That is so horrible about him going into a hypoglycemic seizure. He’s lucky to be alive. Did he get hospitalized? What kind of insulin was he on at the time? Were you testing him at home back then? I can understand why you want to be cautious with him. I would recommend that we try to keep him in the target range for the Start Low Go Slow dosing method. That is one of the two methods we use on this Board and you probably would be more comfortable with that one at this point. The target BG range would be 90-150 (so only higher greens and mid-blues.). It’s way above any concerning low numbers and still keeps your cat in the healthier low to mid blues which will help protect his kidneys. We want to stay away from the yellow 200s — but the cats don’t always cooperate
 
I hope he doesn’t have IBD, especially since, as I am sure you already know, one of the standard treatments for IBD (or SCL) is steroids, which raise blood glucose ☹️ Budesonide is a different kind of steroid that can sometimes be used an doesn’t have the same impact as prednisolone on BG. Some of our members have cats who have health conditions that require steroids, though, and they just have to adjust the insulin dose to compensate for that.
I totally agree that I would not put him through a surgical biopsy at this time. He would need to be in tip top shape for that, and he’s still recovering from some really rough patches.

He is such a cute boy. I was looking at his photo. He really is a big cat, too.
 
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