Advice needed on dosing...is my cat bouncing?

[CheriB]

Looking for advice on whether I need to adjust Meggie’s insulin and if so, how much. This morning, I did reduce her by 0.5U. I'm just not sure if that is the right thing to do.

Here's her information: She was diagnosed with diabetes about 6 months ago. The vet put her on ProZinc. We started out at 1U and worked our way up to 3.5U. All of this time she was under the care and monitoring of the vet and eating prescription dry food. The vet never said anything about testing at home. She would spot check her in the office and do fructosamine. She has been back and forth at the vet every 2-3 weeks...in Nov/Dec/Jan for not eating and throwing up. She usually gets subcutaneous fluids and a cerenida injection, and she feels better. The doctor felt that she could have pancreatitis (one of her labs was slightly elevated). I always felt that her numbers were too high (when spot checked she was in the upper 300-400 range), but the vet said it was because she was stressed when they tested her. Anyway, during all this time, she has never returned to her pre-diabetic self--still very lethargic and lays around only in a few places in the house close to her food, water and litter box. She used to go outside, hang out with my children and sleep with them at night...

Since Jan 25, I started following some message boards and joined the Feline Diabetic Support Group on Facebook and I took over and stopped listening to the vet. I purchased a glucometer (Relion Confirm micro) and have been monitoring her at home. She is currently on 4U ProZinc and 0.5U Novolin R (started this fast acting insulin Jan 30th per a recommendation, because her numbers were so high). She is strictly on wet Fancy Feast now and has been since Jan 25th. I’m feeding her 2 cans 2x a day when I give her her shot. I am in the process of getting Levemir because obviously the ProZinc isn’t lasting long enough. I think I should have a pen by sometime next week.

I still worry that her numbers are too high and after reading some recommendations regarding dosing on this website, I think that she may be bouncing--I'm not sure since I have no experience with this (I'm a bit overwhelmed). Was hoping someone could take a look at her spreadsheet and give me some input. I did go ahead and decrease her ProZinc from 4.0 to 3.5U, with 0.5U Novolin R, this morning and tonight but was unable to get several readings throughout the morning. I will test her every 2 hrs this evening and update the spreadsheet.

Should I continue with this adjustment or go back to the 4.0U + 0.5U Novolin R or just wait until I get the Levemir? I know her numbers are still to high. Am I doing the right things or am I over analyzing?

https://docs.google.com/spreadsheet...lv1zalGcRpwWCRC_prxlQqiUE/edit#gid=1131435116

 

[Djamila]

Hi Cheri, and welcome! You've really been through it lately with all of this! Great job doing research for yourself and getting started with home testing. Vets really do try, but they just don't have the time and experience to be experts in feline diabetes. I'm confident your fur baby will do better with you taking charge like this!

I'm more than a little perplexed that someone would suggest you start R without having a body of data first! Looking at the numbers you have, it doesn't look like it's hurting anything, so no need for you to worry, but that was pretty risky advice.

I do think switching to Levemir seems reasonable given the dose you're on at this point. Prozinc gets expensive at higher doses, and the volume of insulin can get tricky. Levemir, being a u100 insulin is better managed for kitties that need larger doses.

It doesn't really look like bouncing to me. It looks more like insufficient insulin. It looks like she was handling the 4u okay, and you are monitoring closely, so if she does start to go lower, you'll be able to keep her safe. I wouldn't do any other dose changes at this point though since you just changed her diet fairly recently. So maybe go back to the 4u, and give that a couple of days to stabilize. Then if she's still in the same ranges we can consider another adjustment, depending on where you are in the process of getting the Levemir.

Great job having your spreadsheet all set up and updated. That helps so much when looking at a new kitty!!!

 

[Rachel]

Hi Cheri! Djamila has already given excellent info, so I'll second what she said. I think you're seeing just not enough insulin (which is common at first really) and she probably needs a higher dose...but I would also caution you to stick with the 4 units that Djamila suggested and give that several days. I do think Lev will be good for you...it tends to last the longest I think and there are several folks who have used L insulins with the R...we've never really done that with Prozinc since I've been on the board. I think some folks did that long ago, but I haven't the slightest idea how to guide you through that. There are SEVERAL members of the L forum who have used both before so they'll be of huge assistance to you when you switch.

My only suggest apart from what Djamila said is to go ahead and post over in L as well. You can keep posting here so we can help out until you switch, but maybe start a post there letting them know you'll be switching in a week or so and that you have been using R as well and see if they can give you some advice on starting dose with them. Also, you can start to figure out how L is dosed since it does work differently than Prozinc!

Finally, just congrats! You've done a lot of the hard work already...testing at home, taking control from your vet which is scary, I know, switching to low carb wet food, and setting up the SS! Now it's just time to work on helping your baby hit a good dose...and I feel confident that will happen!

 

[CheriB]

Thank you so much for your advice ladies, I will post on the L Forum as well. Just to give some insight as to why I added the R...Because her AMPS and PMPSs were so high, it was recommended to try 0.25 R to knock the numbers down initially so that the ProZinc would be more effective when it kicked in. I started out with the 0.25 U, but it was kind of hard to be consistent with the U100 syringes since the dose was so low. It seemed like her numbers were such that I could increase the R to 0.50 U, so I did and I was happy to see several blue numbers. In hindsight, I think the ProZinc kicks in for her with her NADIR ~ 4-5 hrs...perhaps the R is just working a little to help get her numbers down, and as you guys are observing, she may just need to increase her ProZinc with no R. Hopefully, I can get her off the R when she begins the Levemir. I am going back to 4.0 U ProZinc + 0.5 U of the Novolin R today. It helps me so much to get another view and advice, since I'm a newbie. I cannot thank you enough. Just want my Meggie to feel better and I don't want to mess her up in the meantime.

 

[Kris & Teasel]

I'm glad you got good advice from the other folks here. There are people on the L forum that have experience using R insulin with Lantus or Levemir. As was said earlier we've never seen it done with ProZinc since all of us have been on FDMB. It does require very careful monitoring because you're tracking the effects of two insulins that act differently in terms of onset, usual nadir time and so on. You might find that a depot insulin like Lantus or Levemir will flatten out her BG numbers somewhat.