Advice On Newly Diagnosed and Guilt

[adavid861]

Hoping to get some advice on our newly diagnosed little one Apollo, he is 3 years old and currently on 1u ProZinc and we've been frustrated with the ups and downs. Our vet has been wonderful, and we are working together on a plan to manage this but I've seen so much good down on these boards that I would love for you to look over a couple graphs from the last couple of days.

Sometimes we see great numbers, but for the most part the first thing in the morning and before his night time feed he is quite high. He is fed a wet food only diet (Performatrin Ultra Grain Free here in Canada), twice daily, no snacks or food in between.

When we started insulin on January 1, 2020 he was on 2u, but a curve done at the vet brought him down to 2.2 so our vet switched to 1u and then we noticed when home testing he was going quite high in the 28-30's so the vet advised of 1.5u but again, doing when we did some testing he would drop low 2-3's. So now we are at 1u again. There have been some real lows, and highs.

We just can't get our head around the numbers and not sure where to go from here. We will be setting up a spreadsheet soon, but I see all the great advice given here that I thought I would ask your opinion. Tonight before his shot he was at 30.

We are feeling quite guilty that the signs of his diabetes were there for months (weight loss, increased thurst etc). and we just found out recently. I think the most frustrating part is home testing and seeing those high numbers, and knowing we have a vile of insulin in the fridge but feel helpless to figure what the right dose is for him... are we not giving it enough time? Going from 2u to 1u to 1.5 etc?

 

[Juls and Billy]

Hello and welcome to the forum! I'm a newbie too, so take what I say with a grain of salt.

First off, it's perfectly natural to feel guilty for not seeing the signs. My fiance and I didn't either until our baby got very sick. Cats are stoic. The signs that something is wrong can be very subtle. Billy was doing all the things he should, eating, drinking, peeing, and pooping, until he wasn't. Then off to the vet we went.

Focus now on how awesomely you are taking care of Apollo, and how you are going to get him feeling better. All of this is overwhelming at first-- we've all been there.

My Billy is on ProZinc as well, and his numbers were all over the place at first. The body is adjusting to the insulin and feeling better. The body is used to high sugar levels, and when they start dropping to normal levels, this can cause the liver to freak out. Even though the levels are healthier, to the easily excitable liver, it looks like kitty's blood sugar is crashing. "We're crashing!" the liver shouts. "Release all the sugar!" Boom. High BGL. This is called bounce, and it can be quite common when insulin is introduced. A rule of thumb I've read here is that if the Nadir (lowest mid cycle BGL reading) is less than half of the pre-shot BGL test, then bounce is a likely culprit. I suspect you may have some bounce going on as part of the issue. But again, I am not an expert.

The thing is, you don't want to increase an insulin dose based on bounce levels or pre-shot levels. You have to look at the nadirs. If the nadirs are looking good, upping the insulin can cause a hypo event. Better a day with high BGLs than a dangerous hypo event.

Now, I'm in the US, and I can't really interpret your readings, as the scale is far from what I'm used to. We also need to know if your using a human or pet calibrated meter, as it makes a difference. I can tell you that 2u is considered a high dose to start out with. Most start with 1u and let it stand for a while to see how things work out after the cat's body has time to adjust.

I don't know that food. I looked at the ingredients, and while it is grain free, it does have carbs from potato, carrot, etc. Dr. Pierson recommends less than 10% calories from carbs. It's great that you are on a canned diet. If you can cut carbs under 10%, it will help. If you cut carbs further, make sure you always do a BGL test before giving insulin, as a lower carb food can really drop his blood sugar levels. There's a food chart here, I don't know which are available in Canada, but the information has been invaluable to me and Billy.

Now, a forum link that will help. You should start with New? How You Can Help Us Help You!

Among other things, it will tell you how to make a spreadsheet for Apollo. Look at the link in my signature that says Billy's Spreadsheet. Click on it! Now you can see all that's happened with Billy since we started. See those bouncy numbers in the beginning? Look how fast we had to go down to 1 unit. It's really common. Now, every cat is different. Billy started out so sick we thought we would lose him. Now, he's headed for remission. Some cats go to remission quickly, some take longer, some need insulin for the rest of their lives, but all sugar cats can have long healthy lives.

Oh, hey, I found a Canadian Food Chart here! Looks like your cat food is fine depending on the particular flavor. Look through the chart for the best low carb choices for your baby.

And here's a couple pictures I like to post to remind folks how quickly their sugar cats can start to feel better. The first one is Billy day zero, when he was first diagnosed. He isn't closing his eyes, he looked like that for 2 days. So sick.



The next one is day 11. Look at that happy, active, bright eyed kitty!


Don't worry about not seeing the signs sooner, you are here learning, you want to help your furbaby, and you are completely awesome. Read all the sticky posts. Learn all the things. Knowledge is power!

 

[Judy and Freckles]

Welcome to FDMB. Most of the members on here are American and use a different scale to measure blood glucose. To convert Canadian numbers, you just multiply by 18. So a 3 on a Canadian meter would be 3 x 18 = 54.

You'll definitely want to start a spreadsheet as that will help track your journey and give others who will be helping you with dosing more information to keep Apollo safe. When you have a question, use the ? icon in your title (it's found in Thread Tools (top right hand corner), edit title).(see pic below) . In the title where it says (No prefix) click the down arrow and you have your choice of: 911 (for emergencies), GA (gone ahead - Kitty has passed on), ? for a question. Make sure to 'save changes'. With a ? in your title, you are more likely to draw eyes to your thread. Read lots, ask lots of questions. Everyone on this board has gone through similar experiences. If you need help setting up the spread sheet, just ask. There are experienced people on this board who can help with dosing.

 

[Sienne and Gabby (GA)]

Welcome to FDMB!

I would hazard a guess that most of us missed the signs that our cat was diabetic. I was sufficiently clueless that until I noticed the smell of ketones (it smells like acetone -- nail polish remover) on Gabby's breath, I thought all was fine. She was really sick when she got to the vet and was in the ICU for 4 days.

You mentioned that you're going to be setting up a spreadsheet. I'm one of those members here that's totally spreadsheet dependent. Juls' point about bounces has merit. Bounces happen if your cat drops into legitimately low numbers, if numbers drop into a range your cat is no longer used to, or if there's a fast drop in numbers. Bounces are hugely annoying to us but can be a protective measure on the part of your cat's body.

I'd also like to see more spreadsheet data in order to assess whether Prozinc is giving you the duration you need. The higher numbers at pre-shot times could be an issue with your cat metabolizing all of the insulin earlier in the cycle so the numbers are rising at pre-shot. Again, this is not abnormal but if there's a pronounced pattern, a longer acting insulin (e.g., Lantus or Levemir) may be an option. I think it's too early to consider a switch at this point especially since Prozinc is a good insulin for cats.

One quick thought... When are you feeding your cat? If you're not already doing so, pick up any food 2 hours prior to shot time. The food, even though it's low carb, may otherwise influence your pre-shot numbers.

 

[Ann & Scatcats]

Hi,

Perhaps our God Of The Sun Apollo here are one of those who will do fine on Lantus depot insulin. You can always discuss that here and with your vet when you have more frequent bg test data and a Spreadsheet up going.

 

[Deb & Wink]

"Slow and steady wins the race."
"This is a marathon, not a sprint."
"The tortoise and the hare."
"Know thy cat."

All cliches, but true. When you have a newly diagnosed diabetic cat, it takes time for the cat to get better. The diabetes did not develop in 1 day, 1 week, 1 month. It happened gradually. It will be a gradual process to get your cat feeling better and regulated. It's easy not to notice when something is wrong with our cats. They don't speak human! Only talk in meow's and body language.

I cat sit for someone. They didn't notice one of their cats was severely matted and so badly it was pulling at her fur. I let him know and he gave her a trim. Life gets busy. Work, family responsibilities, running a business, relaxing with friends, etc.

This isn't like taking a tylenol pill and suddenly your headache is gone.

It will get better. Hang in there. Read other posts. Read the "Stickies" pinned to the top of the forum. Check out the Health Links/FAQs forum. Index at the top.

ECID Every Cat is Different ECID Every Caregiver is Different.

Most of us learn our cats are diabetic and they have been that way for some time. It's easy to miss the signs.

Some of us foster and/or adopt diabetic cats, and learn as much as we can before we bring them into our homes. And keep learning.

I know I don't know everything. I know that the vet doesn't know everything. I know that I'm always learning. I know that we can share what we do know and help you out. I know how to read a SS and can look for patterns. I know that your graph doesn't work for me. For one thing, it's so tiny I can't see the numbers. Aging eyesight. So no feedback from me on your graph.
What works for some doesn't work for everyone.

 

[Susan & Claudio]

Don't feel guilty about noticing the signs sooner. My Claudio had all the p's that a non-diabetic would. The only reason I took him to the vet was because he was peeing himself while asleep. The vet wasn't helpful at all. Before he walked out of the room, he handed me a script for Lantus. No instructions on how, when or where to give it. Nothing. Since I know about human diabetics, I figured the basics would be the same. Test, feed, then give shot. Oh, but he did say that he has no problem feeding dry food. I was afraid to tell him that I feed homemade raw. Like Deb & Wink said, diabetes didn't happen overnight and won't resolve overnight. Stick around. You will receive a lot of support and help.

 

[Deb & Wink]

And learn that canned sardines can be a good test time treat, smelly as they are. Right Susan?

 

[adavid861]

Here’s a bit more information until we can get Apollo’s spreadsheet up. Attached is his curve while on 1.5u at home on Jan 13, after the last written we were at:

5:12pm - 5.6
9:04pm - 15.2
10:03pm - 15.7

When Apollo had his first curve a week before at the vet he went to 2.2 at around 2pm while on 2u.

Sorry for the non-standard numbers here, I’m trying to get my head around everything.

We are now on 1u twice a day.

 

[Deb & Wink]

AMPS preshot test done? Right side is cut off, can't see
Any food given? When? Food withheld 2 hours before pre-shot tests?
mmol times 18 for mg/dL
+1 28.3 509.4
+2 28.4 511.2
+3 24.9 448.2
+4 23.3 419.4
+5 19.2 345.6
+6 16.2 291.6
+7 13.4 241.2
+8 14.3 257.4
+9 12.4 223.2
+10 9.8 176.4

No data for +11 or PMPS? Would have been nice to see an entire 12 hour curve.

Don't see that 2.2 you talked about earlier.

So, what are your expectations here?

 

[Juls and Billy]

The 1U is a great place to start. Apollo will need some time to get used to it. After that, the dose might need to be adjusted up or down depending of how he's doing.

You rock for working on the spreadsheet! I'm a newbie myself, and I found the spreadsheet a little intimidating at first. (I'm not Excel girl, heck, I'm not even numbers girl!) But it has really helped the more experienced members give me excellent advice.

Don't fret about the different BGL scale. There's more experienced members familiar with it. You're doing an awesome job helping Apollo!

 

[Deb & Wink]

How's it going with Apollo?

 

[Jordenne/Barb and Jospeh]

We have our share of guilt as well with our little man. It's a long read so feel free to not read it but it makes me feel better saying it. Kinda like confessional

It started with the drinking lots of water. We couldn't go to the bathroom without him there wanting fresh water. It progressed with gradual neuropathy manifesting with weak hind legs. He was on the larger size so we tried to keep his diet restricted but that was a losing battle using dry food

The thing that really grinds my gears is the fact that every one I've ever talked to, every pet store employee and most of the vet techs have all said high quality dry food is best. Good for his teeth and his weight. What a crock! We both bought it hook line and sinker because it made things easy for us.

Joseph would graze and we could tell he wasn't thrilled eating it. We would fill his dish after he was begging for food and instead of diving right in he would hover over it. Almost like he was thinking "god I hate this stuff but its all I got. Okay you can do this" before he would start eating.

We would give him wet foot but feel guilty doing it because it was ingrained that it was bad for him. Nearly 2 years ago Jospeh got an infection and I "spoiled" him during and after treatment with wet food. He gained a bunch of weight and so we cut off the wet food 100%. Then his drinking went through the roof. I thought barb was just not refilling his dish. I thought he is okay he is drinking lots of water and that's good. It's good for me must be for him too right?

Then beginning in November we started really noticing the weak legs getting worse. His hunger was insatiable. I'd feed him when I work up thinking Barb hadn't fed him at all cuz his dish was empty even of crumbs. Barb had fed him. So many carbs his poor pancreas just gave up. He stopped being able to walk more than 5 steps and forget the stairs!

Broke down and went to the vet on Dec 24th. They drew blood and omg it was horrible!!! He reacted so badly! I'm glad I wasn't there for it cuz I would have went through the door and stopped it. He was at 26. Obviously influenced by stress. Started him on Lantus on Dec 29th with little more than a start at one unit stick him here and feed him this expensive as **** food.

I've spent the last month kicking myself for not seeing it earlier. The signs were all there. I could have just grabbed a meter and checked myself and saved all the stress in Jospeh. So much rumination. It's not good. Now I know. Now I am doing everything I can to help him achieve remission. His symptoms have all but disappeared. He doesn't hardly drink any water. Barb says he occasionally drinks but I haven't seen it for a month now. His legs are drastically better. It will be a while before it goes away if it ever does but my little man is playing with his toys again. His dander is nearly gone. He doesn't look like he is in constant pain and he is eating in a controlled healthy way. It's worth every penny and every minute I spend learning more

 

[Vtambo & Rex]

Welcome to this board. It is THE most helpful tool you will have. It is extremely overwhelming at first. And I think we all probably feel guilty at first because we think it is something we did wrong to cause this or should have caught it sooner or whatever. In my own case my kitty was a bit chubby before diagnosis and I should have brought him to vet much sooner but I guess I was in denial. I kept telling myself that I could never get him to drink enough before and was glad he was drinking more now. Silly I know. He got pretty skinny and that’s when I finally took him in. I really got no help from vets. Pretty much everything they told me I did the opposite and that is what it took to regulate him. They wanted him on prescription food. They did NOT want me testing him at home and told me if I did they would not use my findings for treatment. They gave me the scrip for Lantus but they had none in stock so I had to go to regular pharmacy where they would only sell me 5 pens because they don’t sell individually. The vet bought 4 of them from me and said I would never use them all because things happen. In other words he would not live long enough to use them. They wanted me to bring him in every 3 weeks for a fructosamine test to determine regulation even though I didn’t see how that could be as accurate as home testing and it would stress him beyond belief. I switched vets within the clinic and the second vet wanted to dink around with all kinds of supplements etc instead of just getting him regulated right away. After months of all this I finally took the reins myself and started testing regularly at home, using only this food chart and figuring out his dosing myself. Within a few weeks I had him regulated. Then they told me he had early stage kidney disease. So I had to start all over. Kidney food and diabetes food are opposite each other. I needed to find food that would match both criteria. Difficult but I did it. Their solution was again prescription food (which for kidney issues is really high in carbs and really low in protein) and to regulate diabetes just give more insulin. I didn’t think that sounded reasonable. I figured it out with this food chart and just recently when I had in to vet they told me his kidney values were better now than they were 2.5 yrs ago when they said he was in kidney failure and he had no sugar at all in his urine which they said was not common for a diabetic cat. The home testing is not easy at first because obviously nobody wants to get poked in the ear regularly especially not a cat! My boy was exceptionally naughty when it came to this. I got scratched and clawed and bit and hissed at quite a bit, but eventually with the help of treats and being calm about it myself it wasn’t so bad. I admit I was not a diligent tester like some here once I got him regulated. Honestly I did it maybe 2x a week but as long as he was looking good, eating, etc. I didn’t worry too much about it. I also did the urine test strips so could look at glucose and ketones there too. After a while I could always tell if his numbers were up a bit by how he looked and acted. You will get there too. I got to have 3 yrs with him before he passed away just a week or so ago of something not related to diabetes or kidney. I wish you all the best and hope this and all the other posts can help you.

 

[Vtambo & Rex]

Also for me actual injections were much easier than the pen. I never knew how much of the insulin he was getting with the pen. Always seemed like there was a drop left on pen after. I did not find the injections difficult at all and could do the entire process of filling and injection in under 30 seconds. And it did not bother him a bit.

 

[Deb & Wink]

Haven't heard from @adavid861 since 1/20/20. Up to him to post again.