? Advice please? Felix update 2nd May: dropped dose from 2.5u to 0.5 in one week! Weight loss.

Astra&Purrfect

Astra&Purrfect

Member Since 2016
Hello everyone and hiya Suzanne if you’re there!

I’ve decided to post this update about Felix because this is unknown territory for us and any advice would be much appreciated from people who’ve had similar experiences with cats.

Over the last few months, we’ve had to drop Felix’s dose from 3.3u to 2.6u twice a day. But everything’s gone beserk in the last week. His numbers have been all over the place and we’ve had lower numbers on 0.5u today than 2.6u 8 days ago! He was pretty low at nadir 88 mg/dl today (human meter).

When he’s been around or under 200 mg/dl pre-shot, we’ve taking the SLGS advice of 10-25% of the dose. Coincidentally, in this last week he has had frequent loose stools and has dropped almost a pound (he’s already very underweight). His food has not changed. He doesn’t seem to be able to gain weight although he’s been eating around 250 to 300 calories of wet food every day. I’ve stopped giving pancreatic enzymes today just in case it’s too much now and is causing over-processed, over-quick transit of loose stools.

Anyway, I presume that the lower need for insulin is a sign of the pancreas starting up again? But why the worrying diarrhoea though? Any pointers or advice would be appreciated - thank you!

EDIT: He was at 137 mg/DL preshot this evening, the lowest he's ever been preshot, so decided not to inject for the first time. Some might still inject their cat a mini dose but after today we thought not. What dose to give tomorrow depending on numbers, I wonder 🤔

Astra & Felix.
Felix-2.jpg
 
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Hi Astra! I was wondering how dear Felix has been doing.

I looked at his spreadsheet last night and was a little perplexed about the criteria used for reducing the dose. I want to look again before replying. I don’t want to just say something in a second without giving due consideration. Today I am out on a family outing, but I will check in later.

It’s very good to hear from you!
 
Hello, Suzanne.
Nice to hear from you!
The criteria are the lower nadirs and lower starting numbers below 200 and caution. Yesterday, the 2nd is an example on only 0.5 units which resulted in a nadir of 88 with similar numbers to the 28th of April on a much higher dose of 1.75u. In March, we would have had to have given around 3 units to achieve the same result, ref. the 3rd of March.
His ketodiastix has also changed showing weak levels of sugar in the urine as opposed to medium or high.Today, however, we were overcautious and definitely didn't give enough Prozinc because he was too high (or flat). We'll see what happens this evening with his numbers preshot. It seems that there is intermittent function from his pancreas which is making safe dosing a bit hair-raising and unpredictable for us at the moment because 88 at nadir (and dropping) which was what was happening yesterday, despite eating well, is really too low for us to manage without worrying. Hope this answers your query.
Thank you, Suzanne, and have a really great day out! We've been having wonderful summery weather over here but today we had heavy rain and thunderstorms!
Astra & Felix.
 
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It seems like you would be comfortable following the SLGS dosing method where you take reductions of .25 units if Felix drops below 90. I see how he has had some lower preshot numbers and has had some reduced doses, but some of those doses are much too small for him (per your tests on his SS). Remind me how you measure those doses like .15 or .2. Calipers? I really think that his dose is just fluctuating around too much and that is causing some of the wacky BG.
 
Was he ever diagnosed as having Exocrine Pancreatic Insufficiency? I am asking because you had been giving pancreatic enzymes. Have you noticed a change in his BMs for the better since you stopped giving them?
 
This is from the ProZinc dosing methods sticky note— the 3-6 cycles thing applies to cats following the MPM method so would not really apply to Felix, but the other observations and recommendations about changing doses too frequently resulting in unpredictable BG is what I have observed in many cats to be true.
  • After the initial adjustment period, subsequent doses should be held for 3-6 cycles and data collected to determine next steps. Changing doses faster than that, or trying to use a sliding scale, nearly always results in bouncing and wild unpredictable variations in blood glucose, or BG getting stuck high and flat as if nothing is happening. Small steady dose changes work best.
  • PZ typically lasts 10-14 hours in most cats, and one cycle affects the next, so when changing dose, it can take a few cycles before you really see the impact of the change. It’s not uncommon for the first cycle after a dose increase to be a little higher. If this happens, try not to get discouraged. Wait a couple of cycles, collect data, and see what the BG does.
  • Conversely, if you decrease the dose when you shouldn’t, it’s not uncommon to see a good first cycle because there is still some impact from the previous higher dose. Subsequently, the following cycles may result in the numbers starting to rise. If this happens, move back up to the previous higher dose.
 
Astra&Purrfect said:
When he’s been around or under 200 mg/dl pre-shot, we’ve taking the SLGS advice of 10-25% of the dose.
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This recommendation is really for newbies who don’t have a lot of spreadsheet data on their cat. At this point, you have a lot of data on Felix. The really confusing part is that we can’t really say what Felix’s dose is right now because it’s been changed so frequently. That sounds bad, but I don’t mean it like that. I just mean, if, for example, I would recommend shooting a half dose…. I am not sure how much that would be because I don’t know half of what dose?
 
How long has it been since he’s had bloodwork and a vet visit? Has he had an abdominal ultrasound? I am worried about his weight loss and I know you are as well. Is he still having diarrhea?
 
It looks like a dose of 1 unit would be good to try when he is in the upper blue numbers like he has been recently. You tried it once and he had some decent blue numbers. Later you tried the much smaller doses like .15 and .2 so you already proved that those doses were too small for the upper blue preshot numbers. Then if you see that perhaps the 1 unit dose is not quite enough, next time try 1.25.

When you encounter these lower preshot numbers, have you tried to stall the shot and retest in about 30 minutes to see if his BG is stable or rising? You delay the feeding as well, of course.
 
Dear Suzanne,

We’d like to thank you so much for your posts and replies. We do indeed understand what you’re saying about the dose needing to be steady for a few days for stability. The mini doses of .15 and .2 don’t seem to be enough for Felix, at least for the time being. I use syringes with half-unit markers. Really mini (.15) doses are hard to do. We have tried stalling in the past but it didn’t make a huge difference. We inject him fairly late so stalling is a bit difficult.

We decided today, because he was at 289, to use the last effective dose of 0.5 units. It had taken him quite low so we did a skinny dose this time. Consequently, he had a very similar day today with lows of 128 at 4½ hours and a nadir of 92 at 6½ hours.

We were concerned though that he would go too low tonight on that dose as he started at 250 this evening and cats go lower and have less food at night. So, we did have to adjust the dose slightly downwards for safety’s sake. If we can hold a dose safely, how many cycles (12h?) should we hold it?

Felix will be going to the vet soon because we need a new prescription for Prozinc. Although I have to say that she’s pretty unaware about feline diabetes and even suggested not testing him when we first started injecting him! Rather typical me thinks. I have subsequently said to her on the telephone that we’re testing Felix at the very least before every shot and at nadir if poss just like with a human and she went very quiet.

He’s never been specifically diagnosed with pancreatitis or insufficiency. The tests alone could cost a couple of hundred Euros which is needed to buy his insulin and costly strips, syringes, etc. We were going by his symptoms of diarrhoea, malabsorption and inappetance. The inappetance has greatly subsided now over the last few weeks but he finds it difficult to put on weight and his fur is thin.

His motions have slightly improved but it occurred to us that he’s also been going outside much more with the fine weather in the past two weeks. He might be up to his old tricks of going into the field opposite to do his business but then licking cowpats at the same time. Before diagnosis he always had very healthy motions. But when the vet saw him before diagnosing diabetes, he had a slight UTI so she prescribed antibiotics. His stools have never been the same since then. His appetite was good today and no ketones in his urine.

Felix has been watching telly with us recently. This evening, it was our DVD of The Revenge of the Pink Panther (1978)!

Thank you again, Suzanne, and I hope you and yours are well and that your furry, feline family is fine too?

Astra & Felix.
 
I was going to ask if he had been licking any cowpats! I remember one time he became ill from licking that. Felix!

As I recall the Revenge of the pink Panther is funny! Peter Sellers. I believe that was his last film before his death.
 
Hello, Suzanne.
Thanks for the encouragement!
Yes, we use a capsule called Ultradiar which has some soothing ingredients + some probiotic. I've made sure to fill in the numbers in the sheet. We'll keep him at 0.4u now, if poss, and see where that gets Felix.
That's great to hear that you know the Pink Panther films too! We have all the DVDs!
 
@Suzanne & Darcy
Suzanne & Darcy said:
These are good nadirs. Well done, Felix and Astra!
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Hello, Suzanne,
Today's been a funny old day because Felix was at 180 mg/DL a.m. preshot, so we gave food (couldn't stall without feeding him he was so hungry) and waited two hours. To our surprise, he'd dropped to 159 so no shot. Now another 5 hours later, he's at 82! He been eating every 2 hours. Don't know what to think!
 
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