Advice Please

Amanda0621

Amanda0621

New Member
Hi everybody, this is my first post here. My cat Bellatrix has been diagnosed and on ProZinc for 2 years. We have been unable to get her blood sugar under control. We will be seeing a new vet in a couple of weeks (I’ll be pushing for a different insulin) but I wanted to get some thoughts on my girl and what I should do about dosing until our appointment with the new vet.

Her numbers are very high and pretty flat throughout the day, no matter what the dose. She’s currently getting 3u of ProZinc to try to break out of the 500 range but it’s not working. Her vet recommended upping her to 4u awhile ago, but at the time that was advised against in another support group. I’ve grown very frustrated and don’t know what to do for her. I would appreciate any thoughts and advice!

https://docs.google.com/spreadsheets/d/1Ol1XcDapVfOKm9ZXvGkuw5CjfwBwEAPEhz_yyxGddo4/edit
 
Hi there. I'm sorry you are having such a difficult time with Bellatrix. I'm really glad that you are testing for ketones since she's in such high numbers. I don't think you should have decreased her dose back when you went from 2.5 to 2 units at the end of January, but anyway, you have since increased and she's not responding to the insulin.

May I ask what you are currently feeding her. Is it all low carb wet food? What is her feeding schedule like? Do you feed snacks during the day? What kind of meter are you using? I think that, at times, you have been holding the dose too long. If she's on an all low carb wet food and you cant get at least one (or more) mid cycle test in per day (in addition to the two preshot tests) then I could consider doing MPM (modified prozinc method which you can read about in the sticky notes section of this forum) and keep adjusting her dose every 6 cycles as necessary.

Is there anything going on with her health-wise? Does she have a UTI possibly? How are her teeth? Any other potential infections or causes of inflammation? When was the last time she had bloodwork? I'm just trying to think of causes for her insulin resistance.

You may just have to break through some glucose toxicity by raising the dose gradually every six cycles (if she's eating all wet low carb food). If her dose gets to a certain point then you may want to have your vet test her for Acromegaly and Insulin Auto Antibodies (IAA), which are tests that must be sent to the veterinary laboratory at Michigan State University. First, however, I would like to see you increasing her dose according to the MPM if possible.

Do you have any spreadsheet data on her for 2022? Was she always this insulin resistant? What kind of numbers were you getting on her before 2023 and what kind of dose was she getting at that time. Sorry for so many questions.
 
Thank you for your response! Yes, I watch ketones closely because Bellatrix has gone into DKA before. They have been going up and down lately.

Bellatrix is currently only eating Tiki Cat Puka Puka Luau Shreds. I feed her 3x a day (AM, midcycle, and PM), sometimes I can get in a 4th if I'm awake late enough. I can't leave food down during the night because I have 4 other cats who will steal it from her. I use the Relion Premier for my daily testing. I did briefly look over the MPM information, I will read it more thoroughly when I have the chance). I did up her dose to 3.5u of ProZinc, I hope that was the right decision.

She's never had a UTI and isn't showing any signs of one. She does get reoccurring URIs though every few months, but shes not showing any signs of that at the moment. I'm thinking her teeth might be a problem. She's 12 years old and has some some teeth pulled already. The last time she had all of her bloodwork done was when she went into DKA back in August of last year. Everything was okay at that time other than her being in DKA. I assume when we see a new vet in a couple weeks, they'll probably want to get some base line bloodwork and I will have them check out her teeth. Do you think she might do better on a depot insulin (such as Lantus or Levemir)?

I do have some spreedsheet data for 2022. It is in the "2022" tab on her Google Document sheet that I linked in my first post. I would say we have always had an issue with her responding to her insulin, but it has gotten worse. Looking back at her 2022 data, her glucose numbers were all over the place. She has a habit of being very bouncy. She was on a few different doses last year (pretty much every dose between 3u and 1u). They were adjusted based on advice from another feline diabetes group. I will gladly answer whatever questions you have to help you have as much info as possible. Thank you for your time!
 
I feel like I have trodden the path that you are on. I really feel for you. I got some very bad advice from a Facebook group that had me stuck with doing “resets”where I took my cat back to a low dose because maybe I had overdosed him (which was not the case as dose increases had been made gradually). He did much better after I came here and started following the advice of this group.
 
But anyway, would you be willing to just keep trying the increases every 6 cycles to see if we can break through to a better dose? I would not increase more than .25 units each time just yet. If you get into higher dose territory, then we can do .5 unit increases and later on we do dose increases that are about ten percent of total dose — but you are not there yet.
 
So I think we should see if we can break through to a dose that she will respond to - but, yes, I do like the depot insulins. I have used Vetsulin, ProZinc, Lantus and Levemir. My boy had Acromegaly and Levemir was best for us, but every cat and situation is different.
 
So let’s just let this 3.5 unit dose settle for six cycles, okay? And we will see how she is doing— and you keep testing for ketones— okay?
 
Looking back, I wish I didn't follow some advice I had been given, but I was scared and desperate to get Bellatrix under control, especially with the DKA. Yes, I am willing to try increasing every 6 cycles. We had a little more movement at mid cycle with the 3.5 units, she was "HI" at preshot and +4, then at +6 she was 478. Our current vet suggested trying Vetsulin when I asked about switching insulin, but I didn't think it would be any better than ProZinc from what I've read about it. We'll be seeing another vet on May 4th to get their opinion on her treatment.

Thank you so much for your responses! We will continue with the 3.5u and ketone checking and then check back in here in a few days.
 
I had the same problem and wasted 6 months of my cat’s life following bad advice and ended up with him in DKA and spending a week in the hospital. I understand. ProZinc is a much better insulin than Vetsulin. Vetsulin does not work well in cats and is no longer recommended (for cats) by the American Animal Hospital Association or the American Association of Feline Practitioners. Vetsulin is quite a harsh insulin in cats and tends to drop them really hard and then doesn’t last long at all and they end up zooming back to where they started from in a short time.
 
Just keep your spreadsheet updated so we will be able to see what is happening. I know that sometimes it seems useless to even test them when they’re like this — and it is very demo. My cat was like that. I used to be so upset and say, “This insulin is doing nothing… NOTHING.”
 
Suzanne & Darcy said:
Just keep your spreadsheet updated so we will be able to see what is happening. I know that sometimes it seems useless to even test them when they’re like this — and it is very demo. My cat was like that. I used to be so upset and say, “This insulin is doing nothing… NOTHING.”
Click to expand...

We went ahead and upped to 3.75u today. I was able to get a +4 test, it was pretty close to what preshot was. Preshot was 450, +4 was 492.
 
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