Advice welcome

[Julie & steve j]

I really would welcome some advice please. My cat had been on 5.0IU day and 4.5 night of Prozinc for 14 months without issue, but a 6 monthly Fructosamine test showed an elevated number. The vet advised at that time advised to increase insulin. Having increased 5.0IU/5.0IU he became lethargic and stopped eating. A different vet then fitted a Freestyle Libre in order to get more readings which I’ve input to the spreadsheet. Having got very inconsistent numbers after administering different units of Prozinc over a 3 month period, she advised that we saw a diabetic specialist or considered a change to a longer acting insulin such as Lantus. I’m at my wits end with it all and wondered if anyone else has been in this situation and could offer some reassurance. I’m seeing someone from a different veterinary practice next week and need to make sure I ask all the right questions. He is currently on 3.0IU twice daily but his glucose numbers are not dropping below 18. Thank you

 

[jt and trouble (GA)]

I'm afraid I only have words of encouragement. I've seen several cats switch to lantus and their journey changed for the better. I'm sure you will receive many responses. So please hold on for more replies.
Good luck with whatever path you choose.
jeanne

 

[JanetNJ]

I really would welcome some advice please. My cat had been on 5.0IU day and 4.5 night of Prozinc for 14 months without issue, but a 6 monthly Fructosamine test showed an elevated number. The vet advised at that time advised to increase insulin. Having increased 5.0IU/5.0IU he became lethargic and stopped eating. A different vet then fitted a Freestyle Libre in order to get more readings which I’ve input to the spreadsheet. Having got very inconsistent numbers after administering different units of Prozinc over a 3 month period, she advised that we saw a diabetic specialist or considered a change to a longer acting insulin such as Lantus. I’m at my wits end with it all and wondered if anyone else has been in this situation and could offer some reassurance. I’m seeing someone from a different veterinary practice next week and need to make sure I ask all the right questions. He is currently on 3.0IU twice daily but his glucose numbers are not dropping below 18. Thank you

I don't see where you are giving 5units on your spreadsheet. I see 4 units on November 6 was too much and the dose should go down to 3.75. Can you put the most recent readings in the spreadsheet? Nov 8th is the last readings I see on there.

 

[Julie & steve j]

I've updated Benny's spreadsheet. I'm using the alphatrak at the moment and as I work and live alone with Benny it's difficult to get as many readings as I would like. I don't have any readings from the sensor when he was on 5.0IU. We reduced him to 4.5 twice daily after he stopped eating and changed to a diffent vet who applied the sensor. He's now been on 3.0 IU twice daily since 13th Nov. The vet thought he was better to be on less insulin than the risk of hypo at a higher dose. I'm worried that if we leave him on too low a level for too long other complications may arise. He did suffer from diabetic neuropathy when we were trying to get him regulated the first time round. He recovered from the neuropathy during the 14 months he was 5.0IU/4.5IU.

 

[Nan & Amber (GA)]

Hello and welcome!

I'm worried that if we leave him on too low a level for too long other complications may arise.

It is a struggle, balancing these concerns! I see why your vet wanted to reduce, however-- you've hit some very low numbers (40's on an AT will make you sit up and take notice!), and while being in high numbers can do damage over a long period of time, it's the hypos that can kill quickly. When you say that the libre readings were "inconsistent", does that mean he was going really low, then really high? That's a really common pattern, usually indicating that the cat is on too much insulin, so I can see where your vet is coming from here.

To answer your basic questions, yes, it definitely does happen that cat's insulin needs change over time, so that what was once the perfect dose no longer works well. It can take time and patience to figure out the new dose-- the testing you are doing is going to help a lot in this!

Couple more quick observations to throw in:

1. Changing by 1U at a time risks missing the perfect dose (around here we change by 0.25U), so it's possible that all the changes your vet was making while Benny was on the Libre were just too much too fast to figure out a good dose for him. Additionally, looking at the dat you do have right now, it's possible that 4.0U is too much but 3.0U is too little. However:

2. I'm not sure we can really evaluate the the 3.0U dose properly yet. The mid-cycle tests you've been getting are great, but we also need to see where he's starting from i.e. the pre-shot tests. Would it be possible for you to start getting those numbers again?

3. If you're thinking of switching to a long-lasting insulin, you might want to consider Levemir as well as Lantus if your vet is willing to prescribe it. They are very similar in their actions, but at higher doses the Levemir formulation has less of a sting. I don't know that Benny will end up being a high-dose cat in the end, but it's a possibility given that he was on 5U and doing well for a long time.

Lastly, a quick note about the AlphaTrak: it's a great meter, but the strips tend to be really pricey. A lot of us here switched to human meters for that reason, to the point where all of our dosing methods basically assume human meter readings. We can help you figure all this out no matter which type of meter you prefer to use, just throwing that out there as another option if it might work better for you!

 

[Julie & steve j]

Thanks for your advice, it is incredibly helpful. Yes, Benny dropped very low followed by a steep rise very quickly. This has happened on at least 3 or 4 occasions overnight and just once in the day. It's good advice increasing by only 0.25 units. My vet was keen for me to speak to a internal medicine specialist or a diabetic specialist as she felt that Prozinc wasn't possibly the best insulin in that it had too short a duration for Benny. I've moved to a new practice and hope that I can find a way forward Prozinc. I'm getting better at using the Alphatrak so hope by increasing at a slower rate we can find a solution. If not, I'll have to consider change of insulin or specialist advice.

 

[Sienne and Gabby (GA)]

The steep rises after lower numbers are what we term a "bounce." It's truly annoying to us but it's a fairly normal response. You kitty's liver and pancreas interpret the low numbers as dangerous and release a stored form of glucose along with counterregulatory hormones that cause the spike in numbers. It can take approximately 3 days for the bounce to clear.

I am largely in agreement with Nan. It would also be helpful if you could get a before bed test every night. Many cats like to visit lower numbers at night so getting at least one test to insure that Bennie is in safe numbers is important.

There's information on how we approach dosing in the sticky notes on the Prozinc board. You might want to look the information over and see how much it differs from what your vet has been instructing.

 

[Julie & steve j]

Many thanks to you all for the information, it really is appreciated.