Alex OTJ for a few days but not sure if he should be

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_Bobbie

_Bobbie

Member Since 2020
As advised by my vet, I have held off giving Alex insulin for the past 3 days, and he has maintained mostly blue numbers, with some greens sprinkled in (lowest GL 88, highest 141). His appetite has not been good, never seeking out food, and only eating a bit when I put it in front of him. He will happily eat chicken, though.

Are these numbers desirable enough to stay off the juice? Do I want to try to get more <100 test numbers? Should I test more frequently than I have been?

I am quite concerned about his lack of appetite. It has not been great for a couple of months but seems particularly bad since we started treating earlier this month. It may be related to removing his beloved kibble from his diet, though he has been enjoying the Blue Wilderness Mature canned food for a while now. But he also seems to be having some gastro distress. Although he recovered from the terrible night of diarrhea and has since had good bowel movements, I frequently hear his tummy making noises. I am thinking I will get some other flavors of LC food to see if something else is more palatable to him. I'm also waiting to hear back from my vet about other options, perhaps an appetite stimulant. I've read other ideas for encouraging eating, and will keep those in mind.
 
Looking at your spreadsheet, I agree with your vet about the no insulin. Every cat is different, but personally I was wary or injecting under 200 BGL, and would not inject under 150.

It might be time to try a different food. I think his loss of appetite may be from the tummy trouble. A new flavor or variety of food might tempt him. You could also try less common proteins, such as rabbit, lamb, or duck. There's also a probiotic that can be sprinkled on his food that might help. It's called Fortiflora.

The Blue Wilderness Mature is a little high in carbs. 11% calories from carbs. Some cats do better with a little more carb, some don't do as well. You might try something less than 5% calories from carbs, for example, and see if those numbers come down a little more. Although today was brilliant for Alex. Every reading under 114 is pretty awesome.

There's a good food chart here if you would like to look at some options.
 
Thanks, Jules. I should mention Alex is an extremely picky eater. For years he would not eat anything except Iams dry food, which he was introduced to as a kitten because it is what I was feeding my other cats when he joined our family. I have tried to transition him to a better food many times over the years, but he would have none of it. He has never even eaten treats! For whatever reason, when I started offering him the Mature canned food a year or so ago, he was willing to eat some of that.

Over the weekend, I picked up some Blue Wilderness chicken (not the Mature variety), which I believe is only 5% carbs, but he turned his nose up at it. He has eaten it in the past when I accidentally bought it instead of the Mature (the labels are almost identical), so his resistance to it does make me wonder if it has to do with his tummy being upset. Or maybe he is just being his picky self.

I made a list of options from the (amazing) food list created by Dr. Lisa, focusing on venison and rabbit. I just need to get to a better pet store with a wider selection so I can hopefully just buy a couple of cans to see if Alex will eat them. I don’t want to order a whole case of a food since there is a good chance he won’t like it.

I also got a box of Florastor probiotic that @Sienne and Gabby (GA) mentioned, and will try giving that to him. He has taken Fortiflora in the past for his gastro issues, but it wasn’t helpful at that time. I will have to give it to him by capsule because he doesn’t tolerate anything being mixed with his food. Seriously, he is the pickiest cat I have ever had!

So I think it’s just going to be a lot of trial and error finding a lower carb food that he will go for, but I think you are right that it is a good thing to try to get his GL a little lower. And getting his tummy settled may be helpful in getting him to eat, too.

Thanks!
 
I don't think Alex is quite ready to come off insulin yet.
You can lower the dose further than 0.25.
It is really importamt to get a strong remission and that is done by reducing the dose down to a drop and maintaining green numbers.
Then when you do the OTJ trial you want to have most of the numbers green for the 14 days.

I would try 0.1 units of insulin and see how that works.
Here is the link to how to dose 0.1 units. Scroll down the page until you get to the area where it discusses drawing up very small doses. If you are unsure post and ask for help. I will tag @Deb & Wink as I am not a Prozinc user to see what she thinks about trying 0.1 units. I know many Prozinc users don't like to shoot under a certain number.
http://www.felinediabetes.com/FDMB/...info-proper-handling-drawing-fine-dosing.151/

Also if you are going to stop insulin when the numbers are a bit higher, I would go out and buy a bottle of Ketostix and test the urine for ketones just to be sure they done appear. The lack of appetite is concerning.
 
Thank you for your response and for giving me something else to consider. And for tagging Deb. She has been incredibly helpful and I would also love to hear what she thinks before I make any decision.

I do have keto strips and will test next chance I get.

Overnight Alex seemed hungry when I offered him food, then disappointed by his options. He only ate a small amount of the Mature BW, and again turned his nose up at the regular BW chicken. I am going to the store soon and will get a variety of things for him to try.
 
Sometimes when a cat is not eating well, their BG levels drop.
The not eating much has me concerned for Alex.

Yes, lower carb foods may help. But the immediate concern is getting Alex to eat. You might try the "chip and dip" method. Dip a few pieces of his old dry food into the wet food. Put those on a plate, see if he will eat those. Or try grinding up some of the old Iams dry food and sprinkling on top of the canned food.

Yes, his BG levels may go back up with the higher carb food. You'd have to restart the insulin if that happens, but better that he eats well and needs a bit of insulin than risk hepatic lipidosis or other complications.

Could be pancreatitis also. Snap fPL (instant yes or no result) or Spec fPL (sent out to a lab and gives more specific values) blood test can test for pancreatitis. Those tests are best done while a cat is exhibiting possible symptoms of the pancreatitis.

Other ideas. (There are a lot.)
1. You might want to ask your vet if a small dose of something like a regular strength acid reducer (famotidine) would be appropriate for Alex.
2. Does he take a lick or two and turn his head and walk away? He may have an upset stomach or nausea. Ask your vet for something for the nausea.
3. Older cats can be very set in their ways, about what they will and will not eat. (friend has an 18 year old very picky cat. She has been picky all her life. Like Alex.)
4. Heating up the food a tiny bit may make it smell a bit more and get Alex to eat.
5. A particular flavor may be more appealing to him. Try to get different variations of that preferred flavor.
Something with organ meats is often enticing. Turkey & Giblets, Liver & Chicken.
6. Texture can be a factor in a cat liking a particular food. Some cats prefer pates, chunky style or shredded.
7. Does he like fish flavors? Even though fish is not recommended more than a couple of times a week, due to mercury contamination. BUT if he prefers fish, than feed Alex fish.
8. Tiki cat food has many low carb foods that are a more chunky and shredded style foods in a broth or juice. You can always mash them up a bit in the food dish, add a bit of water and you have a bit of gravy.
9. Offering a smorgasbord, 2 or 3 flavors may help Alex to choose one. It's a way to see what else he likes to eat, when you are offering him more foods.
10. Elevating the food dish may help.
11. If he likes chicken and happily eats that, use that as a topper on his canned food. May entice him to eat a few more bites. You may need to repeatedly put more bits of plain cooked chicken on top of this food. May get him to eat a couple more bites.
12. Whatever it takes to get Alex to eat more. He's 17 years old, after all.


Yes, it is possible to dose Prozinc in smaller doses. Such as 0.1U or even drop dosing.
Alex was a bit high at PMPS 2 days ago, 2/17/20. You could have given him a very small dose, like 0.1U or even 1 drop of insulin.

Tag me if you need help with the drop dosing, or even want an opinion in regards to the BG being high enough to give Alex a tiny bit of insulin. That is very dependent on him eating first though.

You also mention bloody diarrhea back on 2/14/20 on the SS. Did you at least call your vet about that?
I know that you give him the Tylan powder, an antibiotic. Usually used for colitis and diarrhea. Serious side effect of the Tylan powder is bloody diarrhea. Vet call is recommended immediately. Stomach upset that continues is another reason for a vet call with this medication.

The Florastor probiotic may help his gut feel better also. The Tylan powder is an antibiotic, which can kill off good gut bacteria as well as bad gut bacteria. The probiotic can help to restore some of the good gut bacteria. Need 2 hours or so between antibiotic and probiotic doses.

How long ago was the dry food removed from Alex's diet?
 
Thanks so much, @Deb & Wink. I am happy to report that Alex ate half a 3oz can of FF beef and liver pate at 8:30, then no food from 9-11 before testing, after testing (GL 77) he ate almost all of the remainder of the can. He still needs to eat a lot more and fully get his appetite back, but it is a start. I bought several other varieties, including Blue Wilderness kitten food. Is it ok to give him kitten food if nothing else really does the trick? I will also be employing some of your other suggestions to hopefully get him eating more. He has a history of hepatic lipidosis from one of the times I tried to change his food and didn't pay close enough attention to how much he was eating (all 3 cats were grazers, and I didn't know then to pay attention to how much each cat ate). So I am mindful of that.

If I had to guess, I would say he has an upset tummy because he seems hungry but then doesn't eat much. I am waiting to hear back from my vet since my inquiry about anti-nausea medication. She was off yesterday and didn't get to the clinic until 11 today. Hopefully she will be in touch soon. I did get in touch with her after the bloody diarrhea on Friday night, and have not been giving him Tylan powder since then so he can reset. I also stopped giving him Zobaline in case that was also causing his diarrhea. I did give him 1/4 capsule of Florastor this morning, but other than gabapentin, it is the only thing I have given him since Friday night. His bowel movements have been normal (firm, no blood) since Saturday morning.

He has not had a good appetite for over a month. It, along with neuropathy, is why I took him to the vet initially. I completely stopped giving him dry food when he got his diagnosis on Feb 5, except for that one time when his GL dropped below 60.
 
Hi Bobbie! So glad to hear Alex is eating, and having better poops! I just wanted to say Bron and Deb are giving you good advice about the drop dosing. It's not something I really had a chance to do with my Billy, so I don't always remember to suggest it.

The kitten food may be a good idea. They generally have more calories, which can help a kitty who isn't eating enough. As Deb said, right now, the best food for Alex is whatever you can get him to eat.
 
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Thanks, Juls! Any suggested GL guideline for drop dosing? Off to review the info Bron shared on how to do it...
 
I'll have to let Deb or Bron guide you on the suggested BGL for drop dosing. It's not something I know well enough. You are taking great care of Alex. I'm so glad he's doing a little better today.
 
_Bobbie said:
Is it ok to give him kitten food if nothing else really does the trick?
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Absolutely. The kitten food has a few more calories, so that may help him gain back a bit more weight.

Any notes on the SS in the Remarks column are helpful. Such as the fact you stopped the Tylan powder for now. Notes for each day, of the meds you are giving would be helpful for us to see. Think of the SS as more than a place to record the BG (blood glucose) levels, the units of insulin given, the times of BG tests. It can be much more comprehensive than that.

Someone yesterday apologized for all the notes on her SS. I told her I LOVED, absolutely LOVED seeing all those notes. It helps me to put the BG tests into perspective, into context and try to see what is going on.

Be back with the drop dosing info. I've told a couple of other people recently on how to do that. Be right back. Give me 15 minutes or so. Please.

p.s. If I've read another reply, I try to remember to "Like" the post. Don't always remember to do that, but I try.
 
No rush on my
Deb & Wink said:
Be back with the drop dosing info. I've told a couple of other people recently on how to do that. Be right back. Give me 15 minutes or so. Please.
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Thank you, you are amazing. No rush on my behalf, as I won’t be dosing Alex until 11pm ET anyway.
I will update the spreadsheet with relevant info this afternoon. Thank you!
 
Drop Dosing

How many drops do you get from your insulin syringes if you draw the liquid up to the first line? Not the first line with a number next to it, or the shorter line that shows half unit markings. The very first line on the syringe. What we think of as the zero mark.
  • Practice, practice, practice to see how many drops you can get out of the syringe.
  • Use some sort of colored clear juice like apple juice or colored water.
  • Mark the syringe well. Painter's tape, duct tape, masking tape at the top of your “practice syringe”. So you don't forget and use that syringe to draw up insulin.
  • Draw the "test liquid" up to the first line on the syringe.
  • After you have drawn up a tiny bit of “test liquid”, point the needle up towards the ceiling and give the syringe a "finger flick. Push out the air bubbles.
  • Slowly “twist” the syringe plunger to push out all the “test liquid.”
  • Then when one small drop of “test liquid” is all that is left on the beveled tip end of the needle, draw the syringe plunger back to "suck" that 1 drop back into the syringe.
  • You are looking for consistency.
  • Try to get evenly sized drops.
  • Practice, practice, practice until you get a consistent number of drops.
Do you think you have the technique down for the drop dose?
Then let me know.

When it’s for real. You’ve practiced and are ready to give a tiny “1 drop” dose.
  • Draw up a tiny bit of insulin, needle pointed up to the ceiling and give the syringe a "finger flick. Push out the air bubbles.
  • Slowly “twist” the syringe plunger to push out all the insulin.
  • Then when one small drop is all that is left on the beveled tip end of the needle, draw the syringe plunger back to "suck" that 1 drop back into the syringe.
"Finger flick” technique - make a circle with thumb and first 2 fingers tucked into first thumb joint. Quickly “snap” those first 2 fingers against the syringe barrel held in your other hand. That will force any air bubbles up to the top of the syringe. Then you can push the air bubble out.

Syringes have a lubricant inside. Before you draw up insulin, moving the syringe plunger up and down a couple of times helps the plunger move more easily.

Give the shot. Monitor.

Later, if you need to, you could increase the number of drops.
 
Thank you, @Deb & Wink. I will practice, practice, practice! In the meantime, it seems like I shouldn't give Alex insulin as long as his GL stays as low as it has been - <100. At what level would you advise giving him a drop?

I just picked up some cerenia from the vet to help with any nausea Alex may have. The plan is to try that, and if by Friday his appetite still hasn't improved, we will try an appetite stimulant. If at any time he stops eating completely or starts vomiting, I will take him to the animal hospital for an ultrasound to check for pancreatitis. I am feeling anxious because I have to be out of town tomorrow and Friday, back mid-morning on Saturday, so my husband is going to have to monitor him. Fortunately, he will be working from home and can keep a close eye on Alex. Plus I will be checking in constantly to see how he is eating and what his GL is!
 
_Bobbie said:
In the meantime, it seems like I shouldn't give Alex insulin as long as his GL stays as low as it has been - <100. At what level would you advise giving him a drop?
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That is the part I forgot to include.:banghead: Sorry, got sidetracked.

I would not give Alex even a 1 drop of insulin if his BG numbers are <100.
If his appetite is good, and only if that is the case, maybe 1 drop of Prozinc if Alex is >120.
Let's keep the threshold BG's a bit higher, since you have not tried the drop dosing yet.
If your husband will be monitoring Alex, he needs to be able to give insulin and do the BG testing also.

Sometimes, the guys are more reluctant to test the blood glucose levels. They are "afraid of hurting the cat" by poking their ears.

Some people test by poking the paw pad instead of the ear. Another option for getting the tiny bit of blood needed for the BG testing. It all depends on what your cat is more comfortable with. Ear or paw.

We've got some great vets in the Boston area. Including MSPCA Angell.
 
Deb & Wink said:
That is the part I forgot to include.:banghead: Sorry, got sidetracked.

I would not give Alex even a 1 drop of insulin if his BG numbers are <100.
If his appetite is good, and only if that is the case, maybe 1 drop of Prozinc if Alex is >120.
Let's keep the threshold BG's a bit higher, since you have not tried the drop dosing yet.
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Thanks for the guidance. So to confirm, if his food intake is still not great but his BG goes above 120, I should not shoot? Alternatively, if he does start eating well, and he goes up to >200, should I give .25, .5, or even 1 unit? Sorry if these questions are nit-picky. I just want to consider possible scenarios and have an idea of what to do if they occur.

Deb & Wink said:
If your husband will be monitoring Alex, he needs to be able to give insulin and do the BG testing also.

Sometimes, the guys are more reluctant to test the blood glucose levels. They are "afraid of hurting the cat" by poking their ears.

Some people test by poking the paw pad instead of the ear. Another option for getting the tiny bit of blood needed for the BG testing. It all depends on what your cat is more comfortable with. Ear or paw.
Click to expand...

Fortunately, he has tested Alex a few times and is getting more comfortable with it. He injected Alex once, but we are both going to need to practice drop dosing in case he needs to do that while I am away. I have sent him the instructions.

Deb & Wink said:
We've got some great vets in the Boston area. Including MSPCA Angell.
Click to expand...
We sure do. And I am fortunate to live close to Angell, though hopefully I won't need to go there any time soon!

Thanks for all this help, Deb!
 
_Bobbie said:
No, she just said to go get an ultrasound o_O I will ask her about that.
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I would push to get a spec fPL test, usually done in-house, which will tell you yes or no Alex does or doesn’t have pancreatitis or the spec fPL which will be sent off to a lab and will tell you how bad the pancreatitis is.
 
_Bobbie said:
So to confirm, if his food intake is still not great but his BG goes above 120, I should not shoot? Alternatively, if he does start eating well, and he goes up to >200, should I give .25, .5, or even 1 unit? Sorry if these questions are nit-picky. I just want to consider possible scenarios and have an idea of what to do if they occur.
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Not nit-picky at all. You are looking for more details on what to do in various situations.
So, some general guidance.

If Alex stays in the green range numbers, < 99 no insulin. Bad appetite, good appetite, doesn't matter. No insulin at those low numbers.
UNLESS you test for ketones and find a trace or more. Then he needs a tiny bit of insulin. At least 1 drop.
If Alex stays > 100 and <120, poor appetite, I would not give insulin for now. UNLESS ketones present. Then 1 drop.
If Alex stays > 100 and <150, good appetite, I would give 1 drop insulin for now.
If Alex is > 150 and <200, good appetite, I suggest 0.1 U of Prozinc. (That is probably 2 drops.)
If BG >200, then I think 0.25U Prozinc.

Basically what I have done is given you a customized decision tree and sliding scale dosing to use with Alex. Plus some contingency planning if Ketones are present.
I've done this for several Prozinc members lately, that are close to being OTJ but not quite there yet.

This could all change rapidly from day to day. Please come back and ask for more info if you or your husband are in doubt as to what to do.

There are a number of documents in the Prozinc ISG (Insulin Support Group). I'd highly recommend that you print copies of these documents out. Especially these 2:
NEW TO THE GROUP: THE PROZINC BASICS. PLEASE START HERE.
PROTOCOL FOR PROZINC / PZI

Quoting from the Prozinc Protocol, selectively:
"Sometimes there are circumstances such as ketones present, an unusually low preshot number, a caregiver leaving the cat with a sitter, relatively high flat curves, loss of appetite, infection, a schedule change, ability to monitor, etc. which may call for adjustments to these guidelines. Please ask for guidance if any of these or other circumstances present themselves or are of concern."

Your Alex falls under those "other circumstances" category, so asking for guidance is quite legitimate.

"If you encounter numbers under 50 mg/dL {2.7 mmol/L} on a human meter or under 69 mg/dL {3.8 mmol/L} on a pet meter, post on the PZI forum and Health to get advice. Start your thread with a 911 icon and a title like: HYPO NUMBERS HELP"

This <50 mg/dL situation hasn't happened yet, but included it just so you know what to do. IF NOT on insulin, BG numbers that low are not a concern when using Prozinc.

Prozinc is what we call an in-and-out insulin. With effects rarely lasting more than 12 hours (Rarely 12-14 in some cats.) So no leftover insulin or an insulin "depot" to take into consideration when adjusting dosing.

In and out, lasts the current 12 hour cycle. Then your cat needs more insulin for the next cycle. Or not, if the numbers are low enough.

As always, pass this by your vet too. Getting her feedback is important.

Does that help a bit more?
 
Hi Bobbie, I simply wanted to make you aware of this.

All the "Sticky" or pinned posts in the Prozinc forum have been updated and there are a couple of new ones.

Highly recommend that everyone using Prozinc or helping those using Prozinc read them thoroughly.

I'll be doing that myself. Been expecting this for some time. Came about a week before I thought it would.
Thanks Marje, and Robert, and especially Djamila for the Modified Prozinc Method. You folks are FANTASTIC!
 
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