Am I being too conservative with Todd's doses?

Todd's mom Heather

Todd's mom Heather

Member
Hello everyone,

I am so glad I found this place. So, I have Todd's spreadsheet set up. I'm sorry I don't have more nadir numbers for you, I know those will be helpful. They are typically in the mid 100s, though. Anyway, I am off work this week (teacher) so I will be able to get more of those numbers in the coming days.

My question is, am I being too conservative with his prozinc? I'm utterly terrified of him dropping too low when I am at work, or in the middle of the night, so I'm afraid I'm not giving him enough insulin.

Today the vet recommended switching him to Lantus, but unless I find some overseas pharmacy to get it cheaper than $350, I simply can't afford it. My goal is to get my guy in the lower ranges overall with Prozinc.

His fructosamine test today was in the 600s.

He is also on 1/2 tablet prednisolone (5mg) every other day for IBD.

Any advice, criticism, suggestions, will all be so greatly appreciated. Thank you..
-H
 
Welcome! Now I'll bombard you with questions and comments:
  • When was your kitty diagnosed?
  • Pred can elevate BG but if it's working well to help his IBD you can dose around that.
  • You're doing great testing but it's important to test before every injection (test/feed/inject - no food two hours prior to that BG test).
  • We don't generally recommend changing a dose in response to the pre shot test number. Rather, an "appropriate" dose is selected, a basic testing routine is followed for a couple of days and then the low BGs produced by that dose are used to assess its effectiveness.
  • Many USA members order Lantus from a reputable Canadian pharmacy, Marks Marine Pharmacy, in Vancouver for about half the price you'd pay where you live.
Here's the basic testing routine I referred to:
  1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
  2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
  3. do extra tests on days off to fill in the response picture
  4. if indicated by consistently high numbers on your spreadsheet, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
  5. post here for advice whenever you're confused or unsure of what to do.
Check out this useful guide to using ProZinc: http://www.felinediabetes.com/FDMB/...prozinc-pzi-insulin-for-diabetic-cats.164995/

I hope this helps for now! :)
 
Thank you for the quick response!

He was diagnosed in July 2018. I've been weaning his pred down since this spring when he was very ill (pancreatitis, hepatic lipidosis, feeding tube, sub q fluids at home, the works). And I think he will be on it for life. My boy is 11.

Isn't it crazy that vets don't stress testing every time? I do my best to test before every shot. However, because he was so so sick before, and stopped eating, I am always hesitant to take away food. It kills me to think I should keep food away 2 hours prior to the test, though I know it will give a more "true" number.

What you say about an "appropriate" dose was a big question of mine. So thank you. When I asked the vet if I should adjust his insulin based on his test number, she said that people don't usually test at home, and had no answer for me. So, what about a AMPS number that's below 100? I would NEVER give him insulin after that!

I guess I will start with 2.5 units for the next few days and go from there! I just adjusted his dose every time because I figured it was like starting over once it was out of his system. I hate feeling like I've done wrong by him all these weeks. Ugh.

THANK YOU for the pharmacy recommendation! In your opinion, do cats do better on Lantus? I guess every cat is unique, right?
 
Todd's mom Heather said:
I guess I will start with 2.5 units for the next few days
Click to expand...
I suggest you try 2 units. I have a feeling that 2.5 u might be a little too much. You had an AM BG of only 115 recently after a 2.5 u dose the night before. Stay at 2 u for the next 4 doses or so unless you get a BG before injecting that's below about 220 - 230 for now (because you use an AT meter that reads higher than the human meters most of us use). You need to accumulate data for a consistent dose. It might also help to calm down his erratic BG numbers.

Yes, Lantus is a good insulin for cats. If a cat is very volatile in his/her response to insulin he/she *might* be calmer on Lantus. I suggest you try to get a more structured routine going with ProZinc for now unless you're near the end of a vial and seriously want to try Lantus.
 
Kris & Teasel said:
I suggest you try 2 units. I have a feeling that 2.5 u might be a little too much. You had an AM BG of only 115 recently after a 2.5 u dose the night before. Stay at 2 u for the next 4 doses or so unless you get a BG before injecting that's below about 220 - 230 for now (because you use an AT meter that reads higher than the human meters most of us use). You need to accumulate data for a consistent dose. It might also help to calm down his erratic BG numbers.

Yes, Lantus is a good insulin for cats. If a cat is very volatile in his/her response to insulin he/she *might* be calmer on Lantus. I suggest you try to get a more structured routine going with ProZinc for now unless you're near the end of a vial and seriously want to try Lantus.
Click to expand...

Ok, cool. Thanks so much for your input!

I also wouldn't mind switching to a human meter... $3-4 per day for strips and lancets is crazy for these AT meters. I just wanted to get him settled before I try changing things on my end. And that's another thing for this momma to learn!

That sounds good about structure. I'm just glad I have a Canadian pharm option if I go that route! I will need more Prozinc in a couple weeks, but I will give it one more vial before attempting to switch.
 
Test strips for the AT meter are $2 each for me here in Canada. :eek: Human meter strips are cheaper but still expensive compared to the US. However, I can buy Lantus OTC for less than half of what you'd pay.
 
The Canadian pharmacy Kris mentioned is great - I ordered Lantus from there when Sam was on it and they make the whole process quick and easy.

When Todd had pancreatitis, was it just one bad bout of it? Or is he chronic? IBD can often be managed without the steroid if you can get him onto a healthy raw food and a daily probiotic. And there is still a fair amount of debate over if a steroid really helps pancreatitis long term or not. So he may not need to be on it for life. (although knowing very little about his history at this point, I could be totally wrong about that!). :)

My guy has chronic pancreatitis and IBD, so you have my sympathy. They can both be tough to manage and make the diabetes journey a little extra complicated. :(

Kris has given you great advice about testing and dose. I'll just add that I struggled with taking food away the two hours before the shot as well. One way I worked around that was making sure that at 2.5 hours before the shot (in the afternoon), I gave my kitty a snack. That way I knew he had eaten and wasn't just sitting there starving during the "no food" part of the day. At night I would use a timed feeder. When it opened he would go get his snack, and then settle down until shot time. This also helped him learn not to wake me up an hour early begging for food. Win-win for both of us! :smuggrin:
 
Djamila said:
The Canadian pharmacy Kris mentioned is great - I ordered Lantus from there when Sam was on it and they make the whole process quick and easy.

When Todd had pancreatitis, was it just one bad bout of it? Or is he chronic? IBD can often be managed without the steroid if you can get him onto a healthy raw food and a daily probiotic. And there is still a fair amount of debate over if a steroid really helps pancreatitis long term or not. So he may not need to be on it for life. (although knowing very little about his history at this point, I could be totally wrong about that!). :)

My guy has chronic pancreatitis and IBD, so you have my sympathy. They can both be tough to manage and make the diabetes journey a little extra complicated. :(
Click to expand...

He had pancreatitis 3 times over the course of 5 or 6 years. Then, this 4th time, was this spring when it was really bad. I have thought about a raw diet, but he seems so sensitive to different foods that I am scared to try anything new. I agree about the steroid.. I've often wondered how much good it does, anyway. I do know it gets into his system though, because he coughs far less, and I only have to give him 1 puff of his inhaler a day, vs 3 before the pred to manage his asthma.

Anyway, thanks for your sympathy. I hate how the pancreatitis would just kick his butt out of the blue. And he is 11... so he is no young kitten. If he were, I would consider switching out our routine. But at this point, if he is on a low dose steroid, and is diabetic, I'm ok with that as long as he is happy. I think his pancreas is so shot that even if he were off the steroid, he would still be diabetic.

I thought about the "no food" thing tonight actually, and did what you suggested before I read your post! Great minds. I made sure he ate a few hours before, and felt a lot better about taking it away.

This is completely unrelated, but have any of you had any trouble with your kitty's teeth since they became diabetic? I know with extra sugar floating around, there is a lot for bacteria to feast on.... At his appointment yesterday she said his gums look awful, and this is the first I have ever heard of any dental issues. She thinks he needs a few extracted. I was shocked.
 
Dental issues are very common and I wouldn't be surprised if diabetes is an aggravating factor. Dental decay and inflammation can certainly make regulation of BG harder to attain. It can also be a contributing factor to ketone development if other things are going on at the same time like nausea, inappetance, vomiting, not enough insulin, etc.
 
Lots of folks on here have had to have dentals for their kitties. It's no fun for the humans, but the kitties usually seem to come through it fine....mostly they just seem unhappy about not getting to eat that morning!
 
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