Back after almost 2 years OTJ

Status
Not open for further replies.
RobbiesMom

RobbiesMom

Active Member
Jumping in here with some facts so there's some info on my boy Robbie (a large 20.5 lb male Maine Coon who also has some arthritis and suffers from a non typical form of asthma) and his situation here in case we need to reach out or if anyone has some thoughts they'd like to share. I am a tad intimidated as so many of the posts on this entire forum make my head spin a bit and I generally consider myself someone who catches on quickly.
Here it goes - Robbie was first diagnosed in late July of 2010 - I began self testing within a week. He was started out at 8u's which my vet quickly adjusted after I ran in pretty upset with info from this forum and he took a much closer look at everything. (It was not a good experience to begin with and I don't want to defend my Vet choice but long story short I've converted a very well meaning and decent Vet into a home testing advocate who has brought himself up to speed on the diabetes protocol.) We switched from wet and dry food to ALL wet, low carb/calorie high protein/fiber FF (at our Vet's insistance). Robbie was adjusted down after only a few doses to 1u than to .75 and .50 - we bounced around between 1 and.50 for a few weeks with numbers going from Blue to yellow after having had a few very scary green numbers. By October he was OTJ and has enjoyed this status ever since. I really felt that the food change was a miracle.
So here we are back with high 300's and a cat clearly not feeling well at all. Exactly why we are back I can't say but I suspect the fact that he had been sneaking some of his "sisters" higher cal food, MY giving him his arthritis meds in a small teaspoon of that food (still kicking myself for that) and also getting into the garbage cans (I originally thought it was the dog till I caught him) might have pushed him there - but something was driving that hunger so perhaps we were headed back here anyway. He tested 373 at the Vet's office 6 days ago and was put on 4U's of prozinc. He got his first shot in the office. After checking in with FDMB I was convinced that 4 was way too high and while I didn't want to go to the 1 or 2 that was suggested I settled in at 3 units with a U-40 syringe BID. This all began 6 days ago and his numbers haven't left yellow and pink except for one blue (190) - however I haven't been able to do a good curve (I'm working on that today) or get many numbers as I work long hours and have a parent in the hospital that I've been dealing with as well. I gave him 4U's this morning - I'll be home all day, can monitor him and I want to see if his numbers move a bit more into less troublesome waters. I imagine I'll get some grief over that but I'm following my gut and having been down this road before I feel OK doing that however I can't express how valuable I find the input and feedback here so let me have it as I'll take and do whatever is required to help my boy - I love all my furkids but he is my soulcat, he talks to me, sleeps with me and holds my hand when I'm upset. I am determined to do right by this loving boy. Thank you very much
 
Welcome back Ellen -

Grayson and I have been here about 2.5 months, and we've run the gamut - from 1u, down to .2u, and back up to 4.4u - our increase was based on a ketone scare Feb 23rd and twice since.

I know it took Grayson a while to settle into the insulin - we started in the high reds, so I was thrilled to get to the pinks and yellows. My only wisdom to share is that Rome wasn't built in a day. It may take Robbie a little while to adjust back to the insulin. Most of us started out lower, and in some cases, had to reduce due to long cycles and unshootable numbers. I've intentionally drug my feet as I've done increases to fight the ketones. I would definitely encourage you to change doses slowly, but you know him better than we do, and as long as you're watching him closely you'll be able to stay on top of any situation that arises.

Welcome back... hopefully Robbie will be one of those lucky ones that gets a second honeymoon!
 
Hi and Welcome Ellen and Robbie,

Sorry you had to come back but at least you know the routine.

You are probably thinking that I'm going to say that 4 units is too much insulin (which it is) but you said it yourself in your post. The first time around you read up on this board and converted your Vet (great job), dropped his dose down to 1 unit and went OTJ.

Why would this time be any different?

As you know we advocate Start Low Go Slow, so you will be urged to start at 1 unit and go from there.

Your ss shows that your second day of insulin he had an inverse curve indicating too much insulin and the numbers have just gotten worst since with the exception of 1 blue number.

Your best chance of going OTJ again will be in the next few weeks, especially if it was triggered by getting into higher carb food, etc.

We are a small and family like group, with more activity in the mornings and evenings. If you have an emergency and no one is here to respond right away post in Health to get immediate responses.

Welcome to our little corner of FDMB.

Robin
 
thank you for your comments - I am trying to be patient - and am very scared of the free falling numbers we experienced last time (a few nights of no sleep with members here helping me along the road as I massaged his gums with maple syrup and tried to get him to eat). So I'm watching him closely today - he's ALWAYS hungry (he was like that from day one) so trying to regulate his eating again makes the numbers wacky too - He's re-learned quickly that an ear prick means a small piece of chicken or two... I taught him how to let me use an aerokat inhaler on him by putting pieces of ham on the mouth piece so I know he'll do almost anything for a snack! :lol: He's moved from 323 this morning at 9am to 231 at noon so nothing too drastic but he has eaten breakfast and a small snack in that time frame too.
 
Hi Ellen,

Was Robbie on Prozinc the last time too? This time around, did the vet run a full blood panel, and were any of the numbers besides blood glucose out of the "normal range"? Wondering if there is something under the surface that led to the relapse. He hasn't had any sort of steroids in the past year or so, has he?

I'll look at the SS momentarily...

Carl
 
thank you Robin He started out at 8u's first time around and was on that for 2 days before I got to this forum and started home testing and as I look back at my old data I only recorded 2 doses on 8u's before moving him to 1 and we bounced around after that - but the 8u's APPEARED to be what jump started something and than it just seemed to be a need to stabilize at least that was what it seemed like at the time and looking back also.
Having gone 6 days with no major movement into lower numbers has me perplexed but as you can see my prior experience was radically different. We started him out at 4 on this new journey and his numbers were better that day - I moved to 3 out of fear from the first experience and because there seemed to be strong consensus here that 4 was just insane however now we seem to be stuck.
As I mentioned I did move to 4 again this morning and am doing hourly testing so maybe that info will shed more light on what is the right thing to do - while I do have gut feelings on this I am also very open to the greater experience of those of you who have been on this road longer and have more info at your finger tips. Plus my gut feeling is only a general idea and still pretty weak at that. Thank you for posting I know it's time out from everyone's personal life and the help and support here is tremendous and much appreciated.
 
Isn't it amazing how cooperative they can be when snacks are involved. :lol:

Hypo's are very scary indeed, that's why we like to start low to make sure we don't miss the right dose by starting too high,
 
Ellen,
Yep, I'm with Robin. Here's what I see....

The first day, both cycles look like they ran "long" (an indicator of a dose that is too high). The next day you got that inverse curve that Robin mentioned (another indicator of a dose that is too high). That evening, high and flat.

The only cycle that looks like the prozinc tried to do its job is the one with the blue 190. But on a dose of 3 units, you only got a 30% drop. That "looks like" it isn't enough insulin, but I think your in a cycle where the insulin is spending more time fighting Robbie's liver than fighting against the rises in BG brought on by the food.

I would drop it to 1 unit for 2 or 4 cycles, and see what the numbers say. Hopefully in that time frame, his liver will calm down and decide to play along.

Just my 2 cents.

Carl
 
Ellen,
Just so you know....
You have a lot more experience that I do, so I'm not an expert by any means. My cat, Bob, was on PZI for 10 weeks last year and has been OTJ since July. So I didn't gain a huge amount of time on the front lines, and most of that time I wasn't "here". I've just been here pretty much every day since then, so most of my "advice" comes from watching other kitties and beans, and what worked and didn't work for them.
I usually tell people to first and foremost "trust your gut" when it comes to big decisions. Robbie just seems to be showing pretty "usual" symptoms of a dose that is higher than it needs to be to me.

Carl
 
Carl - I am getting the report on the full blood panel today however he had just had a full work up 7 months ago and all was GOOD. He has an asthma condition for over 8 years and was on steroids which we do strongly believe led us to the diabetes to begin with (he was also over weight for a few years). He used to take pills when his breathing was terribly bad and once or twice a year he'd get a shot of steroids. The last shot was what pushed him right over the edge - (got the shot in June was diabetic in July) our Vet won't give him a shot again ever and I have to keep him off the pills but he does occasionally have to have a hit off the inhaler which is albuterol or he goes into labored breathing and it's dangerous. Our recent visit was one of choices - the Vet said "the main life threatening issue right now is the diabetes - the breathing concerns me but if the occasional hit of albuterol can ease him over that than do that but use your best judgement I don't want this cat on any kind of steroids if at all possible - that's just too dangerous" So Yes, he was on steroids and YES he had a hit of albuterol about 3 weeks ago and the one before that probably 3 months prior.
He was on Prozinc last time too.
 
If you are open to at least trying the 1 unit to humor us, for at least a week (it takes 3 to 5 days for the rebound hormones to clear their systems) that would be great.

If we are wrong on the 1 unit then you can head right back up the dosing scale.
 
I am truly ashamed to say as a human Type 2 Diabetic that I'm totally confused here. Too much insulin will keep his numbers HIGH? Last time too much dropped him like a stone into the green numbers - our vet put him at 4 based partially on that info but also on the high numbers, his weight and how much he eats (even though it's low carb/calorie he gets/was getting about 6 meals a day 2 full cans of FF and 4 about half cans or a tad less spaced out from 5am to midnight). I did not get to speak to our vet but went over this with the Vet Tech (after spending 30 minutes with the vet before the blood test came in) I missed his call on Thursday and am waiting to speak to him today to get the info off the full blood panel and here from him exactly why he put us at 4 units and to let him know that I moved to 3 until this morning.

I am going to go do our 1:15 test and than more reading hoping to figure this all out so I don't feel so totally clueless. Thank you all.
 
Sometimes when the dose is too high their bg's drop like rocks. Other times their liver dumps sugar to fight off the insulin keeping their bg's high.
 
Here is today so far-
5:45am today last food was at about midnight last night and his shot of 3 units was at 9pm last night he tested 263 and got half a can of FF

9am again this morning - 323 and got half a can of FF
10am 316 had eaten a bit more of the FF (replenished cause he finished the half can and was still hungry) and got a small piece of chicken
11am 263 - small piece of chicken as a treat
12 -noon 231 one small piece of chicken
1pm 177 2 small pieces of chicken

so that's the biggest jump we've seen and now I worry he'll continue down but I know he'll be looking for more food very soon as he typically wants to eat again around late afternoon when we are home. Very anxious to see what 2pm will bring.
 
Just got off the phone with our Vet. His Fructosamine was 556 his Glucose was 290 and his Cholestorol was a bit high (260). Our Vet wants his pancreas to rest as he feels the last time around the few days at 8u's was what than regulated him - we had a long talk and so much of it was not exactly along the lines of what I'm advised here - although our Vet listened carefully to what I told him about our research here and did say he was supportive of me following what felt right for us but that his objective was to see Robbie self regulate and be OTJ as he's had several more successes with this in his practice in the last few years with cats going off dry totally, being on insulin for a bit and than having numbers go way down, regulate and say regulated. He was supportive of us going to 2 units bid if I feel strongly I want to see how that goes but he would rather see me stay at 4 units for a week and bring Robbie in again at the end of that time for just the Fructosamine test. He admitted he has only 2 other patients with beans who self test, while he suggests it to all the others he has don't feel up to it and bring their cats in once or twice a week for testing.
I'm going to go thru the rest of the day and see what his numbers are like - I'm probably going to give him 4 again tonight if all goes OK and do so for the weekend and get some readings along the way. During that time I'm going to continue to read here and elsewhere and get some more information under my belt - as long as he's not going dangerously low, seems perky and happy (which he does) and is eating etc. I am comfortable here . However, the idea of trying 1 or maybe 2 units for a couple of weeks isn't out of the question and I continue to rely on all of you for more input and guidance as I work my way thru this obstacle course of what is the best thing to do for my sweet boy. Thank you for any and ALL feed back - while I love our vet for a variety of reasons I know he is not perfect and while he has had recent success with treating diabetic cats he did feel that his early experience was not broad and told me today he since he has seen so many more diabetic cats (he feels it's the cat food industry and the crap so many cats are fed) in the past few years that he keeps up on the protocol much more closely and that Robbie was a real eye opener for him in many ways and he double checked before calling me with the most recent guidelines and said that 3-4 units for a cat of Robbie's weight was the standard but he'd go to 2 if I felt more comfortable although it was not his reccomendation.
 
Hi Ellen!

First, welcome to PZI. I caught your posts in health last week and was fearful the 4 units was too high. You have to go with you gut and what you are comfortable with, but I agree with Robin and Carl-- I would drop back to 1 unit for a few days and see what I got. I saw your comments about your vet referencing weight as a guideline for dosing. I am not a vet, but weight of the cat is not a determining factor in insulin dose. I have two diabetic cats (Well, one is "supposely" a foster!)...another story :lol: ......but, my 9 pound petite female gets 3.2 units of Prozinc three times a day. My 15 pound boy Maine Coon mix-- looks like you Robbie-- started on .5 units twice a day--increased to 1.5 and now is micro dosed as needed--his last dose was .25 about 5 days ago.

IF you do reduce your dose, please be vigilant about testing for ketones!

Best of Luck to you a Robbie. You are at the right place...there is a Great Group of people in this forum that are ready and willing to help you!

Kim
 
Just did his 2 pm test late as I was on the phone with my step mom about my father who I think I said already is in the hospital. As I was on the phone Robbie went to his bowl crying and I gave him 1/2 a can of Ff and he chowed down with great fervor and asked for more so I gave him almost the rest of the can which he finished and than gave himself a long bath. So the 2pm test was done at 2:30 about 10 minutes after he ate that food and it was 151

I'm wondering why weight doesn't effect dosage when it does in human?. I also would think our vet is checking on up to date veterinary protocol and quoting it to me accurately when he says for Robbie's circumstance, numbers and weight 4 was the base dose. I will have to check on this - I do have a good relationship with our old Vet who is too far away from our house for us to use but she is very highly regarded (appears on the Today Show from time to time etc. ) and always very caring - maybe I can get a second opinion there. I don't like to feel in total conflict with my vet and this forum as I do respect the experience here and to be honest FDMB was right the last time around to a great extent against my vets initial thoughts. So I'm glad our Vet was open to what I was hearing here and hope with all this input I'll do the right thing for Robbie.
 
+8 just tested 176 he'll be due for a shot when I'm not home and I should have left already to see my dad. I would think I should be very careful about the next shot since his numbers have been in the blue for the past 5 hours - I really wish I could get a full curve done right up to his next shot but I am not sure my husband will manage (he's gonna try the 6pm test but than he goes to a job) than I will miss +10,+11 and the 12 hour mark and hopefully come in just in time for 10pm which will be an hour off his PMPS time and am wondering about thoughts on what would be too low to give him anything? Perhaps I use this time frame to try the +2 and stick with that for a week if numbers seem to warrant as suggested here (+1 really but I'm working with my Vet's input too so +2 would probably be where I'd go to) I don't want to keep chasing numbers and do want to settle in at something - 4 has looked pretty good I think today but not if he's still too low for his PM shot, right?
Thank you again for any input
 
Ellen,
If he's still in the blues at 9 or 10pm, that would indicate a long cycle (and too much insulin). It's actually good that he's been going "long" rather than "deep". Each causes you different problems.
If he goes too low from a high dose, what usually follows is a bounce into higher numbers.
If he goes too long from that dose, the downside is that you are faced with a number 12 hours later that may or may not be "shootable", and you may get some overlap at the beginning of the PM cycle because the AM dose hasn't completely been used up. That usually means you have to wait, or you have to shoot a reduced dose.
Of the two, I'd rather see a long cycle than a really deep one.

Tonight, you'll be an hour late, right? The dose will be dependent on what kind of number you get, so you should test him as soon as you get home and post the number here if you aren't sure what to do. It will also depend on what time you would like to give him his AM shot tomorrow. If you want to get back on schedule, then it might make sense to allow for that by shooting a little bit less tonight. Tonight might be an ideal opportunity to cut back like you said, to 2 units or less.

I will be on later tonight, and I'll mark this thread so that when somebody posts on it, I'll get a notification in case I'm not sitting at the PC right then. I'm sure other people will be online at that time too.

Carl
 
For a new member the no shoot number is usually 200.

Cats can't be dosed by weight like dogs. If you want, post in Health about dosing cats by weight and see what others say.
 
thank you Carl that makes a lot of sense - I will be checking as soon as I get home - I stopped in to pick up my sister and HAD to see what the advice was.
Robin - thank you also - I'll go over that with my Vet he is a bit of a "dog" guy but very competent and always a straight shooter with me so if he's not read up properly or is going with his "dog" info I will call him on it and see where that gets me. Between his efforts and the advice here we got Robbie OTJ in 3 months last time around so maybe we'll be lucky (and smarter?) this time too.
As always thank you for the understanding and thoughtful input. Hoping to get a call any minute from my husband telling me he successfully checked Robbie's BG - it would be a first and a nice back up for me.
 
I agree with Carl, that fluids always corresponded to lower numbers for Kitty. It was not always the cycle that I administered the fluids that produced the lower numbers--sometimes it was the following cycle. Another reason that I think, and my Vet feels, that fluids result in lower BGs, is the dilutional effect of the fluids on the blood. When the cat is dehydrated the blood is more "compact" resulting in higher BG readings-- once hydrated the blood glucose level becomes less in the blood due to the blood becoming more dilute. I saw another example of this with anemia in my cat. Last week, my cat was dehydrated (not a result of diabetes), and I took her to the ER. Her Hematocrit was 24--which is techinically anemic, but not badly. The vet administered sub q fluids and I gave them again on Monday. Tuesday, I took my cat in for follow up blood work and her hct came back at 18.6-- much more in line with the severe symptoms I was seeing. This lower number was due to hydration. So, I believe that the same is true with BGs-- the more hydrated the cat- the lower the BGs.

I just wanted to add this, so you can add it to your discussion with your vet.

Hydration is Extremely important in keeping the cat comfortable during a pancreatits flare up!

Good Luck!
 
Just flew in the door at 10: 20 and he's at 369 and eating a can of ff that he almost ripped out of my hand.
He drinks alot these days - I can tell (and one of my warning signs) he paws at the ground near the water bowl - only time he has done this is when he's been diabetic - once he was OTJ he never did it again - now he's back to doing it
I'm thinking of sticking to 4 and seeing how it goes for the remainder of the weekend.
 
It's your call.
IMO, 3 would be better. Remember, this is a longer than 12 hour cycle, and if you plan on getting back to "normal" in the morning, this PM cycle will be a short one.
I still believe that the dose was too high from the get go, and once you are up this high, if the "right dose" is lower, it's going to be difficult to convince your vet that "up" is not the right way to go. The highest dose my cat ever got was 4u, and I know every cat is different. But if 4 is too much, and you don't see better numbers soon, I'm concerned your vet is going to say "go up to 5".

Carl
 
RobbiesMom said:
Just flew in the door at 10: 20 and he's at 369 and eating a can of ff that he almost ripped out of my hand.
He drinks alot these days - I can tell (and one of my warning signs) he paws at the ground near the water bowl - only time he has done this is when he's been diabetic - once he was OTJ he never did it again - now he's back to doing it
I'm thinking of sticking to 4 and seeing how it goes for the remainder of the weekend.
Click to expand...

When Grayson tries to get the food from me, I put the can, fork and bowl on the table, and tell him if he can get it open faster than me, to have at it. He has yet to succeed... but he continues to try! :roll:

It's interesting the way they get our attention to tell us there's something wrong! Good thing you noticed it!

Despite Grayson's current dose, I consider myself a conservative doser... and someone who likes to get sufficient sleep, so I would've reduced the dose.
 
already told Vet I was not interested in upping and would go down before I'd go up- he's ready for that to be what I do. I'll put him back on a 9:30/9:30 schedule so that might help a bit since he got his PMPS at 10:25 tonight. We'll see - and thank you again.
 
Status
Not open for further replies.
Back
Top