Back home & a question about more weird numbers

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wombat88

wombat88

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I'm back home. I actually got home on Tuesday but am still trying to get used to this time zone. That part of travel I can do without! It took over 30 hours of airports and flying to get back to the US and I felt like most of that was spent in a closet. The joys of economy class!

Shaikha was glad to see me and seems to be doing pretty well, despite all that she's been through. She's lost some weight so I need to address that, but it is only a few ounces and given the high numbers plus food changes that's not surprising. She's eating the canned food pretty well, though is less enthusiastic about it than the dry so I've had to do some encouraging to ensure she finishes it all. It is obvious that her brother has been "helping" to clean her plate, so I've been doing some hovering to ensure she gets her fill.

I've updated her spreadsheet, but her numbers the past day or two don't make much sense so I was hoping you might have some ideas. During the boot camp with my vet, he got her down into the 200s, but that was using a mix of IM injections and more frequent dosing to get her lower. With the food changes, he put her on a lower dose after she came home because he was afraid she might start zooming up again. The plan was to stay at 1.5 units to see how she did, and slowly ramp it up if it appeared she needed more despite the canned lower carb food. To complicate matters she's had several food changes because I didn't have lots of cans of foods that were lower carb. She ate Hills i/d while with my vet (24% carb, 29% protein) and after she came home we put her on RC Venison (23% carb, 54% protein). The venison she's eaten before and done well on, plus it is hypoallergenic. She seemed to do well on it and had no problems with the food change. Unfortunately, I only had a couple of cans of the venison, so we had to switch her to RC Intestinal HE. That is a food she's also eaten before and done well on, but the carbs are higher (38% carbs, 37% protein).

Since being home, her numbers jumped to 300s AM and PM PS, then started going into the 400s. My vet said to increase dose slightly, so my friend gave 1.6U (she was afraid to make too many changes). It made no difference. After I got home, I did some mid-day tests and she dropped to 178 at the lowest, but had started out at 435 earlier that day. By PMPS she was up to 474. My vet said to go to 1.8 units. I did that and it seemed to work. She was at 309 the next morning, much better. BUT then she started going weird. The reading at +5.5 was 365 and by PMPS she was at 400. I didn't recheck the mid-day reading, wish I had now. I gave 1.8 units again last night and at +11 she was at 100. I checked twice this time, and the reading was correct. If I didn't know better, I'd say I gave her too much last night, but I know I measured correctly and mixed. I'm jet lagged but competent. :)

I didn't shoot this AM of course, but she's been rising since then. At +6 she was 336 so I'm sure she'll be nice and high tonight. Could I have somehow gotten a larger than normal amount of insulin granules in the syringe last night? I don't really think the dose is too high, plus she's eating higher carb food now. Tomorrow I plan to try a can of Hills d/d duck and green pea, which she's eaten before but stopped eating due to a food aversion. The d/d has 22% carbs and 38% protein so if we can get her to switch to that for a while that would be great. I can get more of the venison in a week or so when I go to the next city for an appointment. It is a long drive from here or I'd pick it up sooner. I plan to ask my vet for a prescription so I can order online from Pet Food Direct too. I've got one that I used for Petsmart but I can't get there very often due to the long drive. With her pancreatitis we want to keep her on a lower fat food (she seems to do better with that), but with the lowest carbs and highest protein we can get. Her IBD means that novel proteins are best. I know there are lower carb foods out there, but I'm trying to stick to single proteins with no fish that won't give her diarrhea. She's got nice firm stools again and I want to keep it that way.

My vet is hoping we can get the PZI to work, but I don't know. She seems to be so inconsistent on it. More frequent dosing may be the key, but with me working dosing three times per day I don't think will work. Plus it is hard enough getting friends to cover twice per day if I have to travel. It's a lot to ask. If PZI doesn't work then we'll try Lantus or Levimir. He hasn't used the latter. I need to do more research but would love to hear from anyone who knows the differences. I've read some threads that suggest Levimir works better for pancreatitis cats than Lantus, but don't know why. I've got the next few weeks off from work, so if I need to make changes now is the time.
 
I also have a very difficult cat to regulate and basically keep alive ..... she also has pancreatitis and throws off ketones and goes easily into DKA. A couple of things jump out at me on your SS.

When you have pred. in the mix, it will mess with your numbers, my Payne also takes pred. for the pancreatitis. Not making a judgement call but the dry messes with the #'s also. The problem is when you add the problems together, you are asking the insulin to do a lot! Since you are going to be home for awhile why don't you just try giving her insulin every 8 hrs. and see if that get's you out of the 400's, 500's and 600's+
because when you give her 3u she goes really low on that dose. You need to figure out how to make the insulin work for you, even if it means she needs it more often. I know you travel but adequate insulin helps the pancreatitis/IBD, which will help prevent flare-ups.

Also the pred. I have found with Payne that dividing her dose into two doses helps her #'s and still helps her. I get gelatin caps at health food store, put 2 1/2 mg. pred. and 1/4 of a 10 mg. pepcid in and give am/pm. That will help a little. Also the high #'s make the system weaker which starts the pancreatitis, etc. going again. If giving her the insulin more often will level her out, that should help everything else.

It is like juggling two balls .... that you can do easily, but with each problem you add a ball ..... pretty soon it all falls down :) Finding out about the insulin and what she needs will help your #'s and pzi is very forgiving. I went briefly to Lantus but she crashed in 10 days because you can't give L 3x a day and my cat needs it that often, what you need to know is does yours? then you can make an educated decision. Good luck whatever you do.

Nancy and Payne (sleeping in the sun without a worry ...... :)
 
Nancy and Payne said:
I also have a very difficult cat to regulate and basically keep alive ..... she also has pancreatitis and throws off ketones and goes easily into DKA. A couple of things jump out at me on your SS.

When you have pred. in the mix, it will mess with your numbers, my Payne also takes pred. for the pancreatitis. Not making a judgement call but the dry messes with the #'s also. The problem is when you add the problems together, you are asking the insulin to do a lot! Since you are going to be home for awhile why don't you just try giving her insulin every 8 hrs. and see if that get's you out of the 400's, 500's and 600's+ because when you give her 3u she goes really low on that dose. You need to figure out how to make the insulin work for you, even if it means she needs it more often. I know you travel but adequate insulin helps the pancreatitis/IBD, which will help prevent flare-ups.

Also the pred. I have found with Payne that dividing her dose into two doses helps her #'s and still helps her. I get gelatin caps at health food store, put 2 1/2 mg. pred. and 1/4 of a 10 mg. pepcid in and give am/pm. That will help a little. Also the high #'s make the system weaker which starts the pancreatitis, etc. going again. If giving her the insulin more often will level her out, that should help everything else.

It is like juggling two balls .... that you can do easily, but with each problem you add a ball ..... pretty soon it all falls down :) Finding out about the insulin and what she needs will help your #'s and pzi is very forgiving. I went briefly to Lantus but she crashed in 10 days because you can't give L 3x a day and my cat needs it that often, what you need to know is does yours? then you can make an educated decision. Good luck whatever you do.
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Shaikha has pancretitis and IBD, so that's why she takes the pred. I do give it to her AM and PM, like you do. She was eating dry kibble because of food aversions developed from several bouts of pancreatitis and IBD this year, but I've gotten her back on canned for now. It isn't the lowest carb canned available, but it agrees with her and is some progress on that front. She also takes zantac and flagyl for the IBD, in addition to ondansetron when needed. Most times though, she needs it. On top of the other two problems (and the diabetes) she's got a low white cell count, plus has been anemic. We've got a lot more than two balls to juggle, unfortunately.

What often triggers the higher numbers for Shaikha is a pancreatitis bout or an infection. She's had both problems this year and has been a mess since late January when she got a very high fever. I'd had her on Vetsulin which actually worked very well, but we ran out of the last bottle and had to switch to PZI.

What you say about giving it more often makes sense, so maybe we need to try that. It does seem that did the trick with my vet's recent attempt at regulation. PZI doesn't seem to last for her, that's for certain. If Lantus is a longer-acting insulin, that could be a problem if it doesn't last like it should and you can't give more. Guess I need to have another long conversation with my vet tomorrow. He'd talked about putting her a more frequent schedule so that may be where we need to head next.
 
Nancy, I assume from what you've said you dose three times per day. So how do you do that? I assume split up the total daily dose into thirds given every 8 hours? Do you feed three meals per day then? She's used to eating twice per day so that would be a change in routine. Or do you feed twice per day and give snacks when you give the other doses? I can't free-feed because my other cat will eat her food, so feeding will have to be done at specific time with supervision. On a more frequent basis does it seem you need more or less insulin? I'm thinking that we were giving 1.5U two times per day, so maybe trying 1 unit three times per day? How long would you stay at that initial dose before you made any changes? I'd assume more frequent dosing takes the body a little getting used to. Just trying to put my thoughts in order before I call my vet tomorrow. Knowing what has worked for others will help.

Wendy
 
Also, ProZinc has a getting used to phase .... if I remember I think it is 45 days. We also struggled in the beginning and tried a bunch of stuff, most didn't work except when we tried TR she really perked up on the 3x a day but re-bounded with the really high dose. (although she is at 12u now :) Another thing I did learn was the more consistent we are about everything, the better her #'s. (In TR you keep a LOT of notes!)

Nancy and Payne (who has moved out of the sun, too hot! poor baby)
 
Okay, I missed your last one .... trying to finish work and need to go pick up a kid, but it is no harder than 2x a day. Take the dose you give a day and divide it by 3 .... I think looking at your SS t.i.d. would be better because she seems to go low with too much higher a dose BUT she seems to need more insulin. I would do a skinny 1u t.i.d.

With a cat on pred. I feed 4x a day but I don't leave food out because they eat plenty with 4 feedings and lots of snacks. (mostly gizzards/liver raw helps clean teeth :) I like her head to be in a food bowl before I give her her shot. I know there are a lot of formulas for how long to hold a dose but I usually give it 3-4 days and you should be able to tell pretty soon how she reacts to t.i.d.

Just sold my last stock so I am off! why do they need to come home so early?

Nancy and Payne (who heard the food talk and now wants a treat :)
 
Sounds like TID may be a good option for you guys, You are exactly right that your dose would be 1u given three times. You can either feed two main meals and feed a snack at the middle shot to keep it similar to your current routine, or you can change the feeding to three meals a day. You definitely want to feed with that middle shot though. My gang gets nothing but mini meals throughout the day!
 
Thanks for the feedback! I don't think Shaikha would mind the extra meal. She begs for food constantly, especially since her diabetes got worse. If I go near the kitchen she's there, hoping. I'll talk to my vet tomorrow about t.i.d. dosing. I do think that PZI is a good insulin and I like the fact that it is "forgiving" (heard that term a lot on this board), but it just doesn't seem to hold her as long as other cats. Giving less more frequently may just do the trick. Now I'll have to figure out how to work that around my schedule, but we'll figure out something.
 
Remember the pred causes them to be hungry all the time, have you tried raw gizzards/hearts or raw turkey meat as treats or when she's hungry? Payne would eat constantly, if I would feed her all day .... the pure protein doesn't raise BG #'s but keeps the edge off the hunger. I also use a dried chicken treat that she loves! If she thinks she's been good or is real hungry, she'll sit on the counter and stare at the closed cabinet where her treats are :)

Nancy and Payne
(if you do feed gizzard/livers remember to cut up but not too small ....)
 
You might experiment with a dose like 1.7 maybe? That lower # this morning (yay!) could have been a good sign that she is using the insulin well, or could be something like maybe she didn't eat normally, or it was a bad reading or such.

If you end up on Lantus, if you are able to test a lot you can add R to it to bring the #s down faster. I don't know too many details, but I think you expressed a concern about potentially getting stuck in higher #s w/Lantus if you can't increase the dose as rapidly, or shoot more often as with PZI. R is faster-acting than Vetsulin and wears off quickly from what I understand.
 
R is pure insulin with nothing mixed in to increase the length it works. Most kitties start with only 0.25u of R in addition to their longer acting insulin because it is potent. It peaks around 2-3 hours after injection. It is difficult to regulate while giving R in conjunction with something else, but it is good to use if numbers are way high, and especially when ketones are present.
 
Just an update, but she was up to 529 at +11 :sad: from her reading this AM, so I called my vet since he had a late clinic and we talked over what has been going on with her. He feels we need to try t.i.d. dosing given how she responded when he had her. Though we've switched her to a lower carb food, he doesn't think it will be enough to keep her in the ranges we need her to be. I gave her insulin a little earlier tonight since she'd had none today, but a slightly lower dose than usual just in case she drops lower than we expect. We'll try one unit three times per day, but he wants me to do a careful curve during the first and second periods to see whether that is too high. He'd rather start her a little lower than with too much insulin as we aren't sure what the cumulative effects will be of her getting more frequent dosing. If she stays lower by the next dose, we'll cut back slightly on each dose and work our way up if need be.

At any rate, she got 1.4 units tonight since she was so high, less than we'd been giving but hopefully enough to bump her down some. He's hoping that will have her in the 300-400 range tomorrow. Then I'll give 1 unit and test every couple hours to see when she reaches nadir and how far she's gone up by the next dose. It will be interesting to see how this works. She has been so erratic but most times the insulin just doesn't seem to last as long as one would expect before she starts zooming up, so we'll see if more frequent doses fix that.
 
Nancy and Payne said:
Remember the pred causes them to be hungry all the time, have you tried raw gizzards/hearts or raw turkey meat as treats or when she's hungry? Payne would eat constantly, if I would feed her all day .... the pure protein doesn't raise BG #'s but keeps the edge off the hunger.
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No raw food for this girl. She has really low white cell and platelet counts, in addition to anemia. She gets infections really easily as it is, so I couldn't take the chance. If her pancreatitis kicks up she always needs antibiotics. I know it is supposed to be sterile inflammation usually, but it doesn't seem to be with her. We tried leukeran last year and it didn't go well.
 
Kelly & Oscar said:
R is pure insulin with nothing mixed in to increase the length it works. Most kitties start with only 0.25u of R in addition to their longer acting insulin because it is potent. It peaks around 2-3 hours after injection. It is difficult to regulate while giving R in conjunction with something else, but it is good to use if numbers are way high, and especially when ketones are present.
Click to expand...

Kelly, I just wanted to comment on Oscar's picture. What a sweet face! Love it! He looks like a darling boy. :mrgreen:
 
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