Bear--Need eyes on high dose problem (long)

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Diabetic Cats in Need (DCIN)

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A couple weeks ago, I heard from Bear's beans. Bear is a youngish (6 or 7 YO), insulin-dependent diabetic on ProZinc, 7U BID when I first spoke with the Beans. Bear is urinating inappropriately, the family has two young children (one just walking), and MamaBean approached me to rehome Bear. They don't want to PTS Bear, they don't really want to give him away, but the pee is becoming an unmanageable problem. Bear was DX diabetic about a year ago.

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The Beans know about hometesting because they hometested a previous feline diabetic. But Bear gets angry, growls, and sometimes pees when he is tested. He has to be sedated at the vet.

I told MamaBean I would like to meet Bear when I was driving near their home during the Kiki transport. I also said that I thought 7U was a terribly high dose. She asked whether they should cut it back, and I said I thought that might help. (The dose was set (I believe) during vet curves...at the vet where Bear has to be sedated.)

The Beans cut the dose back to 5U. I visited with Bear a couple days later on 12/9/10, and he was reasonably easy to test. (I took along a rice sock and also showed PapaBean how to "milk" Bear's ear.) When I tested Bear at about +8, he was 48. I suggested another dose decrease to 3U.

Bear has been eating wet M/D. I looked at the Friskies that the Beans feed to their other cat, found it low carb, and suggested that they also feed the Friskies to Bear. I don't know whether they took my advice. I also found out that the inappropriate peeing started about the time the baby started to walk.

I sent PapaBean links to the food charts, to BCP Vet Pharmacy for less-expensive PZI, and to Cat Attract cat litter.

PapaBean has been testing and he says that it has been much easier since I was there. These are the test results he sent me last Wednesday morning. (Sorry, it's taken awhile for me to find the free time to post this.)

Date – Time..................PS......Units of ProZinc
12/09/2010 – 11:37PM......222.....3 units
12/10/2010 – 7:30AM........463....3 units
12/10/2010 – 7:15PM........416....3 units
12/11/2010 – 8:30AM........ 431....3 units
12/11/2010 – 8:43PM........ 499....4 units
12/12/2010 – 9AM............450....4 units
12/12/2010 – 7:20PM........ 336....4 units
12/13/2010 – 8AM............530....4 units
12/13/2010 - 8PM............ 376....4 units
12/14/2010 - 8:10AM........ 575....4 units
12/14/2010 - 8:15PM........ 455....4 units
12/15/2010 - 8:20AM........ 555....5 units

Here's my thoughts on the matter. I believe that Bear is being overdosed and Bear's beans need to start over at 1U. I am driven to a "do-over" given the 48 I found the day I tested him, just a few days into a dose decrease from 7 to 5U. I also believe that Bear would benefit from a 24-48 hour detox of his system by withholding all insulin during that time before starting over at 1U. I do not know Bear's ketone history, so I would advise that they make sure that Bear continues to eat well, that he stay hydrated, and that they test his urine for ketones during the detox period and the first week on 1U. I would also like to see the Beans get spot checks in the evenings and on weekends. (They both work full time.)

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Here's the thing, though. Bear is a large cat, but he has had the promise of being a large cat since he was a kitten. The large feet on a small kitten tipped the Beans off, hence the cat's name "Bear." However, the AcroMoms here might feel their Acro-senses tingling by looking at Bear's pictures. He is about 17-18 lbs. I can suggest Acro and IAA tests to the Beans, but that might be a financial hardship.

Please let me know what you think. I will be pointing the Beans to this thread so that they can read your answers.
 
Venita,

ProZinc is fairly new. What insulin was Bear on before shifting to ProZinc? Wonder if Levemir would be a better choice for him???

I agree with your suggestion of insulin toxicity based on your reading of 48. I'm guessing that your test was mid day. If he is yoyoing, he's got to feel lousy. Has anyone one checked him for UTI recently?

Claudia
 
Can't really say for sure...i don't see enough data but the hints of overdose are there. Acrocats often but don't always have a clubbed foot appearance. I don't see that but that truly means nothing. Lots of acros have no physical characteristics of acro. He is overweight, but that could be from overdose, overfeeding and it's also a symptom of acro. Like the weight, inappropriate urination can be acro, infection, cystitis, stress or overdose. Hard to pin down.

I think holding a 1u dose for a week might be a little longer than necessary for compounded pzi, and pretty much most insulins; 3 days should be more than enough time to show overdose and start tweaking back up to meet his true dose. That can be played by ear though. Any chance they'll be able to get more checks in?
 
I agree this kitty may have been overdosed and I like the idea of detoxing and starting at 1u with ketone testing.
The inapprorpiate peeing sounds perhaps stress induced as it started with the walking of the child and at test times...
Could they start posting on pzi so we can keep a steady eye on Bear?
 
Venita, thanks for taking the time to help Bear's beans!

I really disagree with the detox strategy.

It appears to me, based on the preshot numbers, that there is no insulin at work at +12, so, I don't see any reason to allow him to bask at high numbers another 48 hours. If he has an infection causing the inappropriate elimination then I would worry about inviting ketones into the situation - something I would never try with my own cat and wouldn't suggest it for another.

If he is being overdosed then cutting back to 1 unit for a couple of cycles makes sense - but they really need to get a + 4, +6, and +8 to determine peak - in my opinion.

Good luck and my best to Bear!

Pam & Layla
 
My thinking behind a detox strategy

When a cat is overdosed with insulin, one result can be chronic rebound. The liver is breaking down glycogen, and creating extra blood glucose. A 24 to 48 hour period without insulin can give the liver a clean slate and thus an opportunity to "reset."

I appreciate the comments about ketones and about checking for a UTI. Checking for a UTI would be important because infections can lead to ketones.

I have seen this detox work just this past weekend with Toby, who Don adopted through DCIN from a shelter in Baltimore. Toby was on 5U BID of compounded PZI at the shelter. I suggested than Don detox him. On Saturday afternoon at about +20, Toby was 343 (no shot). On Sunday morning, at +34 Toby was 298 and Don gave him .75U Lantus. Sunday evening at +12, Toby was 153 and did not get a shot. This morning at +24, Toby was 39. Of course, no shot.

Another example is Brady, who was receiving 4.5U BID of Vetsulin in the shelter, and has not needed insulin since he left there.

There have been others for which detoxing has worked, but I don't have them as well documented as I do Toby and Brady.
 
pam has a point but since there is so little testing we don't know what's causing those ps highs.
fwiw tom has recently brought himself down 300 points from his highest reading ever in 3 hours, that's no insulin.
i'm not sure what's causing his highs...but i do know he has a functioning pancrease. if bear misses a shot and is tested every hour after his meal it will tell somewhat of a story. if he does not come down, shoot. if he comes down but turns around at some point shoot that #
with pzi this is a quick way to tell if the pancreas is trying to do it's job but has too much help from the higher doses.
 
by Diabetic Cats in Need (DCIN) » Mon Dec 20, 2010 4:36 pm

When a cat is overdosed with insulin, one result can be chronic rebound. The liver is breaking down glycogen, and creating extra blood glucose. A 24 to 48 hour period without insulin can give the liver a clean slate and thus an opportunity to "reset."

I appreciate the comments about ketones and about checking for a UTI. Checking for a UTI would be important because infections can lead to ketones.

I have seen this detox work just this past weekend with Toby, who Don adopted through DCIN from a shelter in Baltimore. Toby was on 5U BID of compounded PZI at the shelter. I suggested than Don detox him. On Saturday afternoon at about +20, Toby was 343 (no shot). On Sunday morning, at +34 Toby was 298 and Don gave him .75U Lantus. Sunday evening at +12, Toby was 153 and did not get a shot. This morning at +24, Toby was 39. Of course, no shot.

Another example is Brady, who was receiving 4.5U BID of Vetsulin in the shelter, and has not needed insulin since he left there.

There have been others for which detoxing has worked, but I don't have them as well documented as I do Toby and Brady.
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Venita, I dont' doubt that there are some cats out there getting insulin injections that may no longer need insulin, but, I feel it is dangerous to advise them to stop all insulin for 48 hours.

If you feel so strongly about other successes you've had in the past, then put the information together for them and have them go over the information with Bear's Vet - and see what he/she has to say about the situation.

UTI etc. needs to be ruled out regarding the inappropriate elimination, and if it is found to be stress-related with the new baby, then they can discuss calming medications to help Bear cope with the new addition. There are many alternatives but the most basic needs to be ruled out first.

I think it is obvious to anyone reading the post that a 48 will suggest too much insulin, but as long as someone else owns Bear and is responsible for his care, I think it is in his best interest to have his beans discuss action plans with the vet.

Best,
Pam & Layla
 
Without mid cycle testing, you know nothing about what's happening with the insulin.
You could have dips and bounces on every cycle, or you could have all high flat numbers indicating a need for more insulin as was the case with Oliver when he first arrived at my home.

As Pam suggested, more testing is needed, not blind detoxing.
If Bear's numbers are high through the entire cycle, what would that detox period do to him?

As I was told to do with Oliver, drop to 1u and test more, as suggested by Pam, for a couple days to determine what is really going on. Only then will you be able to better see what Bear needs.

If you want to see how horrible Oliver's numbers were on the dropped dose, you can see them on his ss. That 48 hour detox would have been even worse.
 
skipping a morning ps and testing every hour for 3 hours should tell you something. if he starts to go down you know he can detox for at least a cycle. or even a few hours and then booster shot before next dose of 1U
 
Re: My thinking behind a detox strategy

Diabetic Cats in Need (DCIN) said:
When a cat is overdosed with insulin, one result can be chronic rebound. The liver is breaking down glycogen, and creating extra blood glucose. A 24 to 48 hour period without insulin can give the liver a clean slate and thus an opportunity to "reset."

I appreciate the comments about ketones and about checking for a UTI. Checking for a UTI would be important because infections can lead to ketones.

I have seen this detox work just this past weekend with Toby, who Don adopted through DCIN from a shelter in Baltimore. Toby was on 5U BID of compounded PZI at the shelter. I suggested than Don detox him. On Saturday afternoon at about +20, Toby was 343 (no shot). On Sunday morning, at +34 Toby was 298 and Don gave him .75U Lantus. Sunday evening at +12, Toby was 153 and did not get a shot. This morning at +24, Toby was 39. Of course, no shot.

Another example is Brady, who was receiving 4.5U BID of Vetsulin in the shelter, and has not needed insulin since he left there.

There have been others for which detoxing has worked, but I don't have them as well documented as I do Toby and Brady.
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I understand what your concern is, but we don't have evidence of chronic rebound from the numbers I see (only preshots) and in fact on the 12th, when there was an early shot, you can see there was a definite difference from the previous number. From what I can see, we don't know that there isn't a very steep V cycle.

I would recommend playing each cycle of a reduced dose, 1u or whatever is decided upon, by ear. Pzi does not really build up in the system enough to last for days, so imo chronic rebound is less a consideration than plain old dose-too-high, especially in light of the low mid-cycle number you caught when you were there.
 
was not the rebound test to cut the dose in half (cannot use proper punctuation as my new keyboard is using the weird symbols and I cannot turn it off)
 
I just read about this on Facebook and decided to come here to post a reply. Is there a reason why Bear's beans aren't here themselves seeking advice from people who use PZI or ProZinc? That would make more sense, and would probably be safer, than Lantus/Lev users making suggestions that will then be passed along to them. Venita, if you give them my email address (personal email removed), I'll be glad to try to help with the peeing problem.


Whatever happens on Facebook, unless it is from the FelineDiabetes.com or FDMB page, is not to be discussed here. I have no control over sites that are not my own.

_R
 
missyandlittlegray said:
I just read about this on Facebook and decided to come here to post a reply. Is there a reason why Bear's beans aren't here themselves seeking advice from people who use PZI or ProZinc? That would make more sense, and would probably be safer, than Lantus/Lev users making suggestions that will then be passed along to them. Venita, if you give them my email address (howardcountycats@earthlink.net), I'll be glad to try to help with the peeing problem.
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For all you know, Bear's beans may not even have online access, which would explain their communication via Venita, so your email address won't be of much use to them.

As for suggestions from Lantus/Lev users, there are many who have used several insulins and are more than capable of offering suggestions relating to PZI/ProZinc.

The urination may be something as simple as too much insulin or extreme BG changes. I will have urine issues with Shadoe whenever her BG are very high or change quickly, and before she was regulated, she had urine issues, so there are many reasons why suggestions from many would be preferred to suggestions from just one.
I do believe that urine issues are not specific to any one insulin, so there would be no harm in offering experiences and suggestions to Bear's beans from any person regardless of the insulin being used by the suggester.

Any help that can be given to someone's cat, from any source should be encouraged, especially if the bean has no online access.
 
missyandlittlegray said:
I just read about this on Facebook and decided to come here to post a reply. Is there a reason why Bear's beans aren't here themselves seeking advice from people who use PZI or ProZinc? That would make more sense, and would probably be safer, than Lantus/Lev users making suggestions that will then be passed along to them. Venita, if you give them my email address (howardcountycats@earthlink.net), I'll be glad to try to help with the peeing problem.
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I have plenty of pzi experience, 3 of my 4 diabetics used it and part of this request was for HD moms to see if we recognized anything, hence the L users being present. How are you going to help with this pee problem? Do you know how to resolve it in some way that shouldn't be posted on the board? What if he's acro, or the IU is due to overdose? I don't think it's out of line to suggest that the IU is secondary to the more immediate dosing concern at this time as diabetes often results in IU.. For whatever reason.
 
I didn't mean to swipe at anyone. I've helped many, many people with their cats' litter box issues, and I would like to try to help Bear's beans. But since the litter box solutions need to be customized to the cat, there's no point in posting a gazillion suggestions here.
 
missyandlittlegray said:
I didn't mean to swipe at anyone. I've helped many, many people with their cats' litter box issues, and I would like to try to help Bear's beans. But since the litter box solutions need to be customized to the cat, there's no point in posting a gazillion suggestions here.
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Why not?

This is a board of peer review and not everyone has run into every single possible situation themselves...which is exactly why many eyes and "a gazillion" suggestions is what is needed. The suggestions can be reviewed and an appropriate course of action can then be built on the individual situation. And then if the first thing doesn't work (or is ruled out by appropriate vet testing, or glucose testing as the case may be), there are then additional things to look at without necessarily having to re-call out the troops and request ideas.
 
Just from what I've read here about Bear's situation, the correct dose needs to be determined first since not being closer on the road to regulation is so very often the cause of IE. Since my experience with PZI is that it didn't have any overlap and left Splash's system before the next dose was given (or there was so little left, it had no cumulative effect) I personally do not feel that a "detox" period is needed (since Prozinc is so very similar to PZI, I have no reason to believe it lasts any longer and the continuous high preshot numbers don't give any additional evidence to the contrary). I think a rebound check of either dropping back to 1u or cutting the current dose in half, and getting spot checks to determine how Bear is using the insulin has to happen.

If this were my cat, after dropping the dose and doing some curves, if the IE didn't improve within a few days of getting Bear on a dose that wasn't causing wild swings or possibly the high flat numbers of chronic rebound(which may take a week or two, it doesn't happen overnight most of the time), I would make a vet visit to rule out other medical reasons (including doing a culture and sensitivity on the urine to ensure something isn't missed from a smear on a slide). Once medical reasons are ruled out, then you can move on to behavioral issues and go from there. If it truly behavioral there are several options including medication. That is the route I ended up going with Splash with success.

Anytime there is something like this happening, one has to remember that changing one thing at a time is the only way to know what change caused the positive result (or increased negative effects).

This is simply the route I would go through with one of my own cats. There may be other factors I'm not aware of in this situation or in someone else's situation that would change the approach.
 
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