Bouncy Alfie - Week 9

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Jen and Alfie

Jen and Alfie

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No real news to report on poor Alfie, who is still bouncing around like mad! There doesn't seem to be any real pattern to his responses to different doses, so I'm just keeping him at 3U for now to see if a bit of consistency makes any difference.

But today, our vet has decided we've gone beyond his level of knowledge with all the data I've collected, so he's referring us to their veterinary hospital and their feline medicine specialist. Whether this person is a feline diabetes specialist I have yet to find out. He did say she might want to take the dose all the way back down and start from there, which I'm obviously not keen on. And he'd never heard of Lantus/glargine so I'm not getting my hopes up of that being an option.

Update: We've got an appointment tomorrow morning. They might want to keep him in for tests which won't help his sugar levels!
 
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So, we had and amazing, amazing visit with the vet this morning. It turns out she's one of only a handful of registered feline specialist in the UK, did her doctorate on feline diabetes and has written lots of papers on the subject.

She thinks his dose is way too high and wants us to drop back to 1u and start over. She claims most cats are well regulated on 0.5 - 1.5u and that Prozinc has a very slight depo effect, so changing doses more than once every 5-7 days doesn't necessarily show the full effect. She's very pro home testing, is totally fine with using human meters and was super knowledgeable about nutrition and the need for a low carb diet. She even went as far as to say she sees no reason we can't get him into remission, which I'll believe when and if we see it but was obviosuly great to hear. She's done it for lots of other cats so here's hoping! And if his Prozinc doesn't do the trick, she'll switch him to Lantus (she's also trained in Australia where they can prescribe it as a first treatment and is all for it!).

She was so lovely with Alfie, he didn't even get quite as stressed as he normally does at the vets office. I'd read a couple of her papers before we went so was confident she would know here stuff but it is such a huge relief to feel that we've finally got someone (apart from all you amazing forum friends obviosuly) in our corner. So much so I had a little blub at the end of the consultation, just from sheer relief!

So, we're dropping him back to 1u from tonight and will go from there. She thinks it will probably take slightly more as he's a big cat but it's a good place to start!
 
Wow! I've long been suspicious that prozinc isn't as "in and out" as the non-prozinc users say it is. One cycle definitely influences the next cycle, so it at least seems to carry over a little bit. Does one of her papers address that topic? I'd love to read it if it does.

I'm curious to watch what happens with the drop in dose though. I'm a little less convinced on that part. ;) But I would be more than happy to be proven wrong! It's definitely something we've talked about around here and tried to figure out what is best (holding longer, or raising faster to get to better numbers). It would be so great to see Alfie get some better numbers, and also great to learn a bit more along the journey!

I'm so glad you felt comfortable with the vet. It can make such a difference to have some confidence in the vet you work with through all of this.
 
I'm so glad this went well. You'll be teaching us now, Jen! :) Interesting tidbit about ProZinc. If you can find links to some of her papers to post, I'd love to read them.
 
Unfortunately not, that was just something she talked about with us when looking at his chart. She said the effect obviosuly isn't as pronounced as with Lantus, but it's still there. The articles I've found are from 2014 when Caninsulin was the only licensed insulin the the UK, but even back then she was talking about Lantus and the importance of a low carb diet. I'd post a link but you've got to log in to a vet site for access. Here's a link to an article from around the same time https://www.vetvisuals.com/uploads/AUTHORS/Kerry Simpson/Diabetes-Mellitus-Article-Kerry Simpson.pdf Keep in mind that all the other vets I've spoken to to date have said dry food is fine, you must use a pet meter and haven't even heard of glargine/Lantus even today, so she's definitely thinking differently which is great.

I'm really curious to see what happens too. I've had the feeling for a few days that 3u is too much but didn't know where to go next. To be honest, his numbers are really not great at the minute so I don't think the reduction will make them worse. He had similar number before he even started any insulin, when we did his very first curve, to what he's had the last few days, so it will be interesting to see the results. And he couldn't be much more miserable, so I'm willing to give it a go.
 
Very interesting!!!! Please make sure to keep us updated as we love learning new things here and want to see Alfie get well!

My only caveat is to be sure to do ketone testing often since you'll be dropping the dose. :)
 
Today is the second full day of Alfie going down to just 1u and I am very surprised!

Ok, clearly his numbers are way too high, but he dropped a lot yesterday. I'd assumed he'd just sit in black numbers the whole time.

We also had a mix up with the cat sitter last night (typical for the first night we've gone out and let someone else handle it) that meant he didn't get a shot at all. And his pre shot this morning is the lowest for over a week! o_O

Clearly this dose is too small, but I'm so surprised at the numbers we're getting. The vet's argument was that his extreme bouncing and odd hypos were evidence that his dose was much too high. I'm starting to think she may be right.

It's taking nerves of steel to hold at such a low dose, but she's determined we should to allow all the stress hormones, dumped sugar etc. released by the previous bounces to get out of his system and let the mini depot effect settle so we can see what the dose is truly doing.

We're testing for ketones (ok so far) and he seems fine. Watch this space :nailbiting:
 
Oh, that has to be hard to be working on dosing and leave for vacation at the same time! Definitely eager to see what happens!
 
As long as you're testing for ketones (and you are) you're on top of the situation! If he needs to go up, you can always do that, but it sounds like your vet might have been right on the money! Looking forward to seeing what happens.
 
He's had a couple of good cycles on that one unit! The numbers are still too high, but it does seem to have calmed down the bouncing. Fingers crossed for more good things to come...
 
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