Dissapointed/Ideas?

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Justine & Caesar

Member Since 2012
So after Caesar's emergency hypoglycemic episode and emergency vet trip, I decided to go ahead and give him insulin even though they told me not to. The problem is that neglecting it entirely elevate him back into the 500 range which really worried me as well. Taking the advice of someone in these forums, I gave him only 1 unit (as opposed to the 4.5 prescribed) but truthfully it really didn't give him much relief as far as numbers go.

Well today I called the vet clinic and hunted his vet down who was helping at another other clinic. I took Caesar's BG around 3pm and it was very high. After discussing his trip to the ER with her and my thoughts, she recommended that we go to 4 units just once daily instead of twice. Now, I kind of understand her logic because he peaks late and I suspect she is right that (in part) the reason why he crashed so hard was due to some insulin overlap. However, up until a couple of days before this crash, his readings were 400+ pre-insulin. It was when the readings were in the low low 300's pre-insulin that I suspected 4 units was too much, especially since his peak brought him to 175-200, which was phenominal for him. Anyways, I don't want to re-hash that too much...

I basically told her I was uncomfortable giving him so much after such an episode until we do another curve but explained that I still need to give him some because he is still way too high... and basically told her I was going to start out at 1 or 2 units until the numbers convinced me otherwise. I am surprised she didn't fight me on it considering how adamant she was earlier. I know that vets don't like being told what a course of action should be by their patients, but I'm really hesitant to put someone else in complete full care of him when I've been doing all the work. I know this isn't her fault--I simply can't afford all the bells and whistles they want me to ring and toot. And despite the fearful warnings that testing his BG at home is risky, it's the only reason he's still alive... Not to mention that it was their advice that ended up with him almost being killed. So there's the conflict there. I found myself after this conversation to be a little more empowered, but that still leaves me with some heavy decision making that I just can't screw up.

So that brings us to today. At 8:30pm he was at 539, so I gave him 2 units. I wasn't going to start until fresh tomorrow, but he was acting really drunken and the typical symptoms of crazy-high were approaching fast. Four hours later (at 12:30am) his BG dropped to 359, and now at 2am he's at 296. He's got another 2-4 hours or so before history shows that his peak is, but I feel that I generally got a really good ballpark number to work with. I'm looking at this (so far) and shaking my head because I know if I had given him 4 units as recommended (even just once daily) that we'd be back right where we were with the emergency vet.

I'm so frustrated and disappointed. I just don't think he's ready for once a day treatment given that this was half the insulin she wanted at his high-end numbers. Any thoughts?
 
No insulin works well if given only once a day for cats. They metabolize it twice as fast as humans or dogs. If I remember correctly you are using Prozinc? The makers of Prozinc state that it has a duration of 10-14 hours in cats.
Rather than four units once a day, your vet should have suggested two units, twice a day. Not saying that dose is correct either, just that one-a-days don't work for cats.
Your vet really needs to read the AAHA guidelines for managing feline diabetes. If I can grasp them, she should be able to. I didn't even go to college:-) They clearly state that two shots a day is the proper way to do it.

One thing that I have seen in many Prozinc cats in the time I've been here is the effect of a dose that is too high. Not only can it cause too much of a drop in BG, but another possible result is that it will cause a 12 hour cycle to last longer than 12 hours. I think that is what is going on with your kitty- the dose of four units, and probably lower doses previously, have been too high, and have caused his nadir to be far beyond the normal 5-7 hours after the shot "norm".

If you ask about that in the pzi forum, users of prozinc can tell you what they have seen, and how they have "fixed" it.

Please try not to be discouraged. This isn't easy, and it's hard to believe that someone you've trusted to take care of your pets might not have all the answers you would hope they'd have.

The trick will be finding a dose that works well, and also allows you to shoot every 12 hours. That dose exists. We just have to help you find it:-)

Carl
 
Hello Riot and Caesar.

Yes, I agree with Carl- PZI is a twice a day insulin- giving a large lump would probably shoot him low and then he would be so much higher the next shot. That kind of roller coaster isn't good for anybody- much less our furbaby's.

2u BID- and test as frequent as you can. If you can set up a spreadsheet that would be helpful and the PZI forum is extremely helpful in the advise area.

Good luck!
 
Dittto what Carl and Heather said.

Yes, the dose was too low the other cycle, but we wanted to be cautious -keep his numbers from skyrocketing but not knowing how the dextrose and low nadir from the previous cycle fit in. One of the easiest way to think of this process is that you are data gathering, not agonizing over each number. Once you have some data and can see what he did on what dose, it will be easier to predict what he needs.

And as you are finding, this is not a "go home, give this dose and see me in two weeks" process. Many vets do treat it that way. Our theory is that most owners are completely overwhelmed at the beginning (understandably so) and so vets start them out with an easy routine. This often works if the dose is low enough and there is no diet change. But with a high dose and a change to wet low carb, it is often dangerous advice. Vets have to treat many diseases in many species and their feline diabetes education is usually a workshop. It sounds like your vet is beginning to see he doesn't know very much about FD -- perhaps he can learn along with you. That might save a few cats in his practice in the future!

I like your 2 units and it seems to be bringing him down nicely. And yes, twice dosing is necessary. If not, 12 hours from this 2 units, he would start up and keep climbing until tomorrow morning when he would be sky high again.

Have we shared this document about ProZinc with you?

http://www.felinediabetes.com/FDMB/viewforum.php?f=24 Way too much info, but if taken in small doses, very informative.

Can I help you set up a spreadsheet? Since you are just trying to figure out where he should be in terms of dose, it would be so helpful for us to see your history at a glance. Check your pms if you want help. (Up at the top of the page, "1 new message"
 
As always, thank you for the timely replies and help through all of this. I have a pretty good spreadsheet started, I'm just unsure how to share it with everyone. It's a little rocky, but if someone could direct me as to how to share it I'd be happy to put up what I have today.
 
The spreadsheet you have, did you create it on the googledocs website?

Carl
 
No Justine, now I can see it and it looks perfect. :smile:

Carl
 
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