Dose Change?

KAdkins

KAdkins

New Member
Hi Everyone,

It's been a while since I have posted but, I am looking for some advice about Crunches numbers. He's a very bouncy kitty and we never know where his numbers are going to land. Over New Year's we went through a DKA episode and the vet thinks it's because he was unregulated for so long and has such high numbers for long periods of time. We got through it and the vet suggested dose increases but I am starting to feel like we haven't found the right dose. A lot of the blue numbers from his DKA episode are from short acting insulin doses to help keep his BG low while we flushed out the ketones.

A little background, he came to us at under 6lbs, we are up to over 12lbs post ketone episode and acting like we feel fine. He eats wet food that is fewer than 8% carbs. He typically eats twice a day at shot time and gets a snack mid day.

I am not sure where to go right now, the vet is suggesting another dose increase but I am not sure if that is the right direction to go in. We are willing to do whatever we need to, to help him find regulation, even if it means switching insulins. What do you guys think about his dose and numbers? He has been on 3.2u of Prozinc for quite some time and we have kind of hit a plateau in numbers for the most part. I am trying to get another curve on him every 2 hours today to see what is happening.

Thank you for your help!
 
Here are my comments and suggestions:
  • you've been holding a dose much longer than necessary once it proves to be too low
  • you'd have a clearer picture of how a dose is working if you made a point to get a scattering of BG data every day (that includes the PSs) rather than relying on the odd curve - aim for AM/PMPS, at least one other test in the +4 to +7 range (but move it around) and always a before bed test
  • it's essential to see how low a dose drops his BG to properly assess a dose - you can't rely only on PSs
  • I'd bump him up to 3.4 u right away, get those extra daily tests in and if you don't see blues in the middle part of the cycle, increase by 0.2 u after only 4 cycles - repeat as needed and reduce the rate of increase when low blue and/or dark green appears
  • holding an ineffective dose too long leaves him in high numbers that contribute to glucose toxicity and that has to be overcome before you see a decent insulin response
  • given the DKA in his fairly recent history you need to increase your effort to get his BG down into a lower range.
I hope this is a start. :)
 
Thank you for the advice! We'll bump him up tonight! Our vet hasn't really dealt with very many diabetic cats, we've been sending her his numbers but I'm not sure she knows exactly what to do with them (we really don't either), thank you again!
 
KAdkins said:
Thank you for the advice! We'll bump him up tonight! Our vet hasn't really dealt with very many diabetic cats, we've been sending her his numbers but I'm not sure she knows exactly what to do with them (we really don't either), thank you again!
Click to expand...
Post here as often as you need because we all live this 24/7/365! :smuggrin:
 
Your dose numbers suggest you're using U100 syringes with a conversion chart. Is that correct?

Also - I see your note about Crunches' IBD and treatment with budesonide. It's supposed to have less of a BG raising effect but still does in some cats plus the IBD itself is an inflammatory condition that can make regulation of BG more elusive - but not impossible.
 
Yes, we use U-100 syringes, it makes it easier for my husband to make small dose increases correctly! He does have pretty bad IBD and also has dental problems which I know can raise BG levels, we'd like to get the teeth taken care of but he's nowhere near ready to deal with that!

Thank you!!!
 
Hi there! Kris has given you some good advice already about the testing and dosing, so I'll just comment on the health issues :): it's unlikely his BG numbers will get into really good territory until the dental problems are fixed, so you might talk with the vet about doing that sooner if you can. If he has other health problems interfering, then ignore that, but if you're just holding off because of the BG, I would recommend moving up the dental if you can. For the IBD, are you giving him a probiotic daily? Religiously? It can make a world of difference for IBD cats when given every day. We'd be happy to recommend a couple for you if you're not already giving one.
 
We're currently looking into switching vets, the one we're currently going to is nice and willing to learn but it seems like she doesn't have a direction to go in unless we ask the question. The mentality it's been so far is "if he acts fine, he must be fine" which is how we ended up in DKA territory. Once we get swapped over we're hoping to get some of his other problems under control.

He is on his Budesonide, B12 and a probiotic (can't remember the name), but if you have some suggestions for some that work I'd be willing to try!

Thank you!!
 
Most of us end up doing the FD treatment/planning/analysis on our own so diabetes knowledge or lack of isn't a deal breaker. It's good to have a vet you like for all the other stuff.
 
I agree with Kris. It will be difficult/impossible to find a vet that knows as much as this board does. If you like the vet for everything else, I wouldn't bother changing.

s. boulardii is a popular probiotic that has good results for cats with IBD. Fortiflora is effective if the IBD mainly manifests as diarrhea - and most cats LOVE the taste of it. However, it's rather pricey to give daily in the proper dose. I have used this one with good result for a long time now: https://www.chewy.com/animal-essentials-plant-enzyme/dp/49372 My guy has gone from nearly constant liqui-poo to only rare bouts that clear up quickly on their own (knock on wood).
 
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