Dosing advice please

Kate and Geoff

Kate and Geoff

Member
We are looking for some advice please. Jack (male bombay 14) was diagnosed as a diabetic in July last year. He has never been 'a text book case' and we have been struggling to find any sort of stability.

We only feed him very low carb wet food and we test him often for both glucose and ketones. We measure his food, water and weight daily.

From the start Jack was on Prozinc but following a serious bout of ketosis he was changed to caninuslin and hypurin (4 injections per day made up of 2 x Hypurin bovine neutral and 2 x Caninsulin). Since then Jack has had some dentistry work and all the tests for other diabetes related problems which were all ruled out.

He has been back on Prozinc since mid November and whilst his general dispostion is good, his numbers are still completely unpredictable. Some days he can be totally flat and then inexplicably can have some rapid lows with the inevitable bounce. See attached world mmol sheet

We started dosing at 1.5 u twice a day but we are now up to 2.75 u twice daily. We were on 3u for a while but this felt too high.

He is always hungry and is a greedy eater so we try to cap the daily food allowance to 400g. Nothing less seems to touch the sides. Originally we fed him twice daily but we have since moved to a more regular feeding regime throughout the day and night. This has improved things for him (and us). Generally, per 12 hour period, he has one main meal of between 100 & 120 g and 2 or 3 small top up feeds. His weight is slightly under target at 4.7 kg

If anybody can give give us any insights into correct dosing and why his numbers are so variable, we would be most appreciative.

Thanks. Kate and Geoff
 
Im new myself but have learned, smaller more frequent meals are best for them. Extreme hunger, thirst and urinating are the tell tale signs for feline diabetes. It was for my big blonde Simba. OMG could that boy pee!! Had to invent a box box enough to constrain him from not peeing on the floor constantly while in the cat box, barely. Dosing magic is found from lots and lots of testing and doing a curve weekly. It is as much science as art as the target keeps moving about that we want to achieve.
 
Hi and welcome! Great job with your home testing and keeping up the spreadsheet. It looks like Jack is in very good hands!

Would it be possible to share the link instead of the pdf? There are directions here for how to do that: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

It really helps those of us in the US when we can flip over to the US tab to see the numbers since we use a different system. If that's not possible, we can make this work.

Can you share a little about how you've been making dosing decisions? How do you decide when to go up or down? Also, what is the current status of his teeth? And did the vet rule out pancreatitis when doing the other tests?
 
Hello Djamila. Thank you for your most welcome reply

We have updated our signature with the link to his numbers. Thanks for your help on doing the link rather than PDF

We restarted Prozinc in November at 1.5u and increased slowly with regular curves and our vets guidance until we hit 3. We have currently reduced to 2.75 (for the last 10 days) and very occasionally go down to 2.5 if his preshot is low. We felt that 3 was too high as we had some lows with bounces, some that seemed fairly steep (for prozinc)

With regards to daily dosing decisions we have been cautious as we didnt think that Prozinc was something we should adjust too much. Previously with Caninsulin & Hypurin we had a sliding scale based on the preshot which was easy to follow and we'd vary from 1 to 3 units

Our current rule of thumb with Prozinc is that if his numbers are below 20 mmol (360mg/dl) at preshot we give half a dose, otherwise a full one. However generally we feed him and wait half an hour for an increase in BG. Usually this does the trick so that we can give a full dose (albeit we are currently adjusting the figures by a quarter of unit)

He had 7 teeth out in October and his teeth seem OK at present. We brush them with Virbac generally 3 or 4 times a week

Our vet did some ultrasound last year to see whether pancreatitis was a problem and this was ruled out (along with all the other possibilities - Acromegaly etc)

Thank you
 
Kate and Geoff - Thank you so much for the spreadsheet and the additional information! It does look like Jack is a little tricky!

As for why he's in such high numbers: since other health issues have been ruled out, and he isn't having access to high carb foods, it's hard to say at this point. Is he taking any other medications? Has he ever been on steroids? Do you have other pets in the house that eat different foods?

Beyond all of that though, it doesn't look like he's getting enough insulin right now, especially given his history of DKA. I would increase to 2.25 for three cycles, and then increase to 2.5, and then we can see how he does there.

In general around here, we say not to reduce the dose unless they are under 200. Given how high Jack's normal numbers are, I do think decreasing at a higher number makes sense, but not so high has 360. Ideally you want him to stay in the yellows, blues, and greens.

There have been a couple of other cats with similar spreadsheets to Jack. We ended up deciding that the occasional low numbers just had to be ignored, and dosing needed to be based on the trends in numbers. You are testing enough to catch when he does go low and give him some extra food to bring him back up again, so you'll be able to keep him safe. And so far it doesn't look like he's dropped below 50 anyway (although he did get close with that 56).

Speaking of food: if he's still underweight, I would increase how much you are feeding him. Don't worry about what a "normal" amount of calories might be. He's in very high numbers which make cats feel quite hungry, and since he needs to gain some weight anyway, it's fine to feed him more than usual. When his weight gets where it should be, we can talk about cutting back on calories at that point. Insufficient calories and insufficient insulin are two of the three conditions that lead to DKA, and since he has a history of that already, I would think increasing both dose and calories right now would be a good idea to try to keep him away from that.

That's a lot all in one post, so please ask as many questions as you have!
 
Djamila said:
Kate and Geoff - Thank you so much for the spreadsheet and the additional information! It does look like Jack is a little tricky!

As for why he's in such high numbers: since other health issues have been ruled out, and he isn't having access to high carb foods, it's hard to say at this point. Is he taking any other medications? Has he ever been on steroids? Do you have other pets in the house that eat different foods?

Beyond all of that though, it doesn't look like he's getting enough insulin right now, especially given his history of DKA. I would increase to 2.25 for three cycles, and then increase to 2.5, and then we can see how he does there.

In general around here, we say not to reduce the dose unless they are under 200. Given how high Jack's normal numbers are, I do think decreasing at a higher number makes sense, but not so high has 360. Ideally you want him to stay in the yellows, blues, and greens.

There have been a couple of other cats with similar spreadsheets to Jack. We ended up deciding that the occasional low numbers just had to be ignored, and dosing needed to be based on the trends in numbers. You are testing enough to catch when he does go low and give him some extra food to bring him back up again, so you'll be able to keep him safe. And so far it doesn't look like he's dropped below 50 anyway (although he did get close with that 56).

Speaking of food: if he's still underweight, I would increase how much you are feeding him. Don't worry about what a "normal" amount of calories might be. He's in very high numbers which make cats feel quite hungry, and since he needs to gain some weight anyway, it's fine to feed him more than usual. When his weight gets where it should be, we can talk about cutting back on calories at that point. Insufficient calories and insufficient insulin are two of the three conditions that lead to DKA, and since he has a history of that already, I would think increasing both dose and calories right now would be a good idea to try to keep him away from that.

That's a lot all in one post, so please ask as many questions as you have!
Click to expand...


Hi Djamila

Sorry I think we have confused things as we had the spreadsheet upside down (as we were showing today at the top rather than today at the bottom. We have resorted it and hope it makes more sense. We are currently on 2.75 but this morning we did do a 2.5 u am dose. We will increase and see what happens but wonder if there is residual dose on some days and not on others

Apologies for confusion. Novices at Google sheets and posting on msg boards. Hopefully we will get it right soon.

Grateful for your insights. This is really helpful

Many thanks again
 
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Darwin H. said:
Im new myself but have learned, smaller more frequent meals are best for them. Extreme hunger, thirst and urinating are the tell tale signs for feline diabetes. It was for my big blonde Simba. OMG could that boy pee!! Had to invent a box box enough to constrain him from not peeing on the floor constantly while in the cat box, barely. Dosing magic is found from lots and lots of testing and doing a curve weekly. It is as much science as art as the target keeps moving about that we want to achieve.
Click to expand...
Darwin H

Thanks for your note. Drip feeding far better than two straight meals definitely It’s a continual massive learning curve and every new day you realise that yesterday you didn’t know nearly enough...especially with that moving target.
 
No worries at all. It is a learning curve! I remember the first couple of weeks feeling like every time I posted I had done something wrong. Please know that you're doing just fine!!!

Prozinc can last for 10-14 hours depending on the cat (and sometimes depending on the cycle). So yes, sometimes it's overlapping with the next shot time (which is good), and sometimes it doesn't. That overlap is what starts to bring the PS numbers down, which is why you want to try to keep the dose consistent instead of reducing it. Sometimes it's low enough that you need to reduce, but if you can monitor and steer (give extra food if needed), that's will help to lower the numbers overall.

It's a little bit of science and a little bit of art to figure out how to do this, and we are all happy to help. :)
 
It definitely takes some getting used to! Diabetes is hard enough and then add in learning how to use a message board and Google Docs and it just makes it harder...but trust me when I say that you can't post wrong here! Any questions you have or anything you need and we're here to help!
 
Thank you Djamila. That does make sense, looking at it from an overlap or length of cycle point of view rather than thinking he is just up and down. I guess it depends on the day

We do wonder about the flat days, where the BG just floats along at more or less the same level.

We are trying for one of us to be here all the time but not always easy as both working and regularly making 200 mile daily commutes to various places for meetings. So far we have always covered it. It’s great to know that such knowledge and help is out there.

Thank you again.
 
When a cat isn't used to healthy numbers, and then they get one (like the 65 recently), their body dumps glucose into the blood to try to raise the BG. Then you'll have a few flat cycles while the body then has to "clean out" the glucose that was dumped. It can keep them elevated for a number of cycles afterwards. The more often they get those healthy numbers, the less that happens, but it can take awhile for them to adjust to good numbers again.

Keeping the dose high enough to make those good numbers happen more often is key, without giving so much insulin that they drop too low.
 
Rachel said:
It definitely takes some getting used to! Diabetes is hard enough and then add in learning how to use a message board and Google Docs and it just makes it harder...but trust me when I say that you can't post wrong here! Any questions you have or anything you need and we're here to help!
Click to expand...
Thank you Rachel. Good words, I can see that it’s a great place to be.
 
Djamila said:
When a cat isn't used to healthy numbers, and then they get one (like the 65 recently), their body dumps glucose into the blood to try to raise the BG. Then you'll have a few flat cycles while the body then has to "clean out" the glucose that was dumped. It can keep them elevated for a number of cycles afterwards. The more often they get those healthy numbers, the less that happens, but it can take awhile for them to adjust to good numbers again.

Keeping the dose high enough to make those good numbers happen more often is key, without giving so much insulin that they drop too low.
Click to expand...
Yes excellent. thanks Djamila. We are beginning to see the nuances thanks to your guidance. I can see that the body reacts to these lows as a self defence. Assume this glucose is the glycogen stored in the liver. The flat cycles have been a mystery to us as we always wondered why the insulin didn’t seem to be making any headway into ‘unflattening’ the curves

Elizabeth suggested there would be some excellent knowledge and help to be gained here on FDMB, and this is very evident. Already feeling a whole heap more educated and hopeful. Thank you.
 
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