Dosing change or insulin change?

[JCcat]

So my cat Piggy was diagnosed in early September and I've going through a very confusing journey ever since:

September - October (1st month)

• 3U BID
• Seems good: Spot checks glucose between 169 - 277
• Bad: Fructosamine result returned 558, even higher than pre-insulin era at 525.
• Bad: Very hungry all the time. Vomited almost daily since the injection, had to change his eating schedule to 2 main meals before injections and 3 small meals in between. Vomit less but still once every week or 2 weeks under new feeding schedule.

October - November (2nd month)
Vet asked to increase to 4U BID based on the fructosamine result (>500 is not regulated). 2 days after the change I spotted the first near-hypo episode - Piggy was too hungry 3 hours after dinner that he even bit me. Found out his glucose was at 48 and immediately fed dry food to boost.

Out of fear, I started adjusting the dosage based on the home test results. His glucose seems bouncing back to high 300 - 400 whenever his number gets close to low 100.

• I ended up choose 2.5U BID as his regular dosage and stopped doing daily testing (Piggy resisted a lot)
• Good: Fructosamine result returned 468, improved a lot compared to the previous month but still in Fair Control range
• Bad: Eating drinking urinating levels do not seem to improve. Sharp drop of glucose (>50% drop) 3-4 hr after insulin

November - December (3rd month)
Due to some family arrangement, Piggy became the solo cat in the household and now no one plays (or fights) with him. I wasn't sure if he was happy about it or not but he seemed to eating, drinking, urinating more so I started testing again and found the following trends:

• at 2.5U, his range is very likely within 100-400; sharp drop of glucose (>50% drop) 3-4 hr after insulin, followed by a high rebounce number the next cycle
• at 1.5U, his glucose is nicely controlled within 150-300. He appeared to eat, drink and urinate less. However, my vet didn't like this because he said that means his level is not within the (70-160) range almost all day.
• Fructosamine result just came bk today - went up to 488.

Now my dilemma is:

• High dosage (2.5 - 3U or more BID) to dive in the 50-150 range more, and OK with a high rebounce and drastic change of glucose level
• Low dosage (1.75 - 2U BID) to stay in the 150-300 range, but will be always higher than normal.
• Change to Lantus to see if the bouncing will smooth out?

*Diet: Raw + Purina DM Prescription for 2 main meals and Purina DM or boiled chicken meat for snacks, 1 fiber capsule per day
*No other health issues based on the bloodwork and urinalysis
*No keto (test weekly)
*Always eats
*Generally active. No ill-looking other than the eating, drinking, urinating more than normal cat.

Could anyone please help advise?

His spreadsheet is here: https://docs.google.com/spreadsheet...gItr07sPoYubqjVsEaxWpfvRc05ev6WpEjGZ5/pubhtml

 

[MrWorfMen's Mom]

Hello and welcome. I see signed up in September but never posted before. You've come to the right place for some help.

Do you have data for the 15th of Dec to current date? If so it would be helpful to see what's been happening in recent times. Insulin needs can change over time so while there's some notable clues earlier, doses were skipped or a different dose was given AM vs PM on a number of occasions and it's difficult to hone in on what dose was working best for Piggy.

Also for continuity, if you could copy that link to your spreadsheet into your signature, it will always be available to anyone helping without having to scroll to get to it or you having to copy it into each thread. Thx.

 

[JCcat]

Hello and welcome. I see signed up in September but never posted before. You've come to the right place for some help.

Do you have data for the 15th of Dec to current date? If so it would be helpful to see what's been happening in recent times. Insulin needs can change over time so while there's some notable clues earlier, doses were skipped or a different dose was given AM vs PM on a number of occasions and it's difficult to hone in on what dose was working best for Piggy.

Also for continuity, if you could copy that link to your spreadsheet into your signature, it will always be available to anyone helping without having to scroll to get to it or you having to copy it into each thread. Thx.

Merry Xmas Linda! Thank you so much for getting back to me! I updated the glucose curve till Sunday, 12/22. It is very difficult to test on Piggy (totally went nuts) so I could only manage to spot check him once in awhile. Also added the spreadsheet to signature as advised.

Understood that spot checks are far from ideal but based on the data I have and observations of Piggy's behaviors (appetite, water intake, and urine amount), Piggy seems "comfortable" at 2U BID for now. However, my vet strongly suggested me to go back to 3U BID and "stop doing home test, get panic and change the dosage"... I understand he wanted to bring the glucose down to double digits but with the high rebounce and behavior change (hungry all the time, vomits often, drink and pee alot, restless, etc) I am just not sure if it is even good for Piggy's overall wellness... I see you switched from ProZinc to Lantus, did you have similar experience with ProZinc? Do you think Lantus could help smoothing the rebounces?

 

[MrWorfMen's Mom]

I didn't use ProZinc with my kitty. I have experience with it from helping others with their diabetic kitties. My girl was on Lantus initially and then I switched to Levemir because she was a high dose kitty who experienced stinging from Lantus with the higher doses.

If a cat is bouncing from high to low numbers constantly, they will not feel well. The constant hunger is normal for an unregulated diabetic. They cannot process the food they eat properly so they crave more to get the energy they need. As kitty becomes better regulated, the appetite should level off to more normal amounts.

If you feel Piggy was feeling better and clinical signs were better on 2u then stick with that for a period of 3 days (6 cycles) provided pre-shot tests are 200 or more. If numbers don't improve, then we'd recommend dose adjustments of 0.25u so as not to skip over the best dose. If your syringes do not have half unit markings, I'd recommend you get some with half unit markings to be able to make smaller incremental dose changes. A lot of folks order from https://www.adwdiabetes.com/. The other alternative is to get U100 syringes with half unit markings and use the conversion chart for even finer dose adjustments.

While ProZinc is a gentler pet insulin, it can cause bouncing in some cats and they may do better on a longer acting insulin such as Lantus or Levemir. Right now I think you need to hone in on the best dose for Piggy and that appears to be something between 2 and 3u. Try to work on the testing with Piggy because without mid cycle testing, it's difficult to see how well any dose is working. A lot of cats go lower at night than in the day so we also recommend getting at minimum, a before bed test every night to see what kitty is up to at night and to keep kitty safe.