Dosing help for Figaro?

[Anne Richardson]

Figaro was diagnosed end of November last year. He was very sick, and was probably undiagnosed for quite some time. We started with 1 unit ProZinc twice a day. His numbers were still quite high (500s or even above 600, which on my meter just says "hi"). We went to 1.5, then 2, then 3 all the way up to 4.5 in a couple months with very little change. My vet backed it off to 3.5 when I said I believe he is bouncing which is where he is right now. We had a few days where he would go down to 100s or 200s and one day where he was under 100. Now he's back at 400s pre shot. And not going much lower than 300 at various times during the day. He doesn't seem to be having much of a curve now. His numbers are all over the place, so I can't determine with any consistency when his nadir is, though I believe it to be less than +6. He's been off all dry for months. He eats mostly Wellness chicken, some Friskies pate. He does need a dental, but the vet wants him regulated first. In spite of his erratic numbers, he's gained back the weight he had lost and is keeping it on. He is getting NaCl fluids 2-3 times a week. His potassium levels were really high at one point so no Ringer's. I need help with changing his dosage, as what we are doing now is not helping much. This is my first post here, forgive me if I am not doing it right.

 

[Sue and Oliver (GA)]

Hi Annie and welcome,

We encourage people to develop a spreadsheet. It is a great tool for you and for us. It is hard to give dosing advice without seeing the history. Here are the directions:

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Meanwhile, could you give us the last few days in this format

Amps (am number before food and shot) amt given
+5 (or whenever you got a test - +5 would be the number 5 hours after the shot)
Any tests you got in the +# format
Pmps (pm number before food and shot) amount given

Couple questions: he is getting insulin twice daily? Any other health issues besides the teeth (with some kitties, bad teeth and infections make a huge difference upward in levels. It might be worth asking a vet who specializes in feline dental work about getting it done even though he is not regulated )

There is something we call a bounce. If a cat goes from 400 to 100, his body can panic and release extra sugars to protect him from a number it perceives as dangerously low. Then those extra sugars make the next preshot number artificially high. This can create a roller coaster effect from lower numbers to higher ones. That's why the data (tests) are so valuable - data makes it easier to see a bouncing pattern if there is one.

 

[Anne Richardson]

Hi Annie and welcome,

We encourage people to develop a spreadsheet. It is a great tool for you and for us. It is hard to give dosing advice without seeing the history. Here are the directions:

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Meanwhile, could you give us the last few days in this format

Amps (am number before food and shot) amt given
+5 (or whenever you got a test - +5 would be the number 5 hours after the shot)
Any tests you got in the +# format
Pmps (pm number before food and shot) amount given

Couple questions: he is getting insulin twice daily? Any other health issues besides the teeth (with some kitties, bad teeth and infections make a huge difference upward in levels. It might be worth asking a vet who specializes in feline dental work about getting it done even though he is not regulated )

There is something we call a bounce. If a cat goes from 400 to 100, his body can panic and release extra sugars to protect him from a number it perceives as dangerously low. Then those extra sugars make the next preshot number artificially high. This can create a roller coaster effect from lower numbers to higher ones. That's why the data (tests) are so valuable - data makes it easier to see a bouncing pattern if there is one.

Hi Annie and welcome,

We encourage people to develop a spreadsheet. It is a great tool for you and for us. It is hard to give dosing advice without seeing the history. Here are the directions:

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Meanwhile, could you give us the last few days in this format

Amps (am number before food and shot) amt given
+5 (or whenever you got a test - +5 would be the number 5 hours after the shot)
Any tests you got in the +# format
Pmps (pm number before food and shot) amount given

Couple questions: he is getting insulin twice daily? Any other health issues besides the teeth (with some kitties, bad teeth and infections make a huge difference upward in levels. It might be worth asking a vet who specializes in feline dental work about getting it done even though he is not regulated )

There is something we call a bounce. If a cat goes from 400 to 100, his body can panic and release extra sugars to protect him from a number it perceives as dangerously low. Then those extra sugars make the next preshot number artificially high. This can create a roller coaster effect from lower numbers to higher ones. That's why the data (tests) are so valuable - data makes it easier to see a bouncing pattern if there is one.

Thanks. Not sure if I'm replying in right place. I don't have a spreadsheet per se, because I just write down test times and numbers, but I can give the last week of what I have. He does get his insulin twice a day. We're at 3.5 units of ProZinc.

4/12 Amps-552, +2-589, +4-435, Pmps-429, +2-364. 4/13 Amps-272, +6-398, Pmps-430. 4/14
Amps-473, Pmps-413, +2-473. 4/15 Amps-459, Pmps-Hi. 4/16 Amps-483. 4/17 Amps-Hi,
Pmps-581. 4/18 Amps-532, +2-432, +4-499, Pmps-447. 4/19 Amps-476, +3-404, Pmps-489.
4/20 Amps-586, +6-483.

 

[Sharon14]

Hi Anne, it would be so much easier for you, your vet and us to see a pattern and determine a dose for Figaro if you would set up the spreadsheet. Sue gave you the link. If you're technologically challenged, like I am, someone will be glad to help you with it, just ask.

 

[Sue and Oliver (GA)]

Try this:

4/13
Amps
Any other tests (+5, +7 etc)
Pmps

4/14
Amps
Any other tests
Pmps.

I can't tell which number goes with which date on your first example.

 

[Anne Richardson]

I had everything in neat lines and it all got jumbled when I posted. The edited one is still hard to read, but it goes from left to right following the dates. I am very techniclogically challenged and I only have an iPad. I was reading the SS instructions and it looks like I will need help for sure.

 

[Sue and Oliver (GA)]

Let's see if Marje can help. She can do them on iPads. @Marje and Gracie

 

[Sue and Oliver (GA)]

That is easier to read. So, two choices - too much insulin or too little. You might try reducing to 3 units and see if the numbers look better (there were some pretty big jumps up a unit or more pretty fast). If you do, test for ketones.

Or raise by 0.5 and see if things looks better.

It could be the teeth if they are really bad.

And some cats have high dose conditions and need more insulin. Some of these links don't work but the info is good

http://www.felinediabetes.com/FDMB/...-other-high-dose-conditions-what-we-know.375/

 

[Anne Richardson]

In the meanwhile, I'm going to try this one more time so you can at least get an idea about what his numbers are.

4/12
Amps-552
+2-589
+4-435
Pmps-429
+2-364

4/13
Amps-272
+6-398
Pmps-430

4/14
Amps-473
Pmps-413
+2473

4/15
Amps-459
Pmps-Hi

4/16
Amps-483

4/17
Amps-Hi
Pmps-581

4/18
Amps-532
+2-432
+4-499
Pmps-447

4/19
Amps-476
+3-404
Pmps-489

4/20
Amps-586
+6-483

 

[Anne Richardson]

That is easier to read. So, two choices - too much insulin or too little. You might try reducing to 3 units and see if the numbers look better (there were some pretty big jumps up a unit or more pretty fast). If you do, test for ketones.

Or raise by 0.5 and see if things looks better.

It could be the teeth if they are really bad.

And some cats have high dose conditions and need more insulin. Some of these links don't work but the info is good

http://www.felinediabetes.com/FDMB/...-other-high-dose-conditions-what-we-know.375/

I did go down to 3 units a couple weeks ago, and the numbers were pretty much the same. When we had him up to 4.5 units, it was pretty clear that he was bouncing. So, I was wondering about starting low again and raising much more slowly to see if we bypassed his ideal dose with raising too fast. Does that sound reasonable?

 

[Sue and Oliver (GA)]

Maybe. If he really needs the higher dose, it is kinda scary to lower the dose by a lot. If you decide to do that, only stay for a few cycles before increasing, moving back up by 0.5 at a time and test for ketones daily.

 

[Anne Richardson]

Maybe. If he really needs the higher dose, it is kinda scary to lower the dose by a lot. If you decide to do that, only stay for a few cycles before increasing, moving back up by 0.5 at a time and test for ketones daily.

I need to learn how to test for ketones. When he was first diagnosed he had them, then after a couple weeks he didn't. We have not tested him since then. I do know that one of his kidney values was slightly elevated. One reason for the fluids. He also had diarrhea for several months prior and after his diagnosis. I've finally got that under control. He's only 7, so I really hope I can at least get him regulated, if not into remission.

 

[Sue and Oliver (GA)]

Here is the ketone info.

http://www.felinediabetes.com/ketones.htm

I don't know, with all his issues including having had ketones and potentially having an infection in his teeth, I am reluctant to suggest lowering his dose. It might be what he needs, but if not, it might create some real problems for you.

Your other option is continue to slowly raise the dose and see if the levels improve. The theory is that if he is being overdosed, eventually and maybe suddenly his levels will crash. You'd need to be prepared and be monitoring carefully. That doesn't always happen but it is supposed to.....

Wish I had a better idea. I am nervous about reducing with the other circumstances.

 

[Robin&BB]

His numbers were still quite high (500s or even above 600, which on my meter just says "hi").

Anne, sorry to add another question to the mix, but:
What type of meter (name/brand) are you using? A human-type meter or an AlphaTrak2? (Is important that we have that info, too.)

Is essential that you test for ketones regularly. Here's some good info about that (just click the link shown below):
Are you testing your cat for ketones? If not - DO IT!!!

 

[Robin&BB]

Here is the ketone info.

@Sue and Oliver (GA) - We cross-posted on the ketones, Quick-Draw!

 

[Robin&BB]

I don't know, with all his issues including having had ketones and potentially having an infection in his teeth, I am reluctant to suggest lowering his dose. It might be what he needs, but if not, it might create some real problems for you. Your other option is continue to slowly raise the dose and see if the levels improve. The theory is that if he is being overdosed, eventually and maybe suddenly his levels will crash. You'd need to be prepared and be monitoring carefully. That doesn't always happen but it is supposed to.....
Wish I had a better idea. I am nervous about reducing with the other circumstances.

Yes, I would be nervous about reducing, too, given your current circumstances. I really, really, really want you to get a ketone test as soon as possible. (Would be worth a special trip to Walmart to get the vial of urine strips.)

 

[Rachel]

He had ketones previously? You definitely need to start testing for them ASAP. There are urine testing strips you can get. They're usually by the diabetic supplies I think...but just ask the pharmacist. We use the same ones for our cats that we use for humans.

It's imperative you start testing. I'd go out and buy them tonight if he was mine. Ketones are serious and if he's had them before, he is more likely to get them again.

 

[Rachel]

Haha Robin, I cross posted with you now!

 

[Marje and Gracie]

I'm sorry I'm just checking in. Company coming so I've been swamped.

Anne....I will send you a private message to get a spreadsheet set up. Look in the upper right corn at inbox and when you see a "1" next to it, click on it and you'll see a message from me.

 

[Anne Richardson]

Anne, sorry to add another question to the mix, but:
What type of meter (name/brand) are you using? A human-type meter or an AlphaTrak2? (Is important that we have that info, too.)

Is essential that you test for ketones regularly. Here's some good info about that (just click the link shown below):
Are you testing your cat for ketones? If not - DO IT!!!

Robin, we are using the Relion Confirm. I will look into ketone testing. Thank you.

 

[Anne Richardson]

Robin, we are using the Relion Confirm. I will look into ketone testing. Thank you.

He's regained the weight he lost prediagnosis, and has kept it on. The vet was surprised with his being unregulated that he is able to do this. In theory, if he had ketones, would this happen? I will still look into testing. I was just wondering.