Emmett con’t—too many reductions?

And I wanted to ask you which foods you found that have a few more carbs in them but are still ten percent and under? I need a few food recommendations for another member - things that are higher than the really low carb FF foods - and I remembered that we had talked about it a while ago and you had found a few foods.
I’ll have to look into this one a bit because he’s back to refusing to eat anything but fancy feast salmon and shrimp and merrick rabbit so I don’t really have any food around (aside from my other cat’s food). I THINK some Snappy Tom flavours were slightly higher but still under 10% carbs, but that’s only using approximate numbers based on the back of the package.
 
I still have the human meter as back up, but I’ve been using the AT because his insurance covers the strips, so it ends up being cheaper for me. After insurance pays their share, I end up paying $20 for 50 AT strips vs. $70 for 100 of the cheapest human ones (I don’t think there are any cheaper options in Canada).
I remember now. Yes. I would use the AT too! Big cost difference. I’m glad you have insurance on Emmett.
 
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I’ll have to look into this one a bit because he’s back to refusing to eat anything but fancy feast salmon and shrimp and merrick rabbit so I don’t really have any food around (aside from my other cat’s food). I THINK some Snappy Tom flavours were slightly higher but still under 10% carbs, but that’s only using approximate numbers based on the back of the package.
Oh. Okay. He’s being picky, too! That boy! :)
 
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Oh. Okay. He’s being picky, too! That boy! :)
He’s a nightmare when it comes to food lol.

This reminds me that the other thing with him is that the Atopica is not helping his eosinophilic granuloma. I’ve mentioned this to the vet and we have a couple options, none of them great:

1. A food trial, but that food is generally dry and high carb. Emmett is way too hard to regulate for this to be a good option, so I said no. (I’m also confident his food doesn’t contain chicken/poultry, so I’m not sure this would make a difference anyway).
2. Steroids. lol no
3. An antibiotic shot. Tried this multiple times, didn’t work, not a fan of putting more antibiotics in him when it’s not necessary.
4. Biopsy. This would give answers, but not solutions (see above lol).

So I think my only option is biopsy for the answers at least. At this point, I’m thinking of just letting his body heal the lesions in its own. It generally takes 3-4 months on its own, and he’s been on the Atopica for 2 months with no real change.
 
I had recommended that the dose be held for 7 days only because of the way Emmett is prone to diving occasionally and go into lime. Certain cats sometimes need their doses held a little longer than we would like (because we get anxious to raise the dose back up again because we want to see better numbers.). I hope he will not go lime on the 2.5 dose and that you will be able to consistently shoot his full dose. I would like him to be at a dose where he can get the full dose and not have reduced doses due to lower than expected preshot numbers. I think shooting the reduced doses may be kind of messing him up. Let’s see how he does on the 2.5 units. So far no limes :) How is he doing with his paw?
 
He’s a nightmare when it comes to food lol.

This reminds me that the other thing with him is that the Atopica is not helping his eosinophilic granuloma. I’ve mentioned this to the vet and we have a couple options, none of them great:

1. A food trial, but that food is generally dry and high carb. Emmett is way too hard to regulate for this to be a good option, so I said no. (I’m also confident his food doesn’t contain chicken/poultry, so I’m not sure this would make a difference anyway).
2. Steroids. lol no
3. An antibiotic shot. Tried this multiple times, didn’t work, not a fan of putting more antibiotics in him when it’s not necessary.
4. Biopsy. This would give answers, but not solutions (see above lol).

So I think my only option is biopsy for the answers at least. At this point, I’m thinking of just letting his body heal the lesions in its own. It generally takes 3-4 months on its own, and he’s been on the Atopica for 2 months with no real change.
I was just asking about his paw. How invasive would the biopsy be? I mean, would they just take a small sample? I would stop the Atopica since it hasn’t helped. Do you have any veterinary dermatologists around? Maybe your insurance would pay?

It’s true that your options are limited. Have you ever thought about making food for him? But he’s so picky that you might make food and he would refuse to eat it. Have you ever tried any of the freeze dried raw foods like Stella and Chewy?
 
I had recommended that the dose be held for 7 days only because of the way Emmett is prone to diving occasionally and go into lime. Certain cats sometimes need their doses held a little longer than we would like (because we get anxious to raise the dose back up again because we want to see better numbers.). I hope he will not go lime on the 2.5 dose and that you will be able to consistently shoot his full dose. I would like him to be at a dose where he can get the full dose and not have reduced doses due to lower than expected preshot numbers. I think shooting the reduced doses may be kind of messing him up. Let’s see how he does on the 2.5 units. So far no limes :) How is he doing with his paw?
Yeah, that would be ideal.

What should I do the next time he has a lower than expected preshot number? When he had the 8.2 a couple nights ago, I debated delaying, but wasn’t going to be able to accommodate the new time the next morning. Shooting the full dose also seemed like a bad idea.
 
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I was just asking about his paw. How invasive would the biopsy be? I mean, would they just take a small sample? I would stop the Atopica since it hasn’t helped. Do you have any veterinary dermatologists around? Maybe your insurance would pay?

It’s true that your options are limited. Have you ever thought about making food for him? But he’s so picky that you might make food and he would refuse to eat it. Have you ever tried any of the freeze dried raw foods like Stella and Chewy?
His insurance would cover any diagnostics… not sure about a derm. The vet’s office is closed this week but I can ask the vet more next week.

Edit: yes, it would be removing a small sample.

I’m a little overwhelmed with further vet costs at this point. I have to take my other cat back to the vet because he keeps biting the end of his tail following his tail injury a month or two ago. The vet said a lot of cats lose sensation in the end of their tails after a tail injury and require amputation.

Emmett always refuses “human” food (like if we try to give him a little piece of unseasoned meat), and he really doesn’t like any cat food that is too much like “human” food, like shreds of meat. So I’m not sure this would end up being an option. He LOVES Stella & Chewys though. I use them as a treat.
 
Yeah, that would be ideal.

What should I do the next time he has a lower than expected preshrink number? When he had the 8.2 a couple nights ago, I debated delaying, but wasn’t going to be able to accommodate the new time the next morning. Shooting the full dose also seemed like a bad idea.
It looks like the 1 unit was not enough, but I totally understand your dilemma. It’s just good information for next time, right. Try a little more when he has a similar preshot. You did well to shoot some insulin because that’s a much better choice than skipping. He’s definitely a challenging diabetic, and you really keep good tabs on his BG. It always comes down to that — whether you can monitor and, as you said, you didn’t have time to stall and shoot late.
 
It looks like the 1 unit was not enough, but I totally understand your dilemma. It’s just good information for next time, right. Try a little more when he has a similar preshot. You did well to shoot some insulin because that’s a much better choice than skipping. He’s definitely a challenging diabetic, and you really keep good tabs on his BG. It always comes down to that — whether you can monitor and, as you said, you didn’t have time to stall and shoot late.
Okay! I debated doing 1.5 units or something, but I really couldn’t afford losing sleep to monitor because I had to be up early for work.
 
Hi there. I’m thinking about you and Emmett. How is it going ? It looks like he’s continuing his same general pattern. He had a pretty good cycle last night.

How does your vet feel about Lantus? It might be worth trying it to see if an insulin with some depot capabilities would help smooth out some of his highs, in particular the high preshot numbers.
 
Hi there. I’m thinking about you and Emmett. How is it going ? It looks like he’s continuing his same general pattern. He had a pretty good cycle last night.

How does your vet feel about Lantus? It might be worth trying it to see if an insulin with some depot capabilities would help smooth out some of his highs, in particular the high preshot numbers.
Yeah I keep hoping he’s going to level out a little bit, but so far those preshot numbers keep staying high.

The vet my cats see only uses Lantus (a different vet at the same clinic originally diagnosed Emmett and prescribed Prozinc), so she would be fine with me switching. She’s leaving that up to me. I do think I’m at the point of at least wanting to try. I hate seeing all the high numbers and don’t like how he only really seems to stay in “normal” numbers for a couple hours out of the day. If Lantus is going to help him get back to more consistently lower numbers, I want to try.
 
Yeah I keep hoping he’s going to level out a little bit, but so far those preshot numbers keep staying high.

The vet my cats see only uses Lantus (a different vet at the same clinic originally diagnosed Emmett and prescribed Prozinc), so she would be fine with me switching. She’s leaving that up to me. I do think I’m at the point of at least wanting to try. I hate seeing all the high numbers and don’t like how he only really seems to stay in “normal” numbers for a couple hours out of the day. If Lantus is going to help him get back to more consistently lower numbers, I want to try.
If he were my cat, I would try Lantus (or a generic glargine insulin.) I used ProZinc and Lantus and also Levemir (those last two being depot-type insulins.) Some cats do great on ProZinc, but he’s not getting good duration. The depot effect should, in theory, provide some overlap from one cycle to another and will keep him from going too high, hopefully. I say hopefully because… well… it’s Emmett!
 
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If he were my cat, I would try Lantus (or a generic glargine insulin.) I used ProZinc and Lantus and also Levemir (those last two being depot-type insulins.) Some cats do great on ProZinc, but he’s not getting good duration. The depot effect should, in theory, provide some overlap from one cycle to another and will keep him from going too high, hopefully. I say hopefully because… well… it’s Emmett!
Okay, thanks. I think this gives me the push I need to just make the switch. My other cat is going back to the vet next week to get his tail checked out, so I’ll talk to the vet about making the switch then. Hopefully this will help Emmett, but yeah I think most people agree he’s a bit of an oddball lol.

Side note, this will leave me with over half a bottle of Prozinc… what do people do with unused insulin?
 
Some people offer it to other people in the supply closet. I sent my unused insulin pens to another person who used the same kind of insulin. I threw it in with some ice packs and mailed it two day mail.

Perhaps your vet (the previous vet?) could use it to give to another person who has a diabetic cat?
 
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Oh. And we can help you with the transition to Lantus. Normally we are going to start with a starting dose that’s similar/same as your current dose as long as Emmett isn’t going too low on the current dose.
 
I’m a little overwhelmed with further vet costs at this point. I have to take my other cat back to the vet because he keeps biting the end of his tail following his tail injury a month or two ago. The vet said a lot of cats lose sensation in the end of their tails after a tail injury and require amputation.
I am sorry about this situation with your cat’s tail. I was thinking it might be hyperesthesia, but you said it was an injury. What happened? I hope amputation won’t be necessary.
 
Oh. And we can help you with the transition to Lantus. Normally we are going to start with a starting dose that’s similar/same as your current dose as long as Emmett isn’t going too low on the current dose.
Okay, great. I haven’t done too much reading on Lantus, just the basics. Hopefully it’ll go smoothly.
 
I am sorry about this situation with your cat’s tail. I was thinking it might be hyperesthesia, but you said it was an injury. What happened? I hope amputation won’t be necessary.
So, my other cat (J) likes to sleep on the top of the fridge. I have some wicker baskets up there that have a wire pattern around the rim of the baskets. One time he was up there I heard a lot of shuffling around and thought that was weird because he’s usually quiet. About an hour later he jumps down from the fridge. Immediately after that, I could tell he was injured… basically didn’t want to lift up his tail, didn’t want to put his butt down when he would sit or lie down, wouldn’t jump at all, was very careful climbing. He was fine after a few days but then started biting the end of his tail. I think he feels the pins and needles sensation, rather than a total loss of sensation because sometimes he’ll jump and spin around like something bit him. I’m hoping there are less intrusive interventions we can try first.

I forgot this part… my theory is that his tail got stuck in the basket and pulled it. I know it for sure happened on top of the fridge because he hasn’t been up there since.
 
I am sorry about this situation with your cat’s tail. I was thinking it might be hyperesthesia, but you said it was an injury. What happened? I hope amputation won’t be necessary.
Wow you were right on the money. Although Jasper did legitimately injure his tail, the vet thinks the tail biting is hyperesthesia. She said it’s possibly a sequela to the injury but not necessarily *because* of the injury, if that makes sense.

Also, we are switching Emmett to Lantus. They didn’t have any in today so I will pick it up either tomorrow or Monday.
 
Wow you were right on the money. Although Jasper did legitimately injure his tail, the vet thinks the tail biting is hyperesthesia. She said it’s possibly a sequela to the injury but not necessarily *because* of the injury, if that makes sense.

Also, we are switching Emmett to Lantus. They didn’t have any in today so I will pick it up either tomorrow or Monday.
I will be excited to see how he does on Lantus. Paws crossed!

So what did the vet propose to do about the hyperesthesia? Gabapentin I believe is used sometimes because of its help with nerve pain. While hyperesthesia isn’t necessarily what we call pain (how do we really know what the cat feels), it’s believed to involve the nerves or at least perceptions of the nerves in the brain. I would try Gabapentin and/or some anti-anxiety meds before doing an amputation.
 
I will be excited to see how he does on Lantus. Paws crossed!

So what did the vet propose to do about the hyperesthesia? Gabapentin I believe is used sometimes because of its help with nerve pain. While hyperesthesia isn’t necessarily what we call pain (how do we really know what the cat feels), it’s believed to involve the nerves or at least perceptions of the nerves in the brain. I would try Gabapentin and/or some anti-anxiety meds before doing an amputation.
The vet suggested Emmett start on 1 unit of Lantus, but my understanding is that you can keep them on the same dose?

As for for the tail, we have ruled out amputation as it is not the result of an injury. Thank goodness. We think it might be in part a stress response, and he hasn’t bitten his tail since Monday. This also coincides with when I’ve started consistently locking up J at night, to protect him from Emmett’s nighttime bullying. So we’re going to monitor for now, and if it starts again, we will try gabapentin.
 
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I definitely think 1 unit would be too small of a dose for Emmett. You could try it though. A few cats will have a strong reaction to a new insulin, but still… 1 unit is almost 1/3 of his current dose.
 
Keep in mind it will take about 1 week for the depot to build up — where we can see the full effect of the dose. So initially the first dose will be held for 7 day(barring low numbers requiring a reduction.). After that, you can follow tight regulation (TR) which is very similar to MPM — and make dose increases every 6 cycles if the numbers warrant.
 
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Stress can definitely play a role in these things with cats. Poor Jasper… getting picked on. Was he the outdoor cat?
Neither of them are outdoor cats, but they are harness trained and go for supervised walks :)

The frustrating part is that now Emmett is stressed being separated from Jasper at night lol. Bully or not, he still loves him and wants to be near him.
 
I definitely think 1 unit would be too small of a dose for Emmett. You could try it though. A few cats will have a strong reaction to a new insulin, but still… 1 unit is almost 1/3 of his current dose.
Okay! Thank you for the info. It’s hard for me to imagine 1 unit will be enough in the end, BUT maybe switching is going to give him a strong reaction. I didn’t test Emmett the first week he started insulin back in March, but I remember the 180 switch he did from lethargic to high energy following starting insulin… only to go right back to lethargic until we found the right dose for him.
 
I see your spreadsheet says you started Lantus. I don’t see any tests on the spreadsheet though. How’s it going? I think you should make an introductory post on the Lantus Levemir and Biosimilars forum.
 
I see your spreadsheet says you started Lantus. I don’t see any tests on the spreadsheet though. How’s it going? I think you should make an introductory post on the Lantus Levemir and Biosimilars forum.
So, I ended up deciding to start him tonight instead of this morning. I had to be in the office today, and wanted to start him on a cycle I could test him. My mom was also nervous watching him right after starting a new insulin since she can’t test him on her own in case of emergency.
 
First dose of Lantus given. The u-100 syringes I got from the vet are not gonna cut it… they don’t have half unit markings.
 
I don’t like those pinks, but we have to give it some time to see the full effect of this dose.
Yeah, I think so. I do think it’s interesting that his preshot numbers are just slightly lower than his previous mid cycle numbers… it doesn’t seem like much but if it continues, that’ll add up hopefully.
 
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