First Curve, Possible Rebound?

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andreana22

Member Since 2012
My cat, Nermal, has been on 2 units u40 (= 5 units u100) of ProZinc, 2x a day, for a while now but I think she may need more because she's drinking water and has gone from 10.5 to 9.5 pounds. I took her to a new vet because we've moved since she was first diagnosed. Nermal's fructosamine was mid 400's. The vet also did a glucose curve but only got 3 readings. In the end, she said that the insulin dose was fine. Then she gave me a bag of dry food and said to separate to Nermal from the other cats and let her free feed all day. I wasn't about to give Nermal dry food after having switched her to canned a while back under her original vet and seeing how much better she did. So, while I'm looking for a new vet :smile: , I'm working on doing my first blood glucose curve on Nermal.

To complete the curve, I've been trying to take a blood glucose reading a day. Most recently, I've been taking two, as I get better at using the meter. So far, I have all of the readings except for the first and last in my spreadsheet which I'll try to get on Tuesday (see link below). Her values go down gradually to 233 at +7 and then go back up to 258 at +8, but then they go down again to 245 at +10. Is this a Somogyi rebound? Her values seem kind of high to be rebounding. Or could it be an error on my part, maybe because I have been measuring her over multiple days? Or because she's near the bottom of her insulin bottle? Or could it be because I gave her 3 freeze dried chicken treats after each test and have been testing her twice lately?

Based on the Start Low, Go Slow approach, I should increase her dose by 1 unit and wait 2 weeks and then measure again at +7. Does that sound like a good approach or should I be feeding her more often? She gets 2 cans of Fancy Feast Classic/day now. Any advice is welcome. I'm just really confused as to what to do next.

Thanks,
Andrea
 
It's fairly hard to decipher the numbers. It would be helpful to know what her preshot numbers are - the number before she eats and before insulin. It's important to know that preshot number is so you know she is high enough to shoot. The midcycle numbers are pretty flat. IMHO, she is not rebounding, unless she is a lot lower for preshots.

We don't usually advise increasing by one full unit. (where did you see that as go slow?). I would increase by .25 or .5 and plan to monitor the full cycle. Her numbers aren't awful (regulated cats are in the mid 200s at preshot and double digits at midcycle, but not below 40) but she has room to drop.

Here is our ProZinc protocol


http://www.felinediabetes.com/FDMB/viewtopic.php?f=24&t=109077

It suggests increasing by .25 or .5 (if the numbers are in the higher range) and holding the dose 3 cycles before the next increase.
 
I'm far from an expert, I just wanted to point out that the 'up' and 'down' between 233, 258, and 245 is virtually non existent, these little machines have a +/- 20% accuracy, those numbers are essentially 'flat'. It seems to me that 2 units of prozinc is HUGE for a kitty that small, I would strongly encourage you to maybe rethink the dose, and start over much lower and work your way up more slowly
 
Thanks, Sue and Barb! I'm just learning so there's a lot I don't know. I took the Start Low, Go Slow information from this page - http://www.felinediabetes.com/start-low-go-slow.htm . I thought it said to increase by 1 but misread it. It just says to increase by .5 if the lowest part of the curve is 150.

I also didn't know about the separate protocol for Prozinc because I've only been in the main forum. Thanks for the information!

I just measured Nermal's blood glucose level, preshot, and it's 281. But then at +2 she goes up to 307, her highest value, which doesn't make sense.

I created chart on the second tab of Nermal's spreadsheet (link below). She goes up at +2, then nadir at +7 and then up again a little at +8. Her values are in the range of 233 and 307.

Based on the Prozinc protocol, and her preshot value of 281, I should increase her dose by .25 or .5. Does that sound right?

I'm hesitant to reduce her dosage and start over. I know she sounds tiny but she isn't. She's just really underweight. I can feel every bone in her spine and she's hungry all the time. She has lost a lot of weight. I'm really worried about her.

Thanks so much for your help,
Andrea and Nermal
 
That's not a bad preshot. If you can test today in that 5-7 hour window, I'd think increasing by .25 would be fine. The high number after she eats is normal for some cats. The food temporarily raises their blood sugar and then they come down later in the cycle.

Just for reference, we generally think of a cat as regulated if they are in the mid200s at preshot and in double digits at nadir, but not below 40, which is nearing hypo territory. So her numbers are not a real high but in a mid range. It looks like she has room to drop midcycle, so I am thinking a small dose might being her down a little but not too much. But it's nice if you can monitor when making a change.
 
Hungry all the time, with weight loss is classic for diabetes. An unregulated diabetic may need about 50% more food due to the difficulty in using what is eaten. Frequent, meals will help get weight back on. Low carb kitten food may help as it is intended to help put on weight - ex Evo Cat & Kitten.

It is possible that a second condition is present, too, such as hyperthyroidism. There is a specific blood test for that.
 
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