Further tests needed?

[Ann & Liz]

We are seeing the vet today, for a general appraisal of how Lila is doing at the moment re possibly changing insulin from Caninsulin to Prozinc or adjusting dose?. Also we wonder if due to Lila's age more tests need to be done in case of a disease process causing the diabetes.? Any suggestions gratefully received as to tests we should request. ? Definitely getting ketones tested anyway. We have noticed that Lila was constipated before diagnosis but when starting insulin this improved but is possibly not as improved on the reduced 1u dose.

 

[Critter Mom]

Hi Ann & Liz,

Taking Lila's age into consideration it's a good idea to get a very full blood work-up including kidney and liver markers - if only to use as a baseline for the future. I'd ask for B12/folate, Spec fPL (pancreatitis and diabetes are often comorbid but, again, it's a valuable baseline to have and sometimes it can be an occult problem) and also thyroid. Other members may suggest additional things to consider.

Re the constipation, poorly regulated diabetes can affect stomach emptying and gut motility (diabetic gastroparesis). B12 methylcobalamin supplementation helps with neuropathy; I'm not sure whether it might also be helpful with GI motility issues but it might be worth picking your vets' brains about this.

Looking at Lila's spreadsheet (with a now-working link!) I think it would be an idea to discuss a Caninsulin dose increase to 1.5IU to be held for 5-7 days. This is on the assumption that your vet may need to order in Prozinc. If the vet can switch Lila to Prozinc sooner then, based on her clinical signs in response to the Caninsulin, if she were my cat I'd be inclined to push for the switch to the new insulin (at a low starting dose with a view to following the FDMB Prozinc dose adjustment method).

When speaking to your vets about the Caninsulin side of things be sure to flag - in mile-high letters - that MASSIVE drop from 24.1 AMPS down to 5.4mmol/L at AM+6 on 02.10.16 and tell them about how poleaxed Lila was as a consequence. Given the action profile of Caninsulin she may have been even lower than 5.4mmol/L between +3 and +6 on that cycle. It's way too fast and too steep a drop - and the dose is unsafe.

As well as getting the vet to check ketones (bring a urine sample with you as they may not have a blood ketone meter) pick up some urine test strips ASAP and test daily at home as a part of Lila's regular monitoring programme. Ketones can appear suddenly and build up very quickly so intermittent testing isn't sufficient.


Mogs
.

 

[Ann & Liz]

Hi Ann & Liz,

Taking Lila's age into consideration it's a good idea to get a very full blood work-up including kidney and liver markers - if only to use as a baseline for the future. I'd ask for B12/folate, Spec fPL (pancreatitis and diabetes are often comorbid but, again, it's a valuable baseline to have and sometimes it can be an occult problem) and also thyroid. Other members may suggest additional things to consider.

Re the constipation, poorly regulated diabetes can affect stomach emptying and gut motility (diabetic gastroparesis). B12 methylcobalamin supplementation helps with neuropathy; I'm not sure whether it might also be helpful with GI motility issues but it might be worth picking your vets' brains about this.

Looking at Lila's spreadsheet (with a now-working link!) I think it would be an idea to discuss a Caninsulin dose increase to 1.5IU to be held for 5-7 days. This is on the assumption that your vet may need to order in Prozinc. If the vet can switch Lila to Prozinc sooner then, based on her clinical signs in response to the Caninsulin, if she were my cat I'd be inclined to push for the switch to the new insulin (at a low starting dose with a view to following the FDMB Prozinc dose adjustment method).

When speaking to your vets about the Caninsulin side of things be sure to flag - in mile-high letters - that MASSIVE drop from 24.1 AMPS down to 5.4mmol/L at AM+6 on 02.10.16 and tell them about how poleaxed Lila was as a consequence. Given the action profile of Caninsulin she may have been even lower than 5.4mmol/L between +3 and +6 on that cycle. It's way too fast and too steep a drop - and the dose is unsafe.

As well as getting the vet to check ketones (bring a urine sample with you as they may not have a blood ketone meter) pick up some urine test strips ASAP and test daily at home as a part of Lila's regular monitoring programme. Ketones can appear suddenly and build up very quickly so intermittent testing isn't sufficient.


Mogs
.

Thank you, Mogs, we will definitely mention all the points. Lila had quite a big drop yesterday morning too ( we were doing a curve in prep for today) and that is on 1u we are even dubious about going to 1.5 when she can suddenly have a day of lower readings. Also wary about swapping insulin in case we confuse the picture further. In your opinion will Lila be a fair bit safer on Prozinc from general effects on her body and from hypos.? As we are aware that the Prozinc stays around longer so she may be "at risk of hypos" for longer. Sorry more questions but anxious to do the right thing and not to make a change that turns out not to be the right one. (Oh for a crystal ball, we know)!. When she is bright she seems so good ( was playing a bit last night and quite active late afternoon) but it's not sustained for long, bless her. She is almost brighter when a BG is higher it seems possibly???

 

[Critter Mom]

Forgot to add to my previous post to make sure the vet does a thorough check of the mouth and teeth to see whether Lila may have any gum infections or need any dental work.

Also, be sure to ask the vet to check Lila's eye health and to give her a good overall physical examination.

---------------------------------------

I've not used Prozinc but my understanding is that it is gentler in action and longer-lasting in the cat than Caninsulin. (Dogs don't metabolize Caninsulin as fast as cats so the action in them is not as harsh and it has greater duration in canine diabetics.) The impression I get from hearing about Prozinc here is that it is not as prone to dropping BG like a rock the way that insulins like Caninsulin are wont to do.

If you post on the Prozinc board asking members to give you some pointers on what the BG lowering effect of Prozinc is typically like (the action profile) and how it might differ from the action profile of Caninsulin you might get some replies there before your vet visit.

WRT dosing safety if you start on a low dose then with your home testing you'll be able to gauge the effectiveness and safety of the starting dose from the get-go. With a safe starting dose established the longer duration of Prozinc is more likely to keep Lila's BG levels 'smoother' throughout the day and all going well she would feel better without having to deal with the wild BG swings she has been experiencing on Caninsulin. As you gather more BG data you'll get a much better feel for how low a dose is taking Lila at nadir and if necessary you can then tweak the dose in small increments to improve her regulation while still keeping her as safe as possible. Over time your data will help you to learn Lila's pattern and that, too, will help you keep her safe.

A point worth considering; Lila's chances of remission may be enhanced by choosing Prozinc treatment.


Mogs
.

 

[Critter Mom]

Useful forum sticky on ketone testing for you:

Are you testing your cat for ketones? If not, DO IT!!

One thing I would add to the above is that some kitties are ketone-prone. If I had a ketone-prone kitty or DKA survivor I personally would test daily for urine ketones as a part of its regular monitoring routine. If I was worried about something brewing I'd probably test twice a day as an extra precaution. (Ketones can appear suddenly and build up quickly.)


Mogs
.

 

[Ann & Liz]

Useful forum sticky on ketone testing for you:

Are you testing your cat for ketones? If not, DO IT!!

One thing I would add to the above is that some kitties are ketone-prone. If I had a ketone-prone kitty or DKA survivor I personally would test daily for urine ketones as a part of its regular monitoring routine. If I was worried about something brewing I'd probably test twice a day as an extra precaution. (Ketones can appear suddenly and build up quickly.)


Mogs
.

Thanks Mogs, have had lengthy meeting with vets. Full blood tests tomorrow and to remain on 1u Caninsulin for 1 week and reassess. Urine tested ok.

 

[Alexi]

I have replied to your post in the Prozinc forum.