? Galaxy's thread

[Galaxy (GA)]

We hit 40 at +10! Yes, that's right, 40. I didn't even know numbers can go this high.

So there's clearly a trend visible on the SS, the more I give the higher the numbers go. Yet we haven't even approached the dose that could POSSIBLY work and last a good 12 hours, but I'm not allowed to raise dose for a full week or two (well, 1 or 2? cos that's not clear either) on the same dose, as per vet's instructions.

I've read article after article on feline diabetes and they all agree on this:
"To control BG to <14 mmol/l (252 mg/dl) for as much of a 24 h period as possible; and
To avoid clinically significant hypoglycaemia at all times.
Where more intensive monitoring is feasible, aiming to maintain BG ⩽11 mmol/l (198 mg/dl) may be helpful in further minimising metabolic derangements associated with DM and in encouraging diabetic remission"

one such article and this quote from here.

So, it seems to me that the goal is to maintain a low enough BGL, and the 12 hour intervals is for the owner's convenience. At the moment, the 3 units of Prozinc is nowhere near enough, that's obvious. Yet I don't want to raise just yet, for the above reason (in bold). However, what I could do, is give the 3 units every time his sugar hits the unwanted range, regardless of how many hours have passed. I can do this, I am willing to wake up in the middle of the night and test and shoot. The question there however, is how much to give then? and where do we draw the line, at what number do we shoot again?

An easier question is when would I raise. I would raise the dose IN ORDER TO extend the periods of time between shots. So this is kind of the other way around. Rather than give one dose every 12 hours, we adjust the dose in order to achieve the 12 hour interval.

I am going to throw this out there and see what everyone thinks. Of course I am not going to do this without hearing some opinion first. Has anyone thought of doing this? Or am I being crazy?

 

[JanetNJ]

We hit 40 at +10! Yes, that's right, 40. I didn't even know numbers can go this high.

So there's clearly a trend visible on the SS, the more I give the higher the numbers go. Yet we haven't even approached the dose that could POSSIBLY work and last a good 12 hours, but I'm not allowed to raise dose for a full week or two (well, 1 or 2? cos that's not clear either) on the same dose, as per vet's instructions.

I've read article after article on feline diabetes and they all agree on this:
"To control BG to <14 mmol/l (252 mg/dl) for as much of a 24 h period as possible; and
To avoid clinically significant hypoglycaemia at all times.
Where more intensive monitoring is feasible, aiming to maintain BG ⩽11 mmol/l (198 mg/dl) may be helpful in further minimising metabolic derangements associated with DM and in encouraging diabetic remission"

one such article and this quote from here.

So, it seems to me that the goal is to maintain a low enough BGL, and the 12 hour intervals is for the owner's convenience. At the moment, the 3 units of Prozinc is nowhere near enough, that's obvious. Yet I don't want to raise just yet, for the above reason (in bold). However, what I could do, is give the 3 units every time his sugar hits the unwanted range, regardless of how many hours have passed. I can do this, I am willing to wake up in the middle of the night and test and shoot. The question there however, is how much to give then? and where do we draw the line, at what number do we shoot again?

An easier question is when would I raise. I would raise the dose IN ORDER TO extend the periods of time between shots. So this is kind of the other way around. Rather than give one dose every 12 hours, we adjust the dose in order to achieve the 12 hour interval.

I am going to throw this out there and see what everyone thinks. Of course I am not going to do this without hearing some opinion first. Has anyone thought of doing this? Or am I being crazy?

Looks like he's got some insulin residence going on. You've held the dose 5 days. If it were my cat I'd go to 3.5 in the morning.

 

[Noah & me (GA)]

Do Prozinc kitties bounce? Noah was on an ever increasing dose of Caninsulin until I cut his dose in half. The bounce can be a hard concept to grasp, the fire is getting bigger so you throw less water on it.

 

[JanetNJ]

Are you testing for ketones? That would be a concern with these high numbers. Add lots of extra water to the food.

 

[JanetNJ]

Do Prozinc kitties bounce? Noah was on an ever increasing dose of Caninsulin until I cut his dose in half. The bounce can be a hard concept to grasp, the fire is getting bigger so you throw less water on it.

Sure they do but this cat has never shown a low number yet. I think it's resistance.

@Kris & Teasel @Rachel what do you think

 

[Galaxy (GA)]

No ketones in urine, ever. test it weekly.
also, this same article says, hyperglycemia causes insulin resistance. it's insane! What if I raise it by increments, but he just keeps developing what seems to be tolerance, and then goes even higher?
Yes, always wet food, and warm water on top of that. Plus he's getting the subq fluids now, every day.

 

[Tanya and Ducia]

However, what I could do, is give the 3 units every time his sugar hits the unwanted range, regardless of how many hours have passed.

Hi,
I am not Aa ProZ user but I noticed your "experiment" title and thought I'd chime in.
Do you mean giving multiple shots a day of the same 3U ProZ dose ?
It is way too dangerous, especially for someone being recently Dx.

Some Lantus users give Rapid (R) acting insulin (fast to kick in, short lived) to help Lantus given still BID bringing the numbers down; others used TID method - x every 8 hours. But these are very advanced technique and both require tight monitoring. (I do not know if the same technique was done with ProZ, let's ask @Djamila @Rachel about it). Please do not start the experiment alone.

I totally understand why you are thinking about it - these Black numbers are scary.
I agree with @JanetNJ - the SS does look like glucose toxicity and increasing to reach the breakthrough dose is the only way I heard of.

I do hope someone will chime in shortly to help your boy.

PS. It would be good to start testing ketones daily, it develops very fast.
@Galaxy

 

[FurBabiesMama]

Personally, I would not start messing with shot times at this point. I think I would increase the dose every few days until there is a breakthrough. Staying on the same dose a week or two when it clearly is not having the needed impact makes no sense. It usually only takes three or four days to see the impact of a dose of ProZinc on even 'bouncy' cats.

Can you give us some background here? Your signature says diagnosed Nov 2018. The spreadsheet says "on caninsulin since Feb/March". What was Galaxy on before Feb? How often have dose increases been done and with what result? The first few days on the spreadsheet show the dose being decreased though the numbers stayed high - was this because there was some thought that perhaps the right dose had been passed and too much insulin was being given? If he was on 5u of the previous insulin and still in high numbers, it is not surprising to me that you would not be seeing a response yet on just 3u of ProZinc. Some context here might help.

 

[JanetNJ]

No ketones in urine, ever. test it weekly.
also, this same article says, hyperglycemia causes insulin resistance. it's insane! What if I raise it by increments, but he just keeps developing what seems to be tolerance, and then goes even higher?
Yes, always wet food, and warm water on top of that. Plus he's getting the subq fluids now, every day.

If it is resistance then once you find the breakthrough dose it should start coming down.

 

[Rachel]

Wow...yeah I do see what you mean about those high numbers. You're getting lots of blacks and reds, and that's so scary for us and probably doesn't make our kitties feel super good either. You and your little guy are having it tough right now!

I understand completely why you want to try just giving insulin whenever, but I honestly can't recommend it. There's several reasons and I want to explain them as best I can. First off, what would the unwanted range be? It seems that Galaxy stays in high numbers all day and all night, so I'm not sure exactly when you'd need to give insulin in there. Second, giving insulin like that could be extremely dangerous. You'd have overlapping cycles and if Galaxy suddenly got a drop at any point in time, with extra doses of insulin onboard that are all nadiring at different times, bringing him back up would be a challenge...it would almost certainly require a vet visit and a glucose drip since it wouldn't be the same as just saying if I can get him past nadir, he'll come up on his own. Third, it would be exhausting for you. It's not just waking up in the middle of the night. It would involve you staying up or waking up pretty often because you'd need to test like crazy. You'd also need to keep METICULOUS records to ensure that we all knew (and your vet knew) what was going on at any given time in case of an emergency.

Prozinc should last 12-14 hours. Yes, cats on Prozinc can (and do!) bounce but I don't see that here...you'd see some low numbers if he was, and Galaxy is just staying high. I really think you're just seeing glucose toxicity here (DON'T be scared by that...it just means that the BG has been high for awhile and he's developed some resistance to it). We've seen this a lot here and honestly, the absolute best plan to combat this is to keep raising the dose every 3-4 cycles (yep, every day and a half or two days). If you raise by .25 following this method, in time you'll hit that breakthrough dose and it will come back down. Honestly, cats who do that usually hit that dose and then run back down the dosing scale. No one ever believes me when I say it, but honestly it works! Several people have come back and admitted they never thought they'd hit that dose but when they did they were AMAZED by the change! Heck, I was too when I first got here! It really does work.

There are other options as Tanya mentioned. We've had folks do TID dosing (every 8 hours). That is exhausting too and honestly, I've never really seen it do great things. Generally speaking, that would be recommended if we thought the dose wasn't lasting long enough and I'd usually just recommend Lantus or Lev at that point. It COULD be useful in this case because it might help push the BG down and help keep things consistently lower. We've also done R dosing with Prozinc...not much, but we have used it before and it's been useful at times. Overall, though, I'd be hesitant to use those right now. My first plan would be to try upping the dose like I recommended above because that way, you can know the plan and know what works. I don't like changing too many things at a time, and changing the dose frequently along with other methods would require more testing and more work from you...and might require more times where you wouldn't have someone there to guide you as we just can't guarantee someone will be here every 8 hours.

I know your vet said not to change the dose before 1 or 2 weeks. Did he explain why? I think that in this case, considering the numbers have NOT come down much at all, raising the dose is 100% the correct answer. You can see the insulin isn't high enough as he is staying too high, so why stick at a dose that doesn't work? If you raise every 3 or 4 cycles, you'll be testing to be sure that he doesn't go too low, and you'll be raising in small increments so you won't have to worry too much about sudden sharp drops. What do you think? What would you like to do?

 

[Galaxy (GA)]

changed title of thread

I'm going unorthodox and going to do TID. I am very scared, not sure how I'm going to tell the vet, but our primary goal is to keep his numbers down to at least red/pink at pre-shot. If this is the way I can do this then this is what I am going to do for now. Galaxy's drinking has significantly decreased since last night (normally he drinks 250 mls overnight, there was only 100 missing from the bowl this morning, and has only drunk another 100 since, which is unheard of in his diabetic history). He's no longer hanging out at the water bowl either.

SS remarks section shows what I've done since 10 pm last night.

@Rachel , really good to hear what you’re saying there, it gives me hope. I am fearing Galaxy is one of the extreme high dose cats. Vet also told me last time I saw him that he has cats on 12 units of Prozinc!!! not sure if that's per day or per shot.

What I am hoping to achieve eventually by TID is increase the dose so that the doses extend the period of time to 10-12 hours so then we can go back to BID. Why I am not so worried about overlapping cycles and an ensuing mess of ups and downs is because it has become clear that his doses do not last 12 hours yet, nowhere near; he’s always up to preshot number and HIGHER by the end of +10 hours.

I know your vet said not to change the dose before 1 or 2 weeks. Did he explain why?

he only said that's how long it takes for the cat to adjust. But so far, the only adjustment I've seen on Galaxy's part is what looks like tolerance then resistance and higher numbers.
Do you think you could point out other users who have done TID so I can see their spreadsheets? not to copy them of course but for reassurance. Or shall I start a thread asking for them to 'come forward' lol.

 

[Galaxy (GA)]

We've also done R dosing with Prozinc...not much, but we have used it before and it's been useful at times.

Could you please tell me what R dosing is. I looked in the glossary but it's not there.

 

[Galaxy (GA)]

Can you give us some background here? Your signature says diagnosed Nov 2018. The spreadsheet says "on caninsulin since Feb/March". What was Galaxy on before Feb? How often have dose increases been done and with what result? The first few days on the spreadsheet show the dose being decreased though the numbers stayed high - was this because there was some thought that perhaps the right dose had been passed and too much insulin was being given? If he was on 5u of the previous insulin and still in high numbers, it is not surprising to me that you would not be seeing a response yet on just 3u of ProZinc. Some context here might help.

Hi FurBabiesMama,

before caninsulin we tried glipizide, the tablet, didn't do anything but also I wasn't hometesting yet so can't tell for sure, but when I took him back for another test (not even a curve then, it was another vet, since retired), he was really high. he got the caninsulin then. I still wasn't testing as hadn't yet found the forum. And yes, I decreased, from 6 units (not on the spreadsheet) as he suddenly started drinking a liter a day!!! I thought exactly what you're saying here, that we had passed the right dose. After this I just saw that not much was changing, and pushed the new vet for prozinc, as I knew it's slower acting, longer lasting.

 

[Diana&Tom]

Hi, first I'd like to say that I admire you for being pro-active and making what seems to be a decision based on your wish to do your best for Galaxy. It's so easy to just carry on for weeks and weeks with no progress, hoping for a breakthrough, and it's incredibly frustrating and depressing, I know.

My Tom (in my avatar) was an acrocat and I tried TID for a while in my desperation to get his numbers down. I don't and didn't have a spreadsheet, I just kept a written notebook to log the numbers. This was a good few years ago. All I can remember, to be honest, was the permanent exhaustion of having to work my whole 24-hour routine around testing and shooting - I was like a zombie - and it was all in vain anyway because poor Tom's numbers still hardly budged. The vet I had at the time didn't have much of a clue and I had to urge her to test for acromegaly which sadly came back positive, which of course explained the permanently high numbers which massive doses of insulin barely touched. Of course, every case is different and there is no suggestion at all right now that Galaxy may be an acrocat - but if you haven't done so, I'd talk to the vet about it and maybe do the test if only to rule out the possibility. Nobody wants their cat to have acromegaly but if that is the case at least you'd know what you're dealing with and could look into possible treatments - there are definitely more options now than there were a few years ago. If it's not the case then fine - carry on increasing until you get a breakthrough, which you will eventually.

Good luck, whatever you decide to do!

 

[Galaxy (GA)]

Hi, first I'd like to say that I admire you for being pro-active and making what seems to be a decision based on your wish to do your best for Galaxy. It's so easy to just carry on for weeks and weeks with no progress, hoping for a breakthrough, and it's incredibly frustrating and depressing, I know.

My Tom (in my avatar) was an acrocat and I tried TID for a while in my desperation to get his numbers down. I don't and didn't have a spreadsheet, I just kept a written notebook to log the numbers. This was a good few years ago. All I can remember, to be honest, was the permanent exhaustion of having to work my whole 24-hour routine around testing and shooting - I was like a zombie - and it was all in vain anyway because poor Tom's numbers still hardly budged. The vet I had at the time didn't have much of a clue and I had to urge her to test for acromegaly which sadly came back positive, which of course explained the permanently high numbers which massive doses of insulin barely touched. Of course, every case is different and there is no suggestion at all right now that Galaxy may be an acrocat - but if you haven't done so, I'd talk to the vet about it and maybe do the test if only to rule out the possibility. Nobody wants their cat to have acromegaly but if that is the case at least you'd know what you're dealing with and could look into possible treatments - there are definitely more options now than there were a few years ago. If it's not the case then fine - carry on increasing until you get a breakthrough, which you will eventually.

Good luck, whatever you decide to do!

Thank you @Diana&Tom ; I have just had the biggest scare of my life, and am abandoning the TID. at +8, he's up to 41.4, called the ER vet in despair, who was not particularly worried! they are more concerned about me testing at home, can you believe it... I'm going to give him 4 units at 6pm, which is +12, and then ASAP have him tested for IGF1. basically, all the vets I have spoken to, say that as long as he's not keto-acidotic, these high numbers can be lived with? I will continue giving him subq fluids as well. we'll see after the IGF-1 test.

 

[Jenna Josie]

Hi Edy. I am just going to chime in here, perhaps undiplomatically, and second the idea that this is probably not your best course of action just yet.

our primary goal is to keep his numbers down to at least red/pink at pre-shot.

I think that the primary goal is more accurately to get Galaxy as healthy as you can, which yes, lower pre-shot numbers will be evidence of, but I think that the best way, at this point, is to do as others have suggested, raising the doses every 3-4 cycles (so every one and a half or two days), until you reach the "breakthrough" dose that relieves the toxicity it looks as though Galaxy has developed.

What I am hoping to achieve eventually by TID is increase the dose so that the doses extend the period of time to 10-12 hours so then we can go back to BID. Why I am not so worried about overlapping cycles and an ensuing mess of ups and downs is because it has become clear that his doses do not last 12 hours yet

Your are absolutely right that his doses are not lasting 12 hours, but that is almost certainly because the dosage is too low. Therefore, the way to extend the cycles is the same as the way to get his pre-shot numbers down: to increase the doses every 3-4 cycles until you hit the good dose. As someone mentioned upthread, if you were giving 5 units on your previous insulin, we would expect for Galaxy to need something like that on the new one, at least for a while. You're currently only at 60% of that, so there's a way to go there.

Those numbers are scary, but I would encourage you to try to keep within standard protocols to bring them down most safely.

 

[Diana&Tom]

Thank you @Diana&Tom ; I have just had the biggest scare of my life, and am abandoning the TID. at +8, he's up to 41.4, called the ER vet in despair, who was not particularly worried! they are more concerned about me testing at home, can you believe it... I'm going to give him 4 units at 6pm, which is +12, and then ASAP have him tested for IGF1. basically, all the vets I have spoken to, say that as long as he's not keto-acidotic, these high numbers can be lived with? I will continue giving him subq fluids as well. we'll see after the IGF-1 test.

Unbelievable - some vets just don't seem to realise that long-term high bg can cause serious damage. I remember very well showing my vet my notes with bg forever in the 20s and he wasn't remotely bothered. I despair.
I think you're right to abandon TID and also to get the IGF-1 test. If it comes back ok, celebrate and get on with trying to figure out the dosing dilemma. If not, you have other options to consider. Either way, you'll at least know a little more.

 

[Rachel]

I agree...I think abandoning TID is the right thing. What do you think about raising the dose every 3-4 cycles? Your vet's assertion that it takes 1-2 weeks for a dose to start working is not true...especially with an insulin like prozinc. We have had some cats who needed to settle in to a dose, but even then it's usually only 3-4 cycles at most before we see that they have.

I think it's great that you're going to get the IGF-1 test too! Thanks Diana for that information...I don't know enough about acro to give good advice there, so I'm glad you were able to!

 

[JanetNJ]

I would be surprised if you saw much progress before 6 units.

 

[Galaxy (GA)]

I would be surprised if you saw much progress before 6 units.

I would be surprised to see even after, or before silly numbers like 12 units in one shot, as I've seen on others' SSs. The crisis may have been averted brought on by my insane experiment, he's 'only' 40.4 at +9. I've done a ketone test, definitely shows as negative

; I also remembered that before we started the hometesting and everything, he did have an episode of DKA, and we didn't even know it. I just remember his urine smelling REEEEALLY strong and he stopped eating, lost a lot of weight. This was even before we were given the injection, Caninsulin to start with.he was still on the glipizide back then. It was so scary, I had to feed him out of my hand, and he looked like he couldn't see, and I can't even remember how he recovered from it; now I know he would have needed hospitalisation etc. poor Puss! anyway, at least i know what to look out for, however, I'm not sure how to prevent DKA on these insanely high numbers. ATM I am giving him subQ a good 60 ml a day, and he's not losing weight but not putting on either.
Is there anything else I should be doing to prevent DKA? This is my main concern until we can have the IGF-1 and pancreatitis tests done, hopefully this week, but I'm still waiting to hear back from the vet.

 

[Tanya and Ducia]

Hi,

I'm not sure how to prevent DKA on these insanely high numbers.

you already doing what's can be done at home - they need enough insulin+enough calories and total absence of any kind of infection or inflammation, or at least it's been treated with AB.

If increasing doses of SQF + extra water in ea meal is not in conflict with a cardio disease I would try 100 ml SQF for a few times and see if that's works but his heart has to be good and able to carry extra liquids.
Prevention of ketones' further development is what can be helped at home with insulin, foods and fluids.
Keep a sharp eye on clinical signs.
Testing urine i s exactly what's needed and you already doing it.
Once you read above Trace level of ketones be prepared to go to a vet.

he's not losing weight but

this is terrific!

PS. I almost forgot: a while ago there was talk on the Lantus Forum about SQF interfering with insulin effectiveness IF given just prior to or at the time with injection. The was no conclusion drawn but I, like some others, switched to different times for injection and SQF sections, I think we did 4 hours apart. Not sure what it helped but it definitely did not hurt anything BC Ducia recovered fine from her DKA.

 

[JanetNJ]

I would be surprised to see even after, or before silly numbers like 12 units in one shot, as I've seen on others' SSs. T

My cat is on 12 units twice a day because she has acromegaly. This means she has a tumor in her pituitary gland causing havoc. Most times when you see insane doses like that, acromegaly or some other high dose condition is why.

 

[Galaxy (GA)]

My cat is on 12 units twice a day because she has acromegaly. This means she has a tumor in her pituitary gland causing havoc. Most times when you see insane doses like that, acromegaly or some other high dose condition is why.

Yes, I'm having Galaxy tested hopefully this week. I have looked at CC's SS, been wanting to see acromegalic SSs for a while, as I am suspecting the same issue with my furbaby. Bless 'em! I'd be happy to get a SS like yours after a while. How do you guys cope with this condition? Are you stressed because of the dosing differences? I had a week off last week, and I didn't have a good time, cos it was all about Puss and not being able to suppress his sugar. Stressed me right out.

 

[JanetNJ]

Yes, I'm having Galaxy tested hopefully this week. I have looked at CC's SS, been wanting to see acromegalic SSs for a while, as I am suspecting the same issue with my furbaby. Bless 'em! I'd be happy to get a SS like yours after a while. How do you guys cope with this condition? Are you stressed because of the dosing differences? I had a week off last week, and I didn't have a good time, cos it was all about Puss and not being able to suppress his sugar. Stressed me right out.

I just give her what she needs and test regularly. I really stressed when she got double digits.... But now that I know why it just is what it is.

 

[Galaxy (GA)]

OMG, I don't want to jinx it, but we're still down in red at +7.5 hours! this is new! and for Galaxy it's progress! I couldn't keep it to myself! I know it's still high but there's definitely a downward trend. We might be getting somewhere. I think I should have started hydrating him sooner (SQF). I do keep subq a few hours apart from shots/tests as well.