Getting regulated

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sueandsamwise

sueandsamwise

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How long does it take to regulate a cat on insulin? Sam has been on Prozinc since the first part of Sept and still is losing weight and eating his head off. He's also still drinking and peeing a lot. He's on 2U twice a day. I am getting worried about him. nailbite_smile
 
I can't comment on dosing - I don't know your insulin, but looking at your ss, I wondered how come you have no pm cycle numbers? It is hard to say much when there is only half the picture on the ss. Many cats go low over nite, and you need to know what is happening in the evening.
Also, why are you staying with that dose if it's not enough? With such high numbers, I would think that you should increase the dose.

Others who are familiar with your insulin will be able to say more, but I can't see regulation happening if you are not giving enough insulin.
 
Could it be that this insulin is not a good fit for your kitty? Also, could there be something else going on? A UTI or other type of infection? That could explain the high bg's. This seems like a long time for him not to have had some success with his insulin.

Many people seem to have success with Lantus and Levemir, and while many people have not had success with NPH insulin, we have done ok with it. The NPH acts quickly and does not last as long as Lantus and Levemir... those both are more gentle and slower acting.

I also know that there are some folks here that use both at times... with the guidance of their vet.

Is your vet open to discussing other options? Maybe poke around the insulin boards and see what others have found regarding other insulins. I would definitely give a call to the vet either way... the fact that you are home testing will help you with any insulin should you chose to switch, and it will help your vet get a clearer view of what is going on.
 
Hi Sue,

Has your vet advised you not to increase the dose? Sure looks like you have stuck with your present dose long enough. I could see increasing by .25 units. Also, have you gotten really serious about the treats - only giving low carb? I do agree that you need some more mid cycle tests to see what exactly is happening.
 
Hi Sue! We increased Sam's dose to 2U the last time he went to the vet's 2 weeks ago. He was on .75U twice a day then up to 2 twice a day. He has been very lethargic lately, moving in slow motion so to speak. It takes him awhile to lay down, almost like he forgets what he's doing there. My husband called the vet this afternoon to see if it was alright to up his dose and they want to see him tomorrow. We have been testing him before every shot and he is alway up in the high 400's or just high! He is also not gaining weight. I'm sure they'll think it's because we aren't feeding the DM but he doesn't like it and I don't want to pay for something they just get a kick back from. Maybe the insulin doesn't fit him, he was on Vetsulin before.
 
You've had him checked out in general? No infections? Teeth are okay?

It may be that PZI just won't work or it could be that you need to up the dose. I would just up it by .25, hold for 3 days or so, then another .25. I guess I would use the rest of the PZI, increasing the dose and see what happens. If you are out of PZI and things have not improved, you can get Lantus or Levemir.

And I would get serious about getting more data. It may show you something we have missed completely.
 
I don't think anyone here is able to say the insulin is not a right fit at this stage. And the suggestion of that is premature IMHO at this stage. But I will admit the numbers are wonky and every potential cause of that wonkyness should be explored. The first thing is that consistent testing of the PSs is not going on. We need that data along with the mid-cycle test to really make good suggestions. This looks like it has improved over the last week perhaps. And with ProZinc we like the smaller and methodical dose increases - just to make sure we do not miss anything.

I think Sue has posted over in PZI before. This is where we left off:
viewtopic.php?f=24&t=30501

I'm short on time to re-evaluate the sitch right now - perhaps later. I just wanted to get folks here up to speed.

Sue, I know you want your kitty to feel better like yesterday. But just keep in mind this is more like a marathon and not a sprint. :smile: The additional data you are now getting is helpful. I think the thing now to do is to work with you on capturing a more coplete picture of the curve as your schedule permits.

There is reading here about curves [if you have not read this already]:
http://felinediabetes.com/bg-home-test.htm
 
Sam is at the vet right now. He would not eat this morning at all. Nothing tempted his appetite, not cheese, not a pill pocket, not treats, nothing. His amps was 349 but without any thing in his belly we DID NOT give him the shot. Charlie told them at the vets office so hopefully they won't shoot him. If they do at least he's there where they can help. He also tried to impress them that we can not afford a huge bill of 800.00 again so they can't keep him unless they push him into hypo. They did that once before. nailbite_smile
 
Thanks, Sue, me too. I'm very worried about him. I'd hate to have to euth him just because he can't be regulated. The first time on insulin, it only took a month to get him OTJ. Course, I can't communicate with my vet because I don't like her at all.

No, he's not been tested for ketones nor does he have a history of pancreitis.
 
Sorry to hear this. I hope Sam will be OK.

When Sam is feeling better please visit us in PZI, we would like to help you optimize your testing and get Sam moving forward. Or you can ask the folks here in Health if you like how to optimize your testing too.
 
I know, I've called several and they all have the same mind set as hers. Stone, must eat DM only, etc. I haven't heard anything from them yet.
 
I am not quite sure why you must follow the vet's advice to the letter when it comes to FD.
Why can't you just say that your cat will not eat the DM - at all. I have 4 cats and have tried to give them DM... Not ONE of them will touch it.

My vet office does not tell me what to feed my cats, does not provide me with dosing info, and does not tell me what insulin to use.

My vet office is needed for non-FD meds, testing, Xrays, u/s, dentals.

Maybe you can ask others in your area what vets they see, and how they are with different issues.

YOU are the client, yes? It is YOUR cat and YOUR money, so you should say what goes.
Maybe you can focus on areas non FD with the new vets you interview, and mention in passing that your cat is also diabetic but doing quite well on insulin and you keep a close eye on his numbers by home testing. You could just happen on a vet that is just fine with all that, like my vet office. The vets that see my cats know squat about FD but they have other strengths that I need.

Remember that you are the boss, so don't let your vet push you around.
 
I don't follow the DM advice at all. Even our dog won't eat the DM and he'll eat anything. None of my civvies will eat it either. Sam will eat a bit of it then no more. My hubby just told them that Sam wouldn't eat the DM at all. He is home from the vet now, his BG was 329 when he dropped him off and 249 an hour after the shot. I don't know anything else, what dose, what time, etc. yet.
 
Did the vet not give you advice or have you just not gotten home to hear it?

IMHO, I would increase the dose by .25. Get some mid cycle tests in this weekend. If no movement by Tuesday, increase by another .25.

Can't remember if you have, but if not, get some ketostix and test for ketones.
 
Just hadn't gotten home to hear it. She told the DH to shoot no matter what. Even if he hadn't eaten that day. I couldn't believe it! I will not take her advice on anything anymore. I am going to make an appt with my old vet just to talk to her about Sam. I won't take Sam I just want to ask her questions.

We tested Sam before his shot tonight and it was 156. Nice number. He has eaten a number of times since he got home and had a good meal right after the shot. We will do another test in two hours. The reason you don't see very many tests after his pm shot is usually because we have gone to bed already. My husband has Crohn's disease and sleeps a lot and I have to get up early and work. He stays up if Sam seems "funny".

Sam has been acting more like his normal self tonight. He was "urpy" yesterday and this morning, I heard some sounds in his belly and he did vomit up grass last night. Could be why he didn't eat. What can you give a cat with an upset stomach?
 
156! Wow - where did that come from? Obviously, you should disregard my advice.

Did you shoot 2 units? If so, I would take a couple tests tonight, even if it means setting the alarm. He could possibly dip low. You can also leave out food so he can eat if he needs too.

Lots of people give 1/4 of 10 mg tablet of regular Pepcid for an upset stomach - in a pill pocket or wrapped up in a piece of cheese....
 
Please confirm this with your vet...

my best friend is a vet tech and when Lulu was dealing with tummy issues she recommended 1/4 tablet of Famotidine 10mg I think 1x a day? It is the ingredient in Pepcid AC. She reinforced making sure it was the 10mg tablets. It seemed to help... but there were many other things going on for him at the time (teeth, antibiotics, new to insulin, lots of visits to the vet, nervous moms, and way more attention even for being the favorite... don't tell the others)

I would totally go to my friend's practice if we lived in the same state... and from the discussions I've had with her about diabetes, I know the doc's there highly recommend home testing etc. She's been a tech for 20+ years, and I totally trust her with this, but I would still call your doc and double check. You know your kitty best, but your doc is right behind you and hopefully really supportive.

Amanda

(edited to change the dose from 1/2 to 1/4... I think Sue is correct about that... thanks Sue)
 
+2 another 156! Wow. Great numbers! We will try to stay up and do another test at +3. My doc is NOT supportive, she is an arrogant know nothing! I am so glad Sam has suddenly turned a corner. We did shoot 2U. I am staying up another hour to do another test for sure! Food will also be left out though our resident fat boy will probably eat it. Dry for a pinch, Ghost lets no wet food harden. The pig.
 
I fell asleep and didn't get any more tests last night. Did you see his AMps and the +4! Wow, normal range. I was worried about hypo but after the +4 test he ate quite a bit of food. It was time for his noon meal anyway. I am keeping my fingers crossed that we get to lower the dose not push it up. :smile:
 
What happened? Did he realize you were unhappy and decided to get with the program? That's a great number. Wonder what your PMPS will be? :-D
 
This is exciting, Sue. Did anything else change? Has he been staying inside in this cold weather and maybe not getting into something he shouldn't? Have you changed food?
 
Sam has been staying in since it's cold. We haven't changed foods really I did feed him some Merricks BG which he liked. But we've had a big step back. His BG +3 last night was 547, then this morning twice it was high. :YMSIGH: He was doing so well yesterday too. He was interested in dog food yesterday but we put it up out of reach. So, who knows.
 
Could this be a rebound? If he's body is not secure in the 50 range and his been mostly in the yellows etc? I also wonder if he didn't get into that dog food :-D

Just a thought. Wish I could be of more help. Hugs and pats to you and your kitty.
 
I think I would work on the dog food and make sure he can't get anywhere close. If he is a carb sensitive cat, a bite can make a huge difference....
 
Boy, I thought we caught him before the dog food. He's not to carb sensitive either. I don't know what's going on now. Charlie thought he didn't get all his morning shot, we got new needles and they are pretty small so it's hard to tell when you are under the skin. He was doing so well too. :YMSIGH: Just tested him again 30 minutes ago and it's still reading high.
 
I would think maybe the food. He was at the vet yesterday so had no access to it. That could be the lower number, reacting to no high carb food. Can you switch the dog to wet? Cats who love dry are very sneaky about getting dry. We've had kitties break into cupboards to get at it.

What are you going to do about an evening dose?
 
Our dog eats both. He could really not have to have food down at all, since he only eats when we eat dinner. I do pick up the food but the husband puts it back down. Says his (overweight) dog needs to eat. Anyway, he may have gotten something. I think the short needles are the culprit. I had trouble with shooting the insulin all over my hand the other night and Charlie had it go all over his fur this morning. So, we'll do a PMPS and then shoot two and check on him.
 
After two days of high readings I did a hair shot this morning which showed in the +2 reading of 524. Dammit! And i even managed to poke his ear myself and get blood. Then to go and stick the damn needle right through the fold of skin. Crap, I suck at this. :sad:
 
Breathe, Sue, breathe. You'll be an expert - just be patient.

Darn the high numbers. Did you get rid of all dry food (dog too) in the house? I really think there could be a correlation.......
 
We've been picking up the dry dog food until Reo is ready to eat. Sam doesn't jump up on the cupboards, he's afraid he'll slip on the wooden floor. I do think now that it may have been the dog food. Usually I am pretty good with the needle but just didn't get it in right today. I hate diabetes! :cry:
 
Caught Sam in the dog food tonight! Aghhh. He had a piece out and was eating it. I gave him some canned food and he was happy. No wonder his BG has been so high.
 
If it helps, we also have a drooler that Max wanted to steal food from, so I just switched the puppy to all canned food too. Dog is happier, diabetic cat is safer, and mom is keeping her sanity.

The other upside at least here to the switch is doggie is no longer getting ear infection after ear infection. I may go broke feeding a 75lb drooler all canned food, but my fur babies are happier and healthier.

Mel
 
My boss's drooler also had infected ears, he is allergic to corn. So now he eats a high dollar dog food. Reo hates most canned food and it's high in corn too. I am keeping the dog food up off the floor now. He eats when we eat and that's it! I don't know why Sam is still so high.
 
Can you arrange a full curve sometime [testing every 2 hours for 12 hours]? Weekends are a good time for that. :smile:

Also there are other reasons a cat may run high. I have my incomplete list here:
viewtopic.php?p=77223#p77223

You do not have a profile up which would help you and us. You could answer all the questions in the profile template then put in the answers of questions you get a lot which would help us and help you not have to be frustrated by answering the same questions a million times.

When was the last time you went to a vet, what did they say about the dental situation if anything, have you had a full dental [including x-rays] recently?

I know this can be frustrating but we really are trying to get down to the bottom of things. I had asked earlier if Sam was getting any naughty food and you said he wasn't and it turns out he was getting dog food. So I really need you to really examine all the possible alternatives in order for you to get the best advice.

Also I think you are doing a great job now on getting all of those PSs.

It is possible now that he is not getting dog food that his insulin needs have dropped dramatically and he now needs less insulin and i rebounding. And testing a lot of the only way to determine that [or doing a rebound test].

I encourage you to post in PZI group and get more input from all the folks in there. Asking specific questions helps too.

Health is not so adapt at following one person over a period of time - that's more what the ISGs do.

Also we've started a newbie checklist in PZI - even though it is still in draft form I encourage you to read it:
viewtopic.php?f=24&t=31358

Do you have any thoughts about using U100 syringes instead of the U40s?
 
I can't figure out how to get the profile up. The dog food is now kept off the floor where Sam can't get at it. He had his teeth cleaned last year. Vet did not say a word about his teeth the last visit which was 11/23. They want another look see in Jan. Other than being skinny she said he is healthy. He's been high six days in a row. I know he isn't getting into the dog food anymore. He got a nice fur shot tonight thanks to the husband. We are using the U100 syringes which is causing all the fur shots. Why I don't know.
 
Sue,
Push that needle in all the way up to the hilt [if you are using the 5/16"]. Then be very conscious to push the plunger - not pull the barrel. Hope this makes sense.

Here are those profile instructions just in case you have not read:
viewtopic.php?f=6&t=17766
 
Makes sense. I was pulling back when I was pushing the plunger. I hope I've broke myself of that now. I did good this morning and got the whole thing in. If I insert it under the skin parallell to the spine I can get it in the cat instead of on the fur! I will try to get that profile up. I'm just a retard at anything to do with making stuff on the computer.
 
Good work on getting that curve! If nothing funky happens later today then it seems like you might want to think about increasing. But You should do this in small but methodical increments. Methodical also includes the testing part. If you can, at least try to grab that +3 and +6 every day until you get things nailed down. It's OK if you miss a day just do the best you can. For the increases what we would usually say is to do 10% of the nearest higher integer increases every 3-5 days. So for between 2-3u that would be .3u increases. If you were using U100 syringes and doing the conversion you would have no problem with that. If you continue to use the U40 syringes then try to eyeball .25u increments. It helps if you can get a full curve at every increment. So hold for 3 days, if you think you are seeing improvements then hold for another couple days. If not move on.

I do encourage you to post in the PZI group at least for every increment. If you get up to 4u then absolutely do come back and get more input before proceeding.

Have your "no shoot" number decided on [and be ready to no shoot or dramatically reduce your dose] and know what numbers for the nadir that might indicate she is going too low. Again getting eyeballs following you in PZI will help.

And do read the draft newbie checklist in PZI - there's a ton of info in that topic about many of the issues you may face.

Also are you testing for keytones? If not that's something you might want to do with the high numbers you are having.
http://petdiabetes.wikia.com/wiki/Ketoacidosis

That's my $0.02 - maybe others will have different input.
 
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