Going on 3 Months...

[DiabetesSucks]

Hello all,

I posted a few times when Bengal Beast was first diagnosed in August, but quickly became overwhelmed by all of the info and just focused on establishing a routine. Good news is I have a routine and BB has been fairly easy to test and administer insulin. Bad news is his numbers are still all over the place.

I know you all are going to tell me to get a spreadsheet so you can see, but I just have not had the time to get that done. I have been keeping track of every pre shot number for the past 3 months. He started out in the 400 to 600 range and started on two units of ProZinc. Nothing seemed to get his numbers down until in consultation with my vet, we jumped to 4 and 4.5 units. His numbers began to decline mid-cycle and some pre-shot numbers have been down in the 200s and 100s. I reduced or didn't shoot to compensate.

His weight is stable now at 14 to 14.5 pounds. I am unable to get him on wet food as he has been a lifelong dry food eater. However, he has fully switched from Blue Wilderness to Dr Elsey's and a mix of the Pro Plan DM.

He still drinks too much and pees too much. Sometimes his pre-shot numbers are still in the 400 and 500s. My question is, how long is this roller coaster going to last? When should I give a different insulin a try? I am now almost through my second vial of ProZinc. Should I give Glargine a try?

 

[FurBabiesMama]

It only takes a few minutes to set up the spreadsheet, and it is very important. There is no way we can give you informed advice without seeing what is going on with his numbers. His numbers could be high because he needs more insulin, or they could be high because he is getting too much insulin. Mid-cycle numbers are more of an indicator of insulin impact than pre-shot numbers. The spreadsheet, with pre-shot and mid-cycle data, allows us to see patterns and get a picture of what is happening. Without it, everything is just guessing. Please help us help you by taking out the time to set up the spreadsheet.

You mentioned starting at 2 units of ProZinc - do you mean 1 unit twice a day or 2 units twice a day? 1 unit is the normal starting dose; 2 would be way too high to start out. You said you 'jumped to 4 and 4.5 units' - did you go from 2 to 4? That would be way too big of a jump. It is recommended that increases are made in quarter units. If increases are not gradually made, it is very easy to zoom past the correct dose. If you are giving too much insulin, it can increase volatility... cat goes too low then bounces up into high numbers and remains relatively flat and high for a few cycles then drops again... it's a vicious cycle that turns your cat's glucose into a wild bouncy ball on the loose!

How long it takes to get a cat's glucose regulated varies by cat. It is not always a quick process. Two and a half months is still early for some. The more difficult a cat is to regulate, the more important to have data and be very systematic in dosing changes. Just jumping insulins isn't guaranteed to 'fix' the situation. I have often heard it suggested (including by an internal medicine specialist) to give an insulin about 6 months before determining whether it is the right insulin or not. If you have enough data and have been gradual and systematic in your dose changes and it is just proving to be an epic fail, then *maybe* changing a bit earlier would be in order, but otherwise, I would not suggest it (and not as early as 2 1/2 months anyway).

How are you almost through your second vial when your cat was just diagnosed 2 1/2 months ago???

 

[DiabetesSucks]

It only takes a few minutes to set up the spreadsheet, and it is very important. There is no way we can give you informed advice without seeing what is going on with his numbers. His numbers could be high because he needs more insulin, or they could be high because he is getting too much insulin. Mid-cycle numbers are more of an indicator of insulin impact than pre-shot numbers. The spreadsheet, with pre-shot and mid-cycle data, allows us to see patterns and get a picture of what is happening. Without it, everything is just guessing. Please help us help you by taking out the time to set up the spreadsheet.

You mentioned starting at 2 units of ProZinc - do you mean 1 unit twice a day or 2 units twice a day? 1 unit is the normal starting dose; 2 would be way too high to start out. You said you 'jumped to 4 and 4.5 units' - did you go from 2 to 4? That would be way too big of a jump. It is recommended that increases are made in quarter units. If increases are not gradually made, it is very easy to zoom past the correct dose. If you are giving too much insulin, it can increase volatility... cat goes too low then bounces up into high numbers and remains relatively flat and high for a few cycles then drops again... it's a vicious cycle that turns your cat's glucose into a wild bouncy ball on the loose!

How long it takes to get a cat's glucose regulated varies by cat. It is not always a quick process. Two and a half months is still early for some. The more difficult a cat is to regulate, the more important to have data and be very systematic in dosing changes. Just jumping insulins isn't guaranteed to 'fix' the situation. I have often heard it suggested (including by an internal medicine specialist) to give an insulin about 6 months before determining whether it is the right insulin or not. If you have enough data and have been gradual and systematic in your dose changes and it is just proving to be an epic fail, then *maybe* changing a bit earlier would be in order, but otherwise, I would not suggest it (and not as early as 2 1/2 months anyway).

How are you almost through your second vial when your cat was just diagnosed 2 1/2 months ago???

Thanks for the reply. He was started on 1.5 units twice daily and raised at .5 increments up to 4.5 twice daily over the course of the past few months. His numbers never really changed until we reached the 4 unit mark. I have done a few at home curves where I've tested him every 2 or 3 hours. He is dropping and the lowest recorded number has been around 120. However he still has pre-shot numbers at times in the upper 500s.

He's on his second vial because our refrigerator lost power and I wasn't sure if the previous vial was still viable. Since he has been given 4 to 4.5 and a half units twice daily this vial has gone quickly.

I have varied his shot locations and made sure I am injecting correctly. I'm just more concerned about how long I should try before switching to another insulin. What the consensus is on that.

 

[FurBabiesMama]

I see that he was diagnosed on 8/27, so assuming you started insulin that very same day, it will just be 11 weeks (77 days) tomorrow. I'm sure it feels like forever to you, but that is really not that long. I would want to know for sure that the current insulin is not the right one before jumping ship to another one, so I would give it more time.

You said his pre-shot numbers are at times in the upper 500s but some pre-shot numbers have been down in the 200s and 100s. To me, those wide swings sound like a possible red flag that his dose may be too high. When that happens, and you have to reduce the dose or skip it, that just adds to the volatility. Once everything gets wacky, it becomes harder to figure it all out. I'm glad to hear you increased in 1/2 unit increments and nothing larger, but it is possible that you still could have gone past the correct dose if there was not enough mid-cycle data used to make the dose change decisions or if the right dose was in between somewhere along the way (1/4 unit). If all your pre-shots were high, I would remind you that the pre-shot numbers will be the last to come down. Once you get a cat going into regular numbers consistently during cycles (nadir), over time, the pre-shots should start to come down.

We are very data-driven here. It would be irresponsible of us to make too many recommendations - either about dosing or about changing insulin - without data. So, please consider doing the spreadsheet. It really can be a valuable tool for you in managing this, and it helps us help you.