Hello from new members, Otis and Kate

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Otis & Kate

Member Since 2012
Hello, Sugar Cat Family!

My name is Kate, and I am the caretaker of Otis, aka Mister Big Buckinski, Mister Angel Sweetums-Sweetie-Pie, the list goes on, cause, yea, I’m that kind of mom ;)
I have had Otis since he was three days old. My husband found three tiny orphaned kittens on a job site and we bottle fed them and loved them, and they all grew up to be big and strong. They are all 14 years old and amazing cats.

Otis has a condition called cerebellar hypoplasia, which means that he is very wobbly. He has lived his entire life with this condition and it doesn’t slow him down…too much. It is very normal for Otis to fall over when he walks and to appear drunk, but when he started drinking more water than usual, we took him to the vet and he was diagnosed as being diabetic. That was on August 30, 2012. His blood sugar was quite high, 488, and the vet started him on ProZinc U-40 insulin, one unit, twice a day.

In the blood panel, it also showed that his kidneys were having issues as well. (His biological brother, Owen, also has kidney issues, so perhaps it is hereditary, perhaps it is from the diabetes.) We are taking Otis back for another blood work up in two weeks to have all of his levels rechecked, and in the meantime he is eating a kidney food from the vet, Hills k/d, which is a higher carbohydrate-lower protien food. I asked my vet about this and he said that for the time being, we need to try to manage two issues at the same time as best as we can.
Otis gets his shots at 7:30 a.m., and 7:30 p.m. He has been on insulin for 20 days. The plan is to call my vet at 1:30 p.m. on Monday, after home testing Otis, and he will direct me on how to proceed for the week.

This past week, the test showed that Otis had a BG level of 97 at 1:30 p.m. The vet had me skip his evening dose and recheck in the morning. In the morning he was at 373 at 7 a.m, so I gave him his one unit. The vet had me recheck in the evening, and he was at 265 at 7 p.m., so I gave him a unit. I rechecked this morning, and he was at 350 at 7 a.m..
Are these types of numbers okay for the first month of being on insulin?

I have decided that I am going to home test every morning and evening before his shot after reading everything on this (AMAZING) site. It just makes good sense to me, even though it makes Otis grumpy for a few minutes out of his cushy life. My vet advised me that if Otis had a BG level of 250 or higher, to proceed with the one unit dose. I think that it will make me feel a lot more in control, and less worried, if I check twice a day beforehe eats and is given his shot.

Do you guys recommend doing a curve? Is it imperative to have that every couple of hours BG information? I have read about the curves, and I understand the value of knowing where the BG level is throughout the day, but I don’t really understand what I will use it for, ya know what I mean?

Sorry this is such a long post, I just am so thrilled to have found this group. Fifteen years ago I had a diabetic cat and boy have things changed! I want to be the best diabetic mom to Otis, and am reading all of the great stuff that you have here, though admittedly, some of it is very confusing. Thanks for being such a great support resource and being so Can Do! I know that I can keep Otis safe and healthy, and I look forward to being a member of your community.

-Kate
 
Kate- I am so glad you found us! It is so good that you have Otis and his siblings from such a young age :-D .

I will try to go through and answer-
PZI - good insulin to use. Have you noticed any improvement in the 20 days? You may or may not considering that he is still eating dry food.

Food- you need low carb, canned food for Otis (and all three will benefit) but for the kidney issue- does he (or Owen) have CRF? If it isn't in the final stages they just need food that is low in phosphorous but still high in protein. There are plenty of choices available for both CRF and FD as they kind of go hand in hand. Type in CRF in the search box at the top and you will get a whole lot of topics to read- there are many that have a list of low carb/phos but still high protein so you don't have to reinvent the wheel, so to speak. All three cats will benefit from a canned diet- not just the two with problems.

Home testing- it is great that you are doing that! So many vets actually discourage it saying that they can keep a cat healthy and out of trouble by doing a curve once a month- like a cat won't change between one day to the next? What meter do you use? Some are great, others... not so great. Type in meter in the search box at the top and you will get a bunch of topics to read. Most do a curve once a month, some do a curve every week. Doing a curve at home saves money, is less stressful on the cat, and is more accurate. If you have the equipment to do the testing just choose a day and do it. Dosing for PZI is based mainly on the PS tests (pre-shot) but knowing how low Otis is going is a life saver- his! When you test and put the number in an ss chart- we all have them attached to our signatures- others can look at it and advise on dosing if you have questions. It also gives us the history of what was going on two months ago so you can see if you are better, worse, the same.

The test of 97 at +6 hours after shot was a great nadir number (nadir is what we call the lowest point)! Why did the vet have you skip the dose? Did you test at 7:30 again? What number did you get? PZI is normally out of the system by 12 hours so that is why he was at 373 the next day- no JUICE!!! PZI is a 12 hour insulin (short acting) and doesn't stick around. This just causes him to rise, fall, rise, fall- we call the roller coaster and can damage organs if it goes on too long.

PZI has its own forum so they can really help you with dosing and everything.

Ask all the questions you want- we don't mind at all.

heather
 
Welcome Kate and Otis!

There are several commercial foods that are good for both CKD (Chronic Kidney Disease, also called CRF or Chronic Renal Failure) and diabetes. To manage diabetes, you want to feed a low carb (less than 10%) canned food, and to manage the kidney disease, you want to feed a high quality, low phosphorus canned food. Many vets simply recommend low protein diets for cats with CKD, because they are by default low in phosphorus. However, it's the quality of protein and phosphorus levels that matter, not the protein values. The low-protein prescription kidney diets have only been shown to be beneficial in end stage renal failure and should not be fed long term. In fact, they cause muscle wasting when fed in early stage CKD and are completely inappropriate for an early stage cat. Some vets find it easier to

Here's an updated food list with the values for several premium foods: https://docs.google.com/leaf?id=0B8...MzhkYTkxOGM4NThk&sort=name&layout=list&num=50. You're looking for something with less than 10% carbs (for the diabetes) and less than 250 mg/kcal of phosphorus (for the kidneys). The foods I would suggest are Merrick's Before Grain Beef, Merrick's Before Grain Turkey, Merricks' Cowboy Cookout, Merrick's Surf & Turf, Wellness Turkey, EVO 95% Chicken & Turkey, or Blue Wilderness Duck.

If those are out of your price range the next best thing to feed are the low carb Friskie's Special Diet Turkey & Giblets and Salmon flavors. However, I would strongly urge a food without byproducts, and keep in mind that they're still cheaper than the prescription foods and usually about the same as many grocery store brands if bought in large cans or in cases. Studies have shown that the quality of the protein source does make a difference in controlling the disease, and that needs to be considered along side phosphorus content.

Keeping your cat well hydrated is also key in managing CKD, which means NO DRY FOOD. At all. Dry food is moisture depleted and causes chronic dehydration in cats, often the cause of CKD as cats progress in age. Adding a little water with the canned food portions helps, as do pet fountains, since they encourage cats to drink even when they are not thirsty (cats have very low natural thirst drives, so by the time they seek out their water dish they're already dehydrated).

Here is a fantastic website with a lot of information about CKD: http://www.felinecrf.org/, and more information about CKD and diet: http://catinfo.org/#Kidney_Failure
 
Thank you so much, Heather and Julia for responding to my post!

I have no idea why, but I have not been able get in to this site on my computer since last week! The site kept blocking me right after I posted my first post... :( I'm so glad I'm back!

I have been checking Otis every day, and we did a glucose curve on Saturday. I am using the One Shot Ultra Mini meter, that was a hand me down from my mom. I recalibrated it and I also took it, and Otis, to the vet and made sure that our numbers were the same. They were a couple numbers off, but my vet said it was safe. Is that a good meter to use? It seems like it’s nice because I don’t need a whopper of a drop to get a reading.

I spoke to my vet after I sent him the results of the curve that I did on Saturday. I’m not sure how I can do one of those neato charts that you guys have, but here are his numbers. My vet asked me to skip the shot the night before (Friday evening) and do a curve for 12 hours, checking every two hours, on Saturday.

7 a.m. – 449 (had one unit at 7:30 a.m., after breakfast)
9 a.m. – 414
11 a.m – 252
1 p.m. – 232
3 p.m. -184
5 p.m. – 155
7 p.m. – 165 (did not give him a shot in the evening)

My vet was happy with the results and said that I should give Otis an a.m. shot for the next month. I am still going to check Otis twice a day. I was told that I didn’t need to, but I feel more comfortable doing it. My vet wants Otis to have a fructosamine/glucose test at the end of October, but the morning numbers in the 400's really trouble me. I think that it is because Otis is eating that high carbohydrate kidney food. So, I think I should have the test performed earlier, that way I could change his food to a better one to suit both of his needs. Do you guys think that is a good idea? Oh yea, and Otis is only on wet food. No dry food is in his diet at all. He seems like he feels good and he's happy and comfortable, I just worry about the numbers being in the 400's at all. My vet said that he wasn't worried about it...but I am.

Thoughts?
 
Hi Kate,

You have gotten some excelllent advice about food that will not only help Otis but will lower his glucose numbers.

The goal with insulin is to find a dose that will allow you to give two doses a day, 12 hours apart. If you skip a dose at night, the level will continue to rise for the second 12 hour period without insulin. Then you are faced with a high number in the morning. You shoot insulin at the dose that might seem logical for that higher number, but it is more insulin than he needs and lasts longer than the 12 hour cycle, but not 24 hours, and sets up the roller coaster once again.

With ProZinc, if you get a lower number at+ 12 than at +6, it suggests the dose is too high. If Otis were my kitty, I would reduce the dose by .5 units and work toward giving two shots of the lower dose twice daily. It would be especially good if you are going to change the food to lower carb. Insulin does not last longer than 12 hours in cats. Giving only one shot a day sets up a roller coaster of high morning shots, lower numbers during the day and high numbers during the night.

Here is a document that will give you lots of info about how ProZinc works:
http://www.felinediabetes.com/FDMB/viewtopic.php?f=24&t=32799
You can see that shooting once daily is not recommended.

As others have said, the only way to keep Otis safe is to test before each shot - to make sure it is safe to give the dose you had planned on. Testing midcycle will help you see how the insulin is working - how low he goes midcycle.
 
Here is the topic link to set up a spreadsheet-

To keep up with the BG #'s there is a spread sheet (SS) that we link to our signature line. Here is the link to set up:
http://felinediabetes.com/FDMB/viewtopi ... =6&t=18207

Yes- I would reduce the dose so you can do two shots on a 12/12 basis. Otis gets a big drop- 284 and it lasted all day. If you can change the dosing to .5u am/pm it would be better. As you can see from your current data he probably spent most of his time over 250 that night- over the renal threshhold level. And once you change his food to a low carb one that number should drop- which means you would need a lower dose. The more time they spend under 250 the better they are. My first vet didn't really care if my cat was in the 500's all day as "there wasn't any damage associated with it" and "ketones aren't a problem in cats". Needless to say, I found a new vet because there is damage with high numbers and ketones can be VERY deadly.

The meter is a good one I do believe.

Good going on the first curve!
 
Thanks ladies!

I asked my vet when I spoke to him about giving Otis .5 and he said that I couldn't. He said that it would be an inaccurate dose because I would have to eyeball and also that some insulin would stay in the syringe so Otis wouldn't get all that he needed...

Do you guys eyeball .5?
 
We use syringes that have 1/2u markings. You get them from human pharmacy's.

Otherwise, yes we eyeball it. What you can do is take an old syringe and use a very fine tip sharpie to make a line at what you call the half way point. Then, check every dose against that before shooting.
 
Most of us use .3cc, 5/16", 30-31g syringes with half unit markings. You can get them at any pharmacy. Because you're using Prozinc, a U-40 insulin, and the syringes are for u-100 insulins, you need to use the conversion chart to measure the dose correctly. Here's a link to that chart: http://www.felinediabetes.com/FDMB/viewtopic.php?p=340819#p340819.

I've only used Lantus, a human u-100 insulin, I was raising and lowering the dose in .25u increments, as the dosing protocol for Lantus required. Cats are much smaller than people and most dogs, so they need much smaller doses and dose adjustments.
 
Lots of ProZinc users use the U100 needles with the conversion chart. Many of them dose under one unit; sometimes .1 or .2 units when the kitty needs just a little bit of insulin. It's the way we wean the cat off insulin - giving less and less.

Vets have to treat different species who have many different diseases. It is difficult for them to stay up with the latest on feline diabetes. We live with cats and specifically feline diabetes every day. We are happy with a vet who is willing to learn; we don't figure they can be experts on everything from rats to lizards :mrgreen:
 
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