Hello, new and starting ProZinc

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Brian & Monkey

Brian & Monkey

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Hi there, my cat was just diagnosed as diabetic. She has IBD and had a bad bout of pancreatitis a few months ago. She began losing weight a few weeks ago, and after we saw the vet we found she had diabetes and ketones. We gave her fluids at home and started ProZinc, and are still trying to figure out a dose. I put the spreadsheet in my profile, it's also here.

Monkey has severe food allergies and has to eat Royal Canin rabbit canned and dry. She gets two wet food meals a day (after testing, before giving insulin) and has access to dry all the time, though I've been taking it away about 2 hours before testing to try to get a more accurate result.

I'd appreciate any advice and ideas as we try to get her up to a dose. We really would like to see remission.
 
Brian & Monkey said:
Hi there, my cat was just diagnosed as diabetic. She has IBD and had a bad bout of pancreatitis a few months ago. She began losing weight a few weeks ago, and after we saw the vet we found she had diabetes and ketones. We gave her fluids at home and started ProZinc, and are still trying to figure out a dose. I put the spreadsheet in my profile, it's also here.

Monkey has severe food allergies and has to eat Royal Canin rabbit canned and dry. She gets two wet food meals a day (after testing, before giving insulin) and has access to dry all the time, though I've been taking it away about 2 hours before testing to try to get a more accurate result.

I'd appreciate any advice and ideas as we try to get her up to a dose. We really would like to see remission.
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Welcome! We can help. :) It'll be more challenging to regulate a kitty with food allergies that require feeding a special food. You'll have to dose around it. My guess is the dry is quite high in carbs so if you can wean her off that over time and sub in more meals of the wet version that might help. Here's my new member's handout. You already have a spreadsheet done and testing under way and that's great. You need to set up your signature text and insert a link to your spreadsheet in it.
_____________________________________________________________________________________________

It would help us if you set up your signature (light grey text under a post). Here's how:
  • click on your name in the upper right corner of this page
  • click on "signature" in the men that drops down
  • type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using /glucose meter you're using/what he eats/any other meds or health issues he has.
Another thing that will help us help you now that you've started BG testing at home is to set up a spreadsheet like the one we use here. We can all see it and look at it before offering advice: http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

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Here's the basic testing routine we recommend:
  1. test every day AM and PM before feeding and injecting (no food at least 2 hours before) to see if the planned dose is safe
  2. test at least once near mid cycle or at bedtime daily to see how low the BG goes
  3. do extra tests on days off to fill in the response picture
  4. if indicated by consistently high numbers on your spreadsheet, increase the dose by no more than 0.25 u at a time so you don't accidentally go right past a good dose
  5. post here for advice whenever you're confused or unsure of what to do.
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Here's an explanation of what we call "bouncing". It explains why a kitty's BG can go from low to sky high:
  1. BG goes low OR lower than usual OR drops too quickly.
  2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
  3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
  4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
  5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
  6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.
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Here are some tips on how to do urine ketone testing (VERY important if BG is high and kitty isn't eating well!):
  • put the end of the test strip right in his urine stream as he's peeing
  • slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
  • put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee.
Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light.
 
Hi Kris

I set up the signature as you suggested. Looking at her spreadsheet, do you think I should go up 1/4 unit? Thank you.
 
Brian & Monkey said:
Hi Kris

I set up the signature as you suggested. Looking at her spreadsheet, do you think I should go up 1/4 unit? Thank you.
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Yes, I'd try 1.75 u next dose. Make sure you get a before bed every work day when you aren't home to check mic cycle (1 cycle = the 12 hours after a dose is given). Get some tests between +4 and +7 on days off.
 
Hello again. We have done a curve and increased, and I think we are about to increase again. Can someone explain to me how the curve for ProZinc looks ideally? Like, pre-shot in the 200s and coast in the 100s most of the day? Or higher pre-shots?

If anyone has any advice looking at our spreadsheet, it would be appreciated. I will go to 2.25u tonight.
 
Brian & Monkey said:
Hello again. We have done a curve and increased, and I think we are about to increase again. Can someone explain to me how the curve for ProZinc looks ideally? Like, pre-shot in the 200s and coast in the 100s most of the day? Or higher pre-shots?

If anyone has any advice looking at our spreadsheet, it would be appreciated. I will go to 2.25u tonight.
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An ideal curve for ProZinc would be similar AM/PMPS in the low to mid 200s and a nadir in the high double digits to low 100s. The curve has a gentle "smile" shape where it drops slowly after the shot to a low at nadir and rises gently to a similar level it started at as the shot wears off completely.

Your kitty is bouncy so that means data from a curve done on a bounce cycle like April 04 is misleading. The BGs are bounce elevated and you see minimal response to the insulin and that leads you to think an increase is needed. You don't have evening data that can show a drop that causes a daytime bounce. That might have happened overnight on April 03 giving you that curve next day. You also need more data on days off between +4 and +7 to try to capture nadir range numbers.

I suggest you go back to 1.5 u for several days, get any daytime tests you can through the week and, if impossible, at least a before bed test every evening. You need to have both PS and nadir numbers to assess a dose and, of the two, the nadir numbers are more important.
 
I'm sorry, can you explain a bit more? I haven't seen any evidence that she's going hypo and bouncing back up, is that what you mean? Or what is 'bouncing'?

She's a very small cat and I'm having to poke bruised areas at this point, otherwise I'd test every chance I got. This has been difficult.
 
I'm sorry! I usually put this in one of my posts:

Here's how it works:
  1. BG goes low OR lower than usual OR drops too quickly.
  2. Kitty's body panics and thinks there's danger (OMG! My BG is too low!).
  3. Complex physiologic processes take glycogen stored in the liver (I think of it as "bounce fuel"), convert it to glucose and dump it into the bloodstream to counteract the perceived dangerously low BG.
  4. These processes go into overdrive in kitties who are bounce prone and keep the BG propped up varying lengths of time (AKA bouncing).
  5. Bounce prone kitty repeats this until his body learns that healthy low numbers are safe. Some kitties are slow learners.
  6. Too high a dose of insulin can keep them bouncing over and over until the " bounce fuel" runs out and they crash - ie., have a hypo episode. That's why we worry so much about kitties that have had too high a starting dose prescribed by the vet and the owner isn't home testing.
Here are a couple of examples from your spreadsheet:
  • On March 27 she had a yellow AMPS but was 200 points+ higher at PMPS. Ideally the two PSs would be similar. When they're this different it's a sign that she might have dropped lower than her idea of normal either between AMPS and PMPS or possibly the night of the 26th. The yellow could have been from her rising from a lower than usual overnight BG (on the 26th) and she just continued her rebound through the day on the 27th until the red PMPS that evening.
  • On March 31 she had another yellow AMPS. You ere able to get a mid cycle test that day and her low was blue - not that low but lower than her unregulated normal - and she was up into red at PMPS.
 
Brian & Monkey said:
I'm sorry, can you explain a bit more? I haven't seen any evidence that she's going hypo and bouncing back up, is that what you mean? Or what is 'bouncing'?

She's a very small cat and I'm having to poke bruised areas at this point, otherwise I'd test every chance I got. This has been difficult.
Click to expand...
My newly diagnosed cat also had some bruising the first couple weeks. I've read that their ears produce more capillaries the more you prick their ears (meaning easier pricks with more blood, less pain), so I told myself that even by doing it over the bruised areas, I was making it easier on her on the long run. I also make sure to hold pressure on her ear for at least 30 seconds afterwards, it helps to prevent bruising. I thought about freezing some cotton squares and using that after the prick, but her ears haven't been bruising lately so I've stuck with what I'm doing.

I sit on a stool with her sitting on my lap and a low carb treat or her food ready on the counter in front of us for after testing. I use a warm compress for a minute or two before gently massaging a little neosporin around the area. Prick ear, test, then apply the pressure with paper towel or cotton while praising her and telling her, "All done!" over and over. When I'm done holding pressure I tell her "Okay," and she's allowed to get on the counter and eat her treat. She now purrs the whole time I'm testing and often seems to ask to be tested (probably for the treat and attention). I'm still new at this stuff too and I know it can be difficult so I just wanted to share what has been working for us! Good luck with Monkey, she's lucky to have you!
 
Megan has shared some great suggestions. The pressure on the test site really does help to reduce the bruising - as does rotating where you poke. And it does get better in time. I promise we wouldn't all be testing our cats this much if we were hurting them!!!
 
Thank you to everyone for your help. Regarding the ears, I do hold off with a tissue after poking but she is a bit of a fragile old lady. I went from not doing any medical treatments on her in 14 years, to having to poke multiple times per day :-(

I didn't increase to 2.25u, and did some midday numbers that showed she did go quite low (but no symptoms, she ate her way through it) as Kris was predicting. I moved down to 1.5u and am wondering what to do if I start getting lower PS numbers. It might mean that it's her dose, or might mean that she's getting too much insulin? I am especially worried about shooting at night because we do 8am/8pm and are often to bed by 10pm and it's hard to sleep when I'm wondering about her numbers.

I'm going to get BG in 1/2 hour. If anyone has any feedback for a range to shoot tonight, I'd appreciate it. Thank you.
 
Nice greens on 11 Apr. We'd recommend changing dose by 0.25 u increments. Those greens were nice but a little low if you can't be home to monitor. I would have suggested dropping to 1.75 u. You could try 1.75 u tonight or stay at 1.5 u and do a curve on the weekend.

A good thing to do daily is get a before bed test in. That would be around +2 for you. That test can be informative: if the number is similar to the PMPS the cycle will probably be uneventful and no more monitoring is needed. Is it's much lower (say around 100 points) it can be a sign that she'll drop fairly low overnight. It's wise to set an alarm for around +5 or +6 to see where she is.

You're at a very early stage in her treatment so it's best to be careful in your dose choices and changes - not too often and by no more than 0.25 u at a time. This is a process that can't be rushed and getting her into consistently good numbers can take a long time - many weeks or months. Patience is needed in vast quantities. :)
 
Thank you. I went down to 1.5u because you'd recommended upthread to go to 1.5u. She's had some high numbers so I did give 1.75u this morning but I don't know, maybe I should see what happens with the 1.5u for a few more cycles? What do you think?
 
Looks like you gave 1.75 this morning? Why not stick with that for a few days and see what happens? Any chance of getting a mid-cycle here and there (I know work makes that tough) to see what it does?
 
Hi Rachel. Thank you for chiming in. Because we got into the 60s earlier this week, I have been debating the 1.75u tonight. I know at some point I'll be comfortable shooting at lower numbers! But I hesitate because of last week. I guess my question is, would I be giving up on 1.5u too soon? When can I be sure she's not bouncing around and I can say, ah ha, she needs more insulin?
 
It can definitely be intimidating. If you feel more comfortable with it, give 1.5 for a few days and we can go up later if needed. The reason I would have suggested 1.75 is you've been on 1.5 for 6 cycles which is generally when we recommend a change...and it looks like from that one +7 you got, it isn't really bringing her down much. That could have been a bounce cycle, but I tend to think it's not.

With these higher numbers, I'd want to be aggressive in treating. You want to get her down so that ketones aren't as likely. The greens you got last week really weren't dangerous (but scary I know!) so 1.75 would likely not bring her to a dangerous level. However, I can't guarantee it.

The best way to know for sure about the bouncing is to get whatever mid cycle numbers you can. I know during the day, work stops most of us. But anything you CAN get...an out the door test or a back in the door test...and anything you can get in the PM cycle, especially a +2 or +3 (before bed test) and if you happen to wake up in the middle of the night, grabbing a test can help. The more data you have, the better we can determine if she's bouncing or not. :) And then on the weekends, grabbing a curve or some nadir numbers would really help.

Basically, the dose you give is your choice. I'd give 1.75 if she was mine, BUT you need to be comfortable with it. Get some more data in whenever you can, and we can help you figure out what it means.
 
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