Help Getting Catee Restarted on Insulin

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geekgirldany

geekgirldany

Member Since 2013
Hi everyone,

I got Catee to the vet today. A different vet, same practice...and to my relief gave him Prozinc. Very good vet, kind manner, and answered all my questions. Blood test results will be in tomorrow.

Catee's BG was 275 at the Vet. He has not ate very well today at all. The Vet gave him .5 of the Prozinc at 5pm or so. Catee did eat a little when he got back from the vet.

I hope you all can help me. Vet said he needs to be fed twice a day morning and night. I have always left the bowl out for him to eat when he liked. Even when he was on Vetsulin for a short time.
Can I still let him free feed with Prozinc?

What do I do if he is not eating very much? Do I still give him the insulin if the number is high?

Vet said he would hit his lowest BG around 6 hours. I am very concerned about him going to low/hypo with either not eating/eating very little or free feeding.

Would greatly appreciate any help. Links to information about Prozinc would also be helpful as I have never used it before. Please do not think I am lazy not wanting to look it up for myself but I am so tired. I did not sleep well last night worrying about today's vet visit.

Thank you
Dany
 
Hi Dany, saw your post & wanted to help out . . . No worries about being thought of as lazy! I'm not good at including links but if you go to the Insulin Support Groups forum and click on Prozinc (PZI) you'll find lots of helpful info in the stickies there. My kitty was a Prozinc kitty. Good luck! Nancy
 
The protocol we put together for ProZinc is in my signature in blue.

Lots of people here feed small, frequent meals - especially if they are not going to be around to monitor at nadir.

The biggest difference between Vetsulin and ProZinc is that you don't need to feed ahead of the shot. ProZinc doesn't hit as fast and hard as Vetsulin. So it's test, feed and shoot. Lots of people shoot while their kitty is eating.
 
Thank you all for posting. I will be reading up on prozinc.

Right now he is eating Purina DM dry. The vet said to give him whatever he would eat if he will not eat nothing at all. But as soon as I got back from the vet he started eating on the Purina DM.
 
Dry food is almost universally too high in carbohydrate with the exceptions of
Young Again 0 Carb (5%.as we calculate if and internet only), EpiGen 90, and Stella and Chewey's freeze dried.)

Another problem with dry food is the strain it may put on the renal system due to lack of water. Cats tend not to drink much and when eating dry food, don't get as much water intake as cats on wet food. This can precipitate stones and increase the risks of infection as the urine isn't excreted as often.

Take a look at Cat Info for more information on Feline Nutrition and a food list. Anythin under 10% calories from carbohydrates is good for routine feeding.
 
Well, I am just really in the position of that is the only thing he will eat. He will not eat canned food, dry food addict. I've ordered another bag of Young Again to try him on again. Back in Feb. 2014, they did something to their food and he stopped eating it. The only thing he would eat eventually was Purina DM dry and his BG stayed down well. I tried the Epigen back in Feb and he would not eat it either. EVO, he eats one day, next he doesn't... it is around 8% carbs.

Now I had some Young Again left over from Feb and the company sent me flavoring to get him to eat it. Again one day he will eat it, the next he won't.

My goal is to get him back on Young Again if possible. If not then I will have to stick with Purina DM. I know it is hard on their kidneys but I try :)
 
That's pretty frustrating!

Ever tried baking the canned food to a dry consistency? Use a jelly roll pan, spread the food out thin and flat. Use the temps crackers bake at. See how it goes.
 
I can give it a try... and yes it is frustrating. I've never had a cat that would not jump at eating canned food.

Okay, so I took his BG a little after 11pm and it was 225 this is 6 hours after the vet gave him the insulin. He had ate about 2 ozs of Purina DM.

Now reading the Protocol for ProZinc/PZI on the forum.... it suggests that it can take awhile for the blood sugar to come down using Prozinc (several cycles).
Am I understanding this correctly?

Also the posting talks about cycles... what is considered a cycle?
 
A cycle is the period covered by 1 shot, roughly 12 hours for the long-acting insulins.

It can take about 3 cycles for the glucose to respond effectively; there can be some insulin resistance from having been high for a while. And, individual cats vary in how fast they respond. By home testing, you'll if your cat responds within 3 cycles, or needs more or less time.

So, at +6 he was 225. Not horrible and closer to where you want to be. This is a process of cautiously exterimenting until you find the dose(s) that work best for your cat. As you collect test data, you may find it works for your cat to develop a sliding scale, where you adjust the dose based on the pre-shot AND what you know about how he responds.
 
Talked to the vet tonight and Catee's bloodwork came back. Vet said he has excellent blood work to be such an older cat.

He wants to keep him on the .5 dose for two weeks. He says it will take that much time to get his BG down. Then he wants to do a curve. Leave him in the office during the day and come pick him up in the evening. Not really sure about that as I know the numbers will be high. Would like some opinions on whether this is neccessary.

Also Catee's BG is not going down much. AMPS 309 at +2 came down to 298. PMPS 325 at +6 came down to 290. So, I guess I was use to Vetsulin bringing it down quickly. Vet said he is worried about him coming down to quickly and so wants to keep him on the .5 dosage. Is that standard?

Thank you all for the help. So happy his blood work was good.
 
AMPS 335, ran about 20 minutes late in taking BG and giving shot.

It seems that the numbers are staying about the same as they were before I took him to the Vet. I assume I am giving the shots in him correctly. I feel his fur afterwards and do not feel any liquid. I "feel" like the needle is going into his skin. My friend says Catee is not even paying attention to me giving him the shot so he thinks it is not going in. Plus I am not pushing the fur back to get to the skin?? What the vet showed me and what I have watched I don't even have to do that.

I admit when he first got it last year I was so stressed out and I feel like that transferred to him. He would jerk or run away. Now I just pet and talk to him, pull up the scruff of the neck, put the needle in and give him the insulin. He doesn't even notice.

I hope I am doing it right and getting it in. Just worried as it seems like the BG is not going down quick enough. Put up his BG Spreadsheet in my signature.
 
With ProZinc, you can test, feed, and shoot all within about 15 minutes or so. You want to get the test before you feed, so it isn't influenced by food.

As you collect pre-shot and mid-cycle tests, you will start learning Catee's patterns of response to the insulin, and be able to customize doses based on that.

And you adjust the dose based on the nadir, the lowest glucose level, about +5 to +7 hours after the shot. That means the pre-shot level, if high, isn't what you focus on. you focus on how low Catee goes. Too much insulin can kill very quickly; too high insulin causes problems generally more slowly.
 
Dani,

Since you are already hometesting, it would be less stressful for Catee and you would get more accurate, non-stress induced BG readings if you would do the testing curve at home. It's pretty simple. Well, that is it's simple if Catee is easy to home test.

A curve is simply testing every 2 hours, starting with your pre-shot test, taking a test at +2, +4, +6, +8, +10, and ending 12 hours later with the next pre-shot test.

I bet you could do it. :thumbup :thumbup :thumbup

Sounds like you are much calmer this go around with giving Catee his insulin. You are making it "no big deal" so Catee picks up on that and simply accepts this as something his personal catslave needs to do to him. ohmygod_smile
 
I agree with you that the curve at the vet will not give you much info. Most cats are stressed at the vet and we know stress raises bg levels. Maybe you can tell the vet you'll do the curve at home- you feel confident getting levels and will send the numbers to him. (you are the customer; you get to decide)

IMHO, you are dealing with two different issues. As long as he is on the higher carb dry, the insulin will need to be higher to compensate. So, you can continue to work on getting him to eat lower carb and keep the dose the same but expect the higher numbers. Or you can raise the dose since he is on higher carb food. We generally suggest holding the dose three cycles and then raising by .25 if his nadir and preshots are still too high.

Have you tried these things on wet food?

Adding parmesan cheese or tuna juice
Sprinkling his favorite snack on top
Adding a bit of warm water and making a gravy
Heating it in the microwave until nice and stinky
Crushing up some of the dry and sprinkling it on top
Sprinkling on FortiFlora. This is magic for some cats. It has the animal digest used to make dry irresistible. You can buy ti online or sometimes from the vet (it is a probiotic)

If you give the shot while he is eating, he probably won't notice. As long as his fur doesn't feel wet, I would guess the insulin is going in.
 
Thank you all for posting. I can definitely do a BG Curve. He gets a little fussy but nothing I can not handle.

I got some fancy feast pate... it is worth giving it a try. The FortiFlora, I read on amazon that it made some cats sick. What are you all experience using it?

BJM you said:
BJM said:
As you collect pre-shot and mid-cycle tests, you will start learning Catee's patterns of response to the insulin, and be able to customize doses based on that.

And you adjust the dose based on the nadir, the lowest glucose level, about +5 to +7 hours after the shot. That means the pre-shot level, if high, isn't what you focus on. you focus on how low Catee goes. Too much insulin can kill very quickly; too high insulin causes problems generally more slowly.
Click to expand...

So the Vet said to give it two weeks and do a curve. I assume then he would want to increase the dosage. Should I follow this advice and not increase at all? Or is there a given time period, for example the 3 cycles, that I should go by and increase his does myself. He is on .5 Prozinc right now.

For example let's say his lowest is 270... should I then wait so many days and increase the dose? Or wait for two weeks to see his reaction?

I apologize if I am getting this confused.
 
It is hard to question your vet's advice. I think two weeks is a long time to wait before increasing the dose, if the cat is in higher ranges. All we can say is that we see a lot of diabetic cats and the protocol we developed seems to work well.

We generally consider cats well regulated if they are in the mid 200s at preshot and in double digits at nadir, but not below 50 which is approaching hypo territory. (since you are using the AlphaTrak, which reads lower than the human meters, your number for nadir should be above 80)

So we would generally say that if your cat is in the 300-400 range for preshots and doesn't drop into the 200s at nadir, he has room to go lower. So we'd suggest increasing the dose by .25 and monitoring for several cycles.

The way this works is to collect numbers, decide if he is in good ranges, and if not, slowly and carefully increase the insulin until he is in good ranges.

I've not heard of cats having issues with Fortiflora, but every cat is certainly different.
 
What I've seen with Forti Flora is that some cats go a bit crazy for it, scarf, then barf from eating too much, too fast. That's the only way I've seen it cause a cat to get sick.

If you use it, start with just a pinch at a time until you see how it goes with your cat.
 
Okay, I just did a +6 BG and it was 344. He just ate about 30 to 40 minutes before. He is a free feeder. So he doesn't eat after his shot. He has had problems in the past about eating. So I have just always let him free feed. This is probably causing problems and not keeping it down... I guess.

He is pacing, seems agitated.

I might try 1 unit tomorrow and see how he does.
 
Its OK if he free feeds on the canned food.
I routinely leave canned food out for all the cats (14 in number) and put down fresh at shot time. Gracie is in an area to herself and just grazes.
 
This is the Purina DM Dry food he is free feeding on right now... how long do you leave the canned food out?

Worried about him, goes to his water and turns away, then sometimes he drinks it. He has been pacing alot and seem agitated. Going and laying down in places he usually does not. He has been doing this off and on since his BG went up. I assume since the BG went up it is causing this.
 
I leave it for 10 hours at a time. All my cats have been fine with that.

Have you tested his glucose when he is behaving oddly?
 
Yes I tested it when he was acting that way and it was the 344. Can they act that way when it gets that high?
When it was in the 400s last year he was just really sick/lethargic acting then.

I think he could use 1 unit of Prozinc. I read that it is .1 a pound and he weighs about 14 pounds. So I think 1 unit should not be that big of an increase to cause him to go low.
 
Cats tolerate high BG just fine. It is not uncommon for my Badger to be in the 400's and they act normally.
I would increase the dose to 3/4 unit and see what happens. I would not wait until this evening.
 
I went ahead and did 1 unit. Thought I did a fur shot as he pulled away from me but tested at +2 and came up 258 and this is after he ate. Hopefully it will not go into the low hypo range.

I am not sure then why he was pacing so and just seemed upset. He is losing his eyesight so that makes it even harder to watch. He runs into things alot.
 
Its really important to keep furniture etc in the same locations so a vision-impaire cat can learn where things are. You're probably doing that. A small dab of a scent he likes - a pinch of catnip, for example - on furniture legs may help him detect them more easily and avoid them. You might try a Feliway Comfort Zone diffuser in the room where he spends most of his time. It releases calming pheromones which help many cats. And the spray could be used lightly on the furniture legs.

Do you know why he is having vision loss? High blood pressure and diabetes can cause some vision problems.
 
The Vet said he could not see any cataracts that diabetes usually causes and he took his blood pressure. It was 170. He said most cats that are losing their vision from high blood pressure would range from 190 to over 200. So he does not think that is it. He said 170 was good considering the stress he was under at the vet visit.

He believes it might just be that he is getting older. Although the vision problems did not start until after the diabetes diagnosis last year. So it still could have done something to his vision. I appreciate the recommendations on adding scent to the places where his walking path is as I had not thought of that. All the furniture is in the same place, he has a path he follows when he goes out to his room. Same path never goes a different way.


I was thinking about his pacing last night/earlier this morning. He is still drinking and urinating a lot. That is what is causing him to do that way I bet.

I really do appreciate everyone's help... happy thanksgiving :)
 
Hopefully, the dose increase will help bring down the glucose more and he'll feel calmer.

In my use of ProZinc, the nadir seemed to be closer to the +5 hour mark, than to +7, so if you can, snag a test around then to see how low he is going. Anytime you increase the dose, its a good idea to monitor that nadir period for lows.
 
I used to cat sit for a friend with a blind cat. This kitty would kind of keep to the edges of the room, sort of brushing herself against the kitchen cabinets and such so she would know where she was.

So I was thinking, that maybe Catee would feel more comfy if she had some of those "edge areas" to brush against and orient herself.

Vision loss due to diabetes in cats is not common from what I have read. It's more common for vision loss to happen with dogs.

Hope the 1U makes Catee feel better and gets her BG levels down.
 
If Catee has cataracts they are very visible to the naked eye. The eye looks cloudy. The Patches has cataracts and is about 17 but has been diabetic for over 10 years.
My civi Moxy, about 7 also has cataracts. She has had them since birth.
The vet can even see the retina with a ophthalmoscope. However, both cats an see enough to get around
 
Thanks you all. Good to know it is more towards +5 than +6/7.

Not sure what is happening here. PMPS was 400... the highest it has ever been. I was running about 15 to 30 minutes late giving it to him. Would that amount of time make that much of a difference?

He is still laying in strange places. Not pacing as much but not acting like he did before he got the diabetes again. See what this 1 unit shot does for him.
 
I'd give the one unit a few cycles. There's a chance he went down lower than he's used to and then bounced back up. But it's only one number; let's see what happens
 
AMPS 360. He came down to 202 at +5 last evening. So the nadir number is better. So just monitor him for a couple of more days to see how he does?

Also I figured out what was causing him to pace and agitated. I've been giving him bottled spring water for 4 years. He stopped drinking water of out the faucet. Well on Wednesday I noticed he wasn't drinking as much so I thought the water might be too cold. I mixed in some hot water and he did drink it for awhile. Then he started going to the water bowl and would just turn around. He kept doing this and he would drink a little but not enough. Finally last evening I thought I would try water from the faucet... and he drank it. I mean he sit there for several minutes and filled up. After that he laid down and went to sleep. He has been resting well, rest well through the night. No pacing. I can not believe it was that. I hate that I did not do that sooner.
 
I think I'd stick with the one unit another cycle or so. How is the changing to wet coming? I am thinking, as long as he is eating dry, his numbers will be in the higher ranges and need more insulin. But if he starts to eat wet and the dry is discontinued, he could drop down. So I think you have a balancing act.

If I were you, I would work on getting him converted to wet and watch his numbers carefully. Our Oliver went down 100 points from pmps to amps with the switch from dry to wet. Luckily we tested him that am and adjusted the dose downward to compensate.

Glad you figured out what was upsetting him. Amazing little guys, aren't they?
 
I haven't started him over to wet food yet. I ordered some Fortiflora and it should come Saturday. I do have the fancy feast pate, he weights 14 pounds, so would two cans a day do him?

I also have a new bag of Young Again zero carb coming today. My hopes are that the bag I have is maybe tasting old to him and so he won't eat it. I don't know... he will start to eat it and like he is rolling it in his mouth. Not sure how to describe it, kinda like he is trying to figure out its size. He will then spit some of it out. Strange.

I think him eating the Purina DM dry and free feeding isn't really helping to bring his numbers down. So, crossing my fingers on the above.

On the water, yes they are quite something, he is the most pickiest cat I've ever seen.
 
For my 14 cats, feeding canned food seems to work out to roughly 1 ounce per pound spread across the entire day. Fancy Feast Classic Pates are in 3 ounce cans: he'll likely need at least 2 of the morning AND night. He may need a total of 5 cans per day, at 14 pounds.

How were storing the Young Again 0 Carb you have? Dry food is notorious for containing mold spores and fats can become rancid over time, especially if not refrigerated/frozen. So he may be refusing spoiled food, not being picky. You don't want him vomiting from bad food.
 
Wow, I thought he would need about 6ozs of canned food a day but he will need that at one sitting.

On the Young Again, I had it in his room. Just sat there never gets to hot or cold as he has his own heater and air conditioner... I just happen to have my home office in his room :)
I emailed the company and they told me as long as it was in a dry place it would still be good because the expiration date is in 2015. I went ahead and tried to feed it to him. Like I said one day he would eat it next day he would not. The he started refusing it completely.

The fedex man brought it today. So I need to try it out.
 
Think of dry food as like a raisin. Compare that to a fresh grape. See the difference? That is moisture, not calories. That is why you'll need so much canned; it has about 70 % water in it.
 
Okay, yep that makes sense.

It looks like right now that Catee is going to eat Young Again Zero Carb.... I think the fresh bag of food is what he needed. Now if he starts eating this regularly, how do I monitor his BG to make sure it is not going to low? His PreShot BG is in the middle to higher 300s... low is upper 200s.
Do I still just test at +5 to see how he is doing or sooner than that?

If he takes on to this Young AGain food, I am worried he might go hypo at 1 unit twice a day. I can not monitor him in the mornings because I work.

Another question, how long does it usually take to get them regulated? I am worried about his numbers really continuing to stay in between 200 low and upper 300 high. Worried about organ damage.

Thank you all, I sure do appreciate the help.
 
We generally consider a cat regulated if they are in the mid 200s at preshot and in double digits at nadir, but not below 40s (which is approaching hypo territory). So that is the first goal. We think the renal threshold (below which the pancreas can heal is in the 250 range so the longer he stays under that range, the better)

You want to be careful about shooting under 200 until you have the data to know how low a dose might take him. So if you get a preshot under 200, wait 20 minutes without feeding (which can raise the number) and retest. You want to be sure he is rising, not falling (you don't want to give insulin when their number is still going down) , and nearer or above that 200 number.

Getting some data, especially every preshot and some in that midcycle range (5-7 hours after the shot) will show you how the dose is working and give you info about whether he needs more or less. If you can't be home, the next best thing might be to get a number 2 hours after the shot(that may give you an idea whether he is dropping normally or whether he is dropping fast). If he is dropping pretty fast early, then it might be an active cycle. Always leaving put some food so he could bring himself up if he drops low is a good idea.

Glad he is eating well again. If her were mine, I would still work on getting him to eat wet. Maybe crushing some of the YA as a dreasing for the wet and seeing what he thinks?
 
Glad he's eating! Maybe freeze half the bag to help ensure it stays fresh for him?

The renal threshold is roughly 240 mg/dL, so being below 300 isn't far from that given meters vary +/- 20% from what a lab would get. Upon switching to low carb food, some folks have seen a drop of 100 mg/dL in glucose and a drop in needed insulin of as much as 2 units. You'll want to be vigilant!
 
Thank you both for posting.

I do not know what is going on. His PMPS was 411 today. He did not eat this morning, just some before AMPS. He also seems to not be drinking water again.

Very very concerned as it seems to be going up.
 
What did he eat before he was diabetic? Have you tried crushing up some of that and putting it on top of the Young Again. Does he act like he isn't hungry or does he try to eat and then stop? Is he licking his lips? I am wondering about pancreatitis. Here is a good thread with lots of info. Do any of the symptoms sound like him? If so, he will need to see a vet.

http://www.felinediabetes.com/FDMB/viewtopic.php?f=14&t=83108

Are you doing ketone tests? That would be wise, just so you can stay on top of that possibility. (not enough insulin, an infection and inappetite are the elements of ketones). If he has ketones, a vet visit is necessary too and right away.

If he was eating, I'd suggest upping the dose by .25 since you've been on one unit several days. But it sounds like you think something else is going on. You are his mom and know him best. If you think something is wrong, then I'll have him seen.
 
He doesn't seem to have any of the symptoms of pancertis. He just at a little bit of food. No I am not testing keotones. Vet told me last week he did not have any, which is hard for me to believe.

I should have called the Vet yesterday. I can not increase insulin if he is not eating enough, can I?
 
That's the hard part. It would certainly be best if he was eating so you didn't give insulin on an empty stomach. But not giving insulin if he needs it (and his numbers indicate he does) isn't good. Have you tried hand feeding him? Putting some on your hand and see if he will eat it? Was he eating something before? Even if high carb, if he will eat it, I'd be tempted to give some to him.

Ketones can develop suddenly. So yes, we suggest that beans do regular ketone testing. You don't need your vet's permission. You buy the ketone strips that regular human diabetics use. If he will let you ( and many cats do) you can just stick the strip in his urine stream. Our Oliver wouldn't let us so we had to get a new clean litter box and fill it with aquarium gravel and leave him alone with it. Because the gravel wouldn't absorb the urine, we could get a sample. There are also some litters that are non absorbent and especially made for getting urine samples.
 
If his glucose is elevated fairly high and he has not eaten, a token dose may help bring the glucose down somewhat, plus that may help stimulate an appetite.
 
He won't eat out of my hand. He was eating Pruina DM and that new Pruina Grain Free food before I found out his BG was high. I guess if he will not eat I can try that. I did get the Fortiflora... he helped him eat a bite not much.

I just gave him his insulin at 6pm. I will check at 8pm and see how it has come down. I might go ahead and give him a little bit more of insulin.

So his BG being high could make him not eat or drink? I know it did when he was first diagnosed back in 2013... it was 422 then.
 
I decided to wait until +5 to check BG 284. He ate about 2 ozs Purina DM. Water drinking is not real good. I've put two bowls out now of spring water and tap water. I also have the Purina DM and Young Again out.

AMPS was 373, I eyeball 1.25 units on the u-40 shot.

I do not have ketone strips. I am going to buy the Precision Meter on Amazon that test BG and Ketones. He slept most of yesterday, doesn't seem lethargic.

If you look at my SpreadSheet there is a Sheet 1 that tracks his BG when I first found out. His numbers were actually lower then than he is now on insulin. I am kinda at a lost.
 
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