HELP! need some insulin advice...

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Lkldcatlady

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Hi all - I've been posting on the Health board for a a few weeks now and I thought I would get some info from people using ProZinc as I am. My spreadsheet starts on 5/1, but I actually started giving insulin on 4/27/2013. My vet did start out at 1 at 2 units, but quickly raised the units because I was calling in every day reporting Bob's numbers. I don't think they were used to that and, being a hysterical mom of a newly diagnosed diabetic cat, I think they were just trying to help for the moment. I'm really not understanding what is going on here. When he was on the lower doses, I was still getting 300's in the am (fasting number) and in the very high numbers in the pm. I'm noticing the same thing on his current dose - 4 in the am and 5 in the pm. I thought maybe it was that symogi (sp?) effect, but the times I've tested him at the 5 hour point, he's still pretty high - he doesn't seem to be getting too low. My vet is telling me this process is normal and it will take time to figure out what works for him. Meanwhile, I'm having a nervous breakdown with these high numbers. I do trust the vet - she's a relatively new graduate from the University of FL and she seems to be up-to-date. I just figure you all have been doing this for a while, so you know alot too. Several things to note:

1. I switched to the AlphaTrak meter when he went to 5 units. That meter is definitely reporting higher numbers than the Relion Confirm I was using. It makes sense because my vet uses AlphaTrak and when I would take the Relion meter in, theirs would always be higher than mine. :cry:

2. Even though his numbers are high, Bob is doing MUCH better than he was when he was diagnosed. For the first 3 weeks, he did nothing but sleep and drink water and looked pretty depressed. He's now cleaning himself, using his cat scratcher, playing a little bit, sitting in the window, etc. this last week, he seems back to his old self although he's still drinking and peeing more than usual.

3. I'm reading alot about Lantus and everything I read makes me think it's better insulin. My vet says they've had success with both. Not sure why they started me on the ProZinc. She wants to give it another month and says we can try Lantus at that point if we don't have more results. Any thoughts?

4. We will be changing to the Young Again zero carb dry food at the end of the week. He's a very picky difficult cat and doesn't like the wet food....

Sorry for all the babbling,.....just trying to get all my thoughts together. :-D
 
Hi Dara,

I replied to some of your threads on Health. I post on both forums. You'll find that this board is much smaller than Health and people are generally on in the am and pm. So if you want dosing advice, give us time to reply. If you have an emergency, post on Health.

Looking at Bob's spreadsheet, I am guessing he is bouncing. He had yellows midcycle and then jumps back up. The best way to figure out if this is what is happening is to get midcycle numbers during the day and at night. Once you have the overall picture of the what the insulin is doing, you can adapt better. A new diabetic can bounce from yellows as well as lower numbers. It depends on what his body has become used to.

It sounds like you stared at a lower dose but then increased rapidly and but large amounts. We suggest increasing by .25 or .5 units as the numbers indicate. At this point, I don't think I would advise a complete restart. But if he was getting better numbers at 2 units, that might be a possible place to restart. You could lower the dose to 2 units (I'd suggest the same dose for am/pm) when you can monitor for a few days. Get midcycle numbers both day and night and then slowly add or subtract as the numbers suggest. If you do this, start testing for ketones daily.

It is hard to get your head around but too much insulin can cause high numbers as much as too little insulin does. I may have given you this already.
Here is some info:

Rebound: Oddly, too much insulin may result in increase of blood glucose (BG). This "Somogyi effect" is often noted by pet owners who monitor their pets' blood glucose at home.
The reason: anytime the glucose level drops too far or too fast, the animal's organism may defensively dump glucose (converted from glycogen in the liver), as well as hormones epinephrine and cortisol, into the bloodstream. (If these are insufficient, hypoglycemia ensues!) The glycogen raises the blood glucose, the other two may make the pet insulin-resistant for a time. This phenomenon was first documented by a Dr. Michael Somogyi. [33]
Even when raising the insulin dose slowly and carefully, it's possible to pass the correct dose and go on to an overdose. (A typical case is increasing bidaily dosage from 1 unit to 2, passing a correct dose of 1.5 units.) This may produce a rebound—a swift jump in blood glucose up from a dangerously low reading, to beyond the previous pre-shot level. Always consult your veterinarian when changing your pet's insulin, and consider smaller dose changes.

Rebound: Rebound

AlphaTrak meters do read about 30 points higher than human meters. Since we are looking for ranges and patterns, we don't worry too much about the difference. Just be sure you add the AlphaTrak on your signature so people can adjust if you get down to the lower ranges, when it becomes more important.

Lantus could be a better insulin for him, but I'm with your vet and would give ProZinc a change first. Often it takes over 6 weeks before their body adjusts to the insulin. Are you feeding a high carb dry right now? If so, that could certainly account for the higher numbers. I hope Young Again works for him, but I would still be working daily to get him on wet low carb. Not only for the carbs, but also because wet is just better for cats. I assume you have been given this vet website with great ideas for transitioning food: www.catinfo.org
 
Hi again Sue! I did test a couple of times this week at mid-day and was getting in the 300's! This is so frustrating. Can you explain why he might be feeling better? My vet says it "is certainly reflective of his system trying to equalibrate to the dosage of insulin he is receiving now that we are only making flucuations in his dosages slowly". She is referring to the fact that we stayed on 4 and 4 for 7 days (instead of jumping around each day depending on his numbers) and now he's on 4 and 5, which she would like him to stay on for 7 days. Also, they tell me they only increase or decrease prozing by 1 full unit. No half doses or smaller... I just hate to decrease his dose when he is actually feeling better. The first 3 weeks, he was practically in a coma and now he's acting like his old self again.

I have ordered the zero carb Young Again cat food. Bob ate it yesterday (a sample) and seemed to like it so I thought I would give it a try. It seems to a decent good quality food - only meat ingredients - no grains or potatoes or veggies. They tell they have had lots of luck with cats going into remission and it's very good for healthy cats too. Gives them a good coat, etc. Keeping my fingers crossed.

I'm going to print your response and take it to the vet on Friday with me. See what she thinks....
 
A bit of info on human vs pet-specific meters here, along with some sample data.

The AlphaTrak will generaly read higher than a human meter at low numbers by about 30 points. Its the difference between reading temperature as Fahrenheit vs Celcius. Still means the same things. A human glucometer value less than 50 is potential hypo territory; for the AlphaTrak, it is any number less than 80. At high numbers, it really doesn't matter - high is high and you're going to intervene, probably with an increase of the dose UNLESS it is due to transient reasons such as vet stress, or bouncing from a lower than 'normal' glucose level.
 
BJM - i bought the alphatrak meter because it's what my vet uses and I wanted to be on the same page with them. this is so aggravating! I would assume a monitor made for pets would be more accurate than a monitor made for humans. what the heck! I emailed my vet the information Sue gave me and the vet said that she felt that his middle of the day number is not low enough to cause the symogi effect. She feels that Bob is a little insulin resistant at this point and that he just needs some more time. PLEASE tell me I can trust my vet. Between this board and my vet's office, I'm so upset that there is such a big difference in treatments, etc. :cry:
 
The AlphaTrak is fine - it is more "accurate" by 30 points than human meters. We just don't suggest it because it and the strips are so expensive.

You can certainly continue with the dose you are on. Just monitor carefully. One of two things will happen - either the cycles will be high and flat (which suggests too little or too much insulin) or he will crash at some point. If you are monitoring, you should be able to stop a crash. Unfortunately the only way to know if you are giving too much insulin is to lower the dose. If he continues to be high and flat, at least talk the vet into upping the dose by .5 instead of one full unit. If you get to 5+ units, then I think a try at a lower dose is worth a try. It only needs to be a test for a couple cycles; if it isn't working, then go back up.

You might check out Simon's Mother's thread on this forum. Joyce's vet wanted to increase by one full unit up to 3. We talked her into just increasing to 2.25 and now Simon is getting green nadirs. I'd hate to think what might have happened on three units. It is possible to go over the idea dose.

I am not a vet. I have just helped a lot of people with diabetic cats. It is possible that he is a high dose kitty and it will take 5+ units before you see improvement. There are conditions that require high doses of insulin. Go with your vet for now but if it he doesn't show improvement and the dose keeps increasing, the lower dose trial might be work a try.
 
Sue, I'm not sure how the .5 units work with my insulin. Is it possible to give a .5 unit increase? My needles are only whole numbers....I think I remember reading something about calculating the difference using the same needle the Lantus users need....but I don't recall
 
You have a couple of choices. Eyeball the space between the unit lines. (you can mark it with a permanent marker or tape and use that one as a guide each time you want to shoot .5.) Or you can buy U100 1/2 unit syringes and use the conversion chart:

http://www.felinediabetes.com/insulin-conversions.htm

Lots of people use U100s and the chart. It is especially helpful when you shoot small doses and in small increments.
 
Breath honey breath. It's going to be ok.

I have to chime in on the high dose. If you had started low, 1 unit and increased gradually by .25u or .5u and finally arrived at 5 units then right now we would be suggesting you get Bob tested for Acro/IAA which are high dose conditions because most cats hardly ever get over 5 units without having one or both of those conditions.

BUT since the increases have been fast and increased by whole units, I agree with Sue that you can drop the dose by half and see if those high numbers will come down. The Prozinc website suggests a starting dose of 1 unit.

I know the learning curve is very steep in the beginning and much of the information doesn't make sense at first. Read small articles at a time or it will become overwhelming.

If you decide to stay with your vet suggested 4 & 5 units be sure to print out the article "How to handle low numbers", prepare a hypo kit, stock it with Karo syrup, medium and high carb food with gravy and mark the carb % on the top of the can with a sharpie. As long as you are testing you will be able to catch a low number and steer it up with the higher carb foods before it becomes a crisis.

You could also welcome your Vet to come and read the information here on the website, maybe it would ease both yours and her minds that the information shared here is good solid proven information gathered over many years by many dedicated people who live with and treat their own diabetic cats on a daily basis.

Welcome to our little group!
 
I'm breathing! :shock: I keep hearing people say 4 and 5 is alot of units and I called the vet yesterday and she doesn't seem concerned. I think I mentioned before that she says a little insulin resistance is common with cats and she thinks if we stay at the current dosage for 5-7 days and then continue up until we get hsi numbers to start coming down, then we are in good shape. So, if you think that this is a situation where his dose is so high, it is causing his number to go up high toward the end of the cycle, what exactly do you think I should do? Please spell this out for me - first, I want to confirm this is the case. Would I need to do a curve at home? Every 2-3 hours? Then if I confirm that is what is happening, I should drop his insulin in half for at least 2 cycles to see if it improves, right? If his numbers go sky high when his insulin is dropped for the 2 cycles, does that mean teh 4 and 5 units were actually working? Sorry, lots of question marks....
 
Yes, he could be a high dose cat. In that case, your vet is right and you should keep/increase the dose. Do these symptoms sound familiar?

http://felinediabetes.com/FDMB/viewtopic.php?f=12&t=375

It is possible he is insulin resistant. Once they sit in the high numbers for a while, they can be resistant..

Any time we see a cat on a high dose when the dose was increased pretty fast, we suspect that they are over the" ideal" dose. They can sometimesexhibit rebound - going from a low number to a high number. That's the easiest kind to say - yes, the dose is too high. You should reduce. Bob is not doing that. A high flat cycle can also mean the dose is too high, but it is not as definitive. And in that case, the only way to know is to reduce the dose for a few cycles and see if the numbers improve. He does go down midcycle; he is not in the pinks for the whole cycle.

Bob does go down some at nadir but not always. And he is at high preshot numbers whether he had a lower midcycle number or not. His midcycle numbers are yellow - they have room to go down.

Since this is causing you anxiety (understandably) I think I would stay with the dose your vet suggests. I would suggest that you increase by only .5 not a whole unit when she suggests you increase. If you increase, be sure to get a midcycle so if he does go down, you can catch it. After a cycle or so with the increase, do a curve - get some numbers every 2 hours or so. - to see exactly what is happening. Be prepared with the hypo instructions printed off and the supplies ready. (If I say that, my theory is that it won't happen. :mrgreen: )

At this point, I won't suggest going back down to a smaller dose. I don't want you to doubt your vet, and truthfully, she could be right. The reason we suggest trying a lower dose for a few cycles is that it is an easy way to find out if the dose is too high - because the numbers improve. But it carries some risk and if you are worried about doing it, don't.

Remind me again. What kind of food? I saw you were looking at Young Again on Health. What is he eating now? If he is eating high carb dry, then I would be very careful about introducing even lower carb dry at those high doses. Change it a little at a time and monitor carefully.
 
He is still on the 1/3 dry UR and 2/3 DM. I will slowly introduce the Young Again and try and get him to eat some canned food as well. But I will definitely keep an eye on his BG during the very slow transition.

I read the link you sent. The whole reason I took Bob to the vet was it seemed like he was whistling when he breathed and he opens his mouth almost as if he is going to sneeze but doesn't. And the said (in a loving way) that he had a big head, but I think his head has always been big. UGH. I really hope it's not that growth hormone thingy.
 
Hmm. That could be a high dose condition. You might send the info to your vet. It is not a common thing but does impact cats. It means he needs more insulin but can live a good life. You might post on Health and ask for input on high dose conditions; we have lots of people dealing with them.
 
I don't know if it will help at all, but you might try a side by side test with the Relion meter, and see which number makes you feel less anxious. Even if the Relion is reporting lower than the AlphaTrak, you might see numbers that match his mood and make more sense.

One test that you can do is to drop the shot to something super low like a .5 or a 1unit and see how he responds for a day or two. If the numbers drop, you could probably go back to scratch and start with 1unit. When my cat thinks he's dropping too low (and this can be ANY drop below what his body has gotten used to for example: 500 down to 400), he would flood himself with sugar as a protective measure, and the more I fought back with insulin, the more sugar he fought back with. When I backed off, he started to show much lower numbers.

Getting him off the dry food will drop his numbers fast, so transition with care.
 
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