Help with Oscar's Prozinc Dosing..

Nga Vo

Nga Vo

New Member
Hello everyone!

Oscar has been diagnosed for 3 weeks and his symptoms are improving massively, it's so lovely to see him play and be himself again. We have changed his diet so he has - half Hills Prescription Diabetic m/d (16.5 % carbs) and half Lily's Kitchen Suppurrs (0% carbs), hopefully, we will be able to transition him to only Lily's Kitchen soon.

Originally, he came back after 3 days the vets and was started on 1.5IU at home, a week later, he was back at the vets and was sent home with instructions to up it to 2.5IU. Oscar is currently on 2.5IU of Prozinc now, however, we are a little bit concerned his BG is still quite high. We tried upping it to 3IU (with the vets advice), however, this caused his BG to 'bounce' and so we switched back to 2.5IU the next day to let him have more time to settle with the insulin.. It has now been 2 weeks since he is on 2.5IU.

We have been doing lots of home BG testing and collected a lot of data which we are finding difficult to interpret.. We are also finding it hard to get advice on Prozinc from our vets and have had conflicting information on what to do in regards to his diet and dosing.

It would be great to hear some advice on our concerns below:

1. Is Oscar's curve normal for a newly diagnosed diabetic cat? We are wondering what we can do to improve his BG levels as his BG before feeding/dosing is around 30mmol (540mg/dL) and nadir is between 10-15mmol (180mg/dL - 270mg/dL). We are thinking we need to up his Prozinc to 3IU?

2. Feeding: We are recommended to feed him twice a day and take his food away after he has eaten as they believe this is what's causing his curve to bounce. This is contradicting the advice that we have researched because we thought that Prozinc is a long lasting insulin, therefore we can leave his food out but avoid letting him eat 2-3 hours before next dosing (as the BG levels would be inaccurate). So basically we are wondering whether we should take his food away or whether we can leave it out but take it away 2/3 hours before next feed/dose?

(SS in my signature)

Thank you so much!!!

Nga & Oscar
 
Hi Nga and Oscar! Welcome to our forum! It's great to hear that his symptoms are improving and he's feeling better. One of the best things is when they start to feel better...it always makes my heart happy to see my babies feeling good.

Well I can skip a lot of the advice we give new folks since you're already doing great! I'm glad to hear you're in the process of a food transition to a low carb, wet food. As you transition fully you will probably notice that Oscar needs less insulin. You're also home testing which is one of the biggest hurdles we usually face with our kitties. And you've got your SS set up and linked! So basically, great job!

On to your questions:
1. Oscar's numbers are pretty good. Yes it's high but that's fairly normal at first. You have to work towards getting the right dose. I do think you might be seeing a bit of small bouncing, which isn't uncommon. We've found that smaller increases are best, especially with bouncers, as they help lesssen the bouncing (though they probably won't eliminate it). It does look like he might need an increase, but I wouldn't jump to 3. Any chance you could eyeball 2.75? 2.5 is getting him a pretty good drop, which is probably causing him to bounce back up to those reds and blacks, so maybe a smaller increase would help get him a little lower overall but hopefully keep him from bouncing too much.

2. Food. You can leave food out all day as long as you take it up 2 hours before shot. Most of us free feed or give several small meals a day. People here have found often that several small meals benefit the cat better than 2 big ones. I free feed (though I don't have a diabetic anymore but I did). A lot of vets suggest 2 meals a day but we've found that it doesn't really work better.

Are you using a human meter or a pet specific meter? Either is fine, but we just have to interpret the numbers a little differently based on that.

Also, can I ask why he was at the vet's for several days? Was it to help get him regulated or was he having some health problems that required hospitalization? Again, I only ask because the more we know about Oscar, the more we can help...other health problems can affect our dosing advice.

Please feel free to ask all the questions you have! We're here to help and we know this is a steep learning curve. :)
 
Rachel's given you some great information, so I'm just popping in to say hello and welcome!

And yes, I leave wet food out for my cats all day long. i just add some extra water to keep it from drying out (and to help with hydration for them).

Did you make your own spreadsheet? Or is that the one from here? It is acting funny in my view, and I know some of the world/us spreadsheets have been a little strange lately. If you made it, then don't worry about this part. If it's ours, let me know and I'll share you the link about the problem folks have been having.
 
I saw your thread over on intro and commented there. I wanted to move the comments here since we're not supposed to advice on that forum and others who want to help out will need some info too.

I don't think I knew about the ketones when you posted earlier. Oscar was in DKA when he was diagnosed? I ask because that does change dosing advice for us since you need to be more aggressive with that. Do you test for ketones at home?

You mentioned skipping a shot recently, but it doesn't look to me like you skipped any shots recently...when was this?
 
Thanks so much for your postings!

This is going to be a long post but I thought the more I write about Oscar the more advice we can get.


Oscar’s Diagnosis:

Originally, we found he stopped eating dry food and lost appetite, we thought this was because of the hot summer we had and switched him onto wet food, however, his appetite was still not great so we took him to the vets. Vets said he had a bad molar that was then extracted. After 2 weeks, his gum was still not healed properly and even the patch on his arm where the catheter was wasn't healing (we now think this is because diabetic cats don’t heal quickly). We took him back and the vets gave us painkillers and antibiotics for him.

After another week he lost 400g dramatically (he weighted 6.3kg and was then 5.9kg) and started having yellow goo coming out his eyes one morning, we were terrified and took him back to the vets who said that he wants to do a bacterial swap of his gum where the tooth was extracted but we had to come back in 2 days to do it as he was on antibiotics therefore this would affect the results. We just felt that there was something else not right about Oscar and asked that he also take a blood test..

2 days later we came back to do the bacterial swap but we were told his blood test came back and he had high BG, ATL and cholesterol all pointing to diabetes. He did a urine test and found he had ketones. At the time, we were quite unsure whether he had DKA to be honest.. Because he was completely fine, not acting ill or lethargic. We felt that the ketones in his urine might be because he’s been starving himself for ages but obviously the vets knew better, so we agreed to hospitalize him. They gave him a shot of something to help with his appetite, he ate and they started him on insulin. After a day, the ketones were gone from his urine. The vets decided to keep him for another 2 days to regulate him. He came home after and was on 1.5IU, we took him back to the vets a week later for a check up and were told he had no ketones but his BG had gotten higher, probably because he’s gotten his appetite back and is eating more now. He stayed at the vets for another 3 days so they can up him to 2.5IU.

Ever since I found that we could do home testing (we use AlphaTrak2), we’ve been doing his curve at home and he is so much more comfortable and happy. After so many trips to the vets, we could tell he was stressed out and fed up.. We test his urine at home frequently with urine dipsticks, and he has not had any ketones thankfully. His appetite is great, gum has healed, he’s happy, playful again and after month of seeing him starving himself and losing weight dramatically, he is now staying put at 5.8kg and strict diet.

Skipping Dose Recently:

We have only had to skip one pm dose ever. He was now able to eat quite a lot of his food all at once, the vets told us to take his food away after he eats instead of leaving it out. So after his am feeding and shot, we took the food away. However, when it was time to do his evening shot, we found that his BG was 10.7mmol (192.6mg/dL). Perhaps it’s low because he hasn’t eaten at all since his am feeding? We called the vets and were told anything below 15mmol (270mg/dL), we were to skip. So we gave him his pm feeding, skipped the dose, however, we tested him 3 hours after and his BG was in something like 30mmol (540mg/dL).. But we still didn’t give him the shot, as we didn’t know we could back then! The vets also said if he doesn’t eat his meal, we should skip and if he eats some, then give him half the dose. We decided the next morning after seeing posts on this website that we can leave the food out and so we did. We haven’t had to skip or stall any doses since.

I’m going to check my spreadsheets again. We used our own spreadsheet and transferred our readings on the spreadsheet provided on feline diabetes however, perhaps we made a mistake somewhere if you can’t see the skipped dose? I will definitely check again now!

Thanks again for all the information and support. I don’t know how I could cope!


Nga & Oscar
 
I think, especially considering he's had ketones, that there are two things that need to change, but not both at the same time.

He isn't getting enough insulin, and his food is too high in carbs. But here is the thing: If you increase his insulin AND get him off of the Hills, he could go too low. So you need to do one at a time. Can you get him off of the Hills? Does he like his low carb food enough for that to be his only food? Diabetic cats shouldn't be on anything more than 10% carbs. If you can slowly ween him off of the higher carb food, you will likely see his numbers come down a bit.

Then once he's off of that, we can see if he needs a dose change.

However, if you can't get him off of that food, then we should talk about increasing his dose.
 
Unfortunately, he's been really stubborn with the Lily's Kitchen cat food (which I believe is like less than 1% carbs).. We did give him just that and he had one bite and turned his nose up at it. Even mixing it, he will try to pick out the Hill's so I have to really mix it all well. We've tried now and again to just leave Lily's Kitchen out but he will not go anywhere near it. I know how stubborn he can be and would rather starve so have had to resort to slowly transitioning him. It's taken 2 weeks to get to 50:50, hopefully 75:25 this week.

I've ordered some Ziwipeak, Mac's and Granata which should be coming in 2 days so I'll definitely be getting him to try that only but I'm super anxious he will have none of it!
 
kibble addicts are hard to transition! It look me a couple of months to get my guy onto wet food, so I completely understand. If you've made it to 50/50 that's already a great start!

Yes, I would keep trying different foods. It took me probably ten different foods to find something my cat would eat at all, and I don't think he really liked a food until I got him onto raw food.
 
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