Help with Pudge please

Pudge

Pudge

Member
Hi everyone,
I've been following this thread since Pudge was initially diagnosed in March. The first time on insulin after he was DKA he was regulated and in remission within one month. He has been in remission up until the beginning of November when his numbers were elevated. I had a full blood panel done and the vet said there was nothing of concern. I suggested possibly his teeth and she said they aren't horrible and will need to be cleaned in the next year but nothing to be alarmed about. He was started back on insulin and I cannot get his numbers regulated.

My vet has been great to work with but I feel I don't always trust her suggestions and she has stated there is only so much research on diabetic cats that she knows of. She said to start him back on 2u of ProZinc to which I said I would be more comfortable starting at 1u for a few cycles first. Since then his numbers have been so up and down. I have tested for ketones which was negative. He has been more interested in human food which worries me as thats what he was doing when he was DKA. His numbers were never this high when he was first put on insulin in march. I sent my vet his recent numbers and she responded that we should try Hills MD food to which I said no. He is currently eating Weruva and Fancy Feast Classics. She said to try switching to 2u once a day or doing a sliding scale (which is what we did the after his initial diagnosis). At this point, I am at a loss as to what to do and what dose to give. Is it maybe his teeth causing these numbers? I have updated his spreadsheet (I think), if anyone has any suggestions or any recommendations regarding dosing etc. I would really appreciate it. Thank you so much!
 
Hello and welcome! I'm sorry to hear Pudge is back on the juice, but glad you were keeping an eye on things so you could get him back on when needed!

First: food. I agree that the Hills isn't necessary. Fancy Feast Classics are fine and as far as I know so is Weruva.

Second: Teeth. If your vet has said he needs a teeth cleaning sometime in the next year, I'd schedule it now and get it done. Bad teeth COULD cause him to fall out of remission (it's happened!). It couldn't hurt to get them cleaned and see if that helps.

Third: DKA. That usually happens with not enough insulin + not eating + an infection. It can happen without all the elements, but that's usually how it happens. Another reason I'd get the teeth cleaned. Make sure there's nothing going on there that could end up causing another DKA.

Fourth: BG numbers. Looks like you've been getting some crazy numbers! You've been hitting some greens and with the doses being kind of all over the place, it's hard to know for sure what to do. With former DKA on board, I think my best suggestion would be stick with the 1.5 you've been giving for a few cycles. Grab whatever mid cycle numbers you can (I don't know how your schedule works with that) so we can see what that's giving him. Then we can determine if we need to go up or down from there. Can you get a few extra numbers today by chance? We've found that consistency works best in dosing which is why a sliding scale isn't really recommended...if you stick with one dose for a few cycles it gives the cat time to sort of settle in some and see what that does. Then if you aren't hitting blues and greens, we raise the dose for a few more cycles, etc.

I believe we can help you get more regulation with Pudge. Please let us know if you have questions/concerns! A second round of diabetes is often very different from the first round, and it can be overwhelming I know!
 
Rachel has given you good advice. I would also echo her comment that the second diagnosis can be quite a bit different, and more stubborn, than the first one. We are here to help :bighug:
 
Thank you so much to both of you! It really helps reassure me that just because his diabetes seems different this time, that it is still normal. I will continue dosing at 1.5u and I will get some mid day readings tomorrow as I am off work. I am also off next weekend so I will do another curve and see where we are at. Is it okay to get his teeth cleaned while he isn’t regulated?
 
Pudge said:
Is it okay to get his teeth cleaned while he isn’t regulated?
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Absolutely yes. In fact if his teeth are a contributing factor, it will be awfully hard to get him regulated until they are taken care of. Since the vet said they aren't bad, it's possible that they aren't part of the problem, but if he needs a cleaning anyway, might as well take care of it.
 
I've added in some numbers to my SS from yesterday and today. Can anyone take a look and let me know what they think? Should we try a few more cycles of 1.5u or move to 1.75u. Thank you!
 
Yes, I think you're ready to move up to 1.75. I'd do it on a cycle you can monitor. It's possible that you're seeing some mild bouncing from that blue yesterday (today's high and flat was classic bounce cycle) but I don't feel comfortable staying at a lower dose too long with a DKA having happened in the past.

Make sure you keep up the ketone testing...it's important to catch that fast if it's happening!
 
Thank you so much for your help :) I will move up to 1.75, monitor and post his new numbers. I'll also do another ketone test this week
 
I've added pudges new numbers and I feel like the insulin isn't even doing anything :arghh:. Im concerned because 2u put him into hypo but it seems 1.75u isn't working. Ive also added his labs in from when we found out he was out of remission.
 
Pudge said:
I've added pudges new numbers and I feel like the insulin isn't even doing anything :arghh:. Im concerned because 2u put him into hypo but it seems 1.75u isn't working. Ive also added his labs in from when we found out he was out of remission.
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I suggest that you finish today at 1.75 u and go to 2 u tomorrow. It's not a certainty that he'll drop into lime green again on 1 u. Make sure to get a +2 on the day you increase.
 
It's so hard to return to a dose that gave a lime green. I agree with Kris though that the numbers you're seeing are too high, so 1.75 isn't working right now. Some cats will just occasionally dive like that. They don't really need a reduction, they're just having a weird day. Of course the only way to know is to give the reduction, see the high numbers, and go back up again. Considering the history of DKA and that this is your second round of diabetes, you may need to talk a more aggressive approach this time.

You could also try using u100 syringes with the conversion chart. That would allow you to more easily dose in between the 1.75 and 2u. Or using the u40's, do a "skinny" or "fat" dose where you draw the 1.75u, and then just a tiny bit more. Or draw the 2.0u and push out a tiny bit so it's just a little under. It's a bit harder to be accurate that way, but I made it work for awhile before I switched syringes, so it can certainly be done.
 
I'm going to change my mind now. I just spent a little more time looking at your spreadsheet. It looks like your initial dosing was kind of all over the place. I think I'd stay at 1.75u for two more cycles. Do keep testing for ketones though because I don't like seeing him in those numbers. I'm just wondering if he needs a little more time to settle in. I'd encourage you to post after you get tonight's numbers though, and try to grab another test in the +2 to +4 range before bed if you can. It makes me nervous to keep a DKA kitty at a dose for very long, but I'm also wondering about the bouncy numbers you've had.
 
Thank you both! I don’t know what I would do without this forum, I have been so stressed about my poor baby this week.
Yeah my main concern is how high he has been consistently and with a history of DKA it makes me so nervous. I think I will stick with 1.75u until the weekend when I am off work and can monitor him more closely if I need to increase the dose. I’ll get some more numbers tonight and add them to the SS.

I also managed to get him an appointment for his dental cleaning with an ABVP vet in town just in case it his teeth causing a raise in his BG.
 
Just to clarify - two more cycles is only 24 hours. So it would have been last night's cycle and this morning's. If you don't see a better number in one of those cycles, I wouldn't wait until Saturday. He's really too high right now, and especially for a DKA kitty.
 
On the 28th my partner was giving pudge his evening shot, he had checked in on this forum earlier in the day and saw about giving him a “fatter” 1.75u shot so that’s what he did, without seeing we had later decided to wait two more cycles. So, pudge has been getting a fat 1.75u (I would say approx 1.9u?) since the evening of the 28th. I updated his SS. We got some great numbers that night and yesterday. Today we woke up with a 23 :(. I finally thought we had found the right dose! Is he bouncing because of the nice blue we saw the other day? How do we stop a bounce?
 
Alas, you can't really stop a bounce. You just have to wait until they clear. I'm not convinced that's a bounce though. He's had reds before, and AT2's tend to show a bit more variation than human meters. More likely, it's still just not enough insulin. Because of that, I wouldn't worry about the accidental increase. He was heading that way anyhow. He just got there a day sooner than planned. :) Which also means that tomorrow morning, if nothing exciting has happened before then, you can go ahead and move to 2u.
 
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