Well you know that I don’t agree with letting her hypo. I really don’t understand that at all. I certainly don’t agree that giving 1 unit of ProZinc to a non-diabetic cat would be safe.
@Marje and Gracie
I’ve read the previous thread and this one. A few things I want to clarify:
1. there is a difference between low blood glucose and a hypoglycemic episode. I don’t see any BGs on her SS which would result in a symptomatic hypo so I think it’s best to get the semantics correct to keep anyone from thinking she is actually having symptomatic hypos. While a cat can have a symptomatic hypo in the 40s, in almost 14 years here, I’ve only seen one time where a cat “might” have had some symptoms (like glazed eyes and staring) in the 40s on a human meter.. I’ve never seen one in the 50s on a human meter. While it is
imperative we closely monitor any BGs below 50 on a human meter, it’s best to only use the term “hypo” when we see symptoms.
2. I have seen symptomatic hypos in diabetic cats receiving as little as 0.25u of insulin. When a vet says a nondiabetic cat can be given 1u of PZ without a hypo, that can possibly happen. I remember one instance here where a member’s family member accidentally gave the insulin shot to their nondiabetic cat. We were up all night with the member monitoring the cat, and the BG was fine. But that is
one shot in a cat that is able to regulate the insulin and blood glucose in its body. That is not a
diabetic cat whose body has lost the ability to deal with insulin and regulate its blood glucose. While PZ is not a depot insulin in the pure sense of the term as Lantus and Levemir ( and biosimilars are), we have noted it can, at times, have a residual effect from one cycle to the next so continuing to give too much insulin to a diabetic cat is going to result in a symptomatic hypo. I would not suggest 1u bid for Tiger at this time. Also….shooting three times a day can be done with PZ and we’ve had members do it effectively but if you are gone long hours, I wouldn’t do it. We’ve gotten thousands of cats regulated shooting twice a day.
3. While I understand why some members need to use the Libre, it does run low at low numbers. Because of that, if we aren’t seeing a test when the BG is low with a handheld meter, it’s difficult to know if the dose is correct. I am also confused when you are using an AT and not so a better way to make that apparent would be appreciated.
4. One reason you are seeing so much and such drastic bouncing is because she isn’t being fed the correct amount of food to work with her insulin. Dropping from Hi to 440 or 256 to 59 in two hours is too fast. The faster the drop, the harder the bounce. It’s really important to feed her something in the 6-10% of calories from carbs divided up into four meals at PS, +1, +2, and +3 (to start) to work with the onset of the insulin. You might find a different feeding schedule works best for her but that is where we usually start. In addition, because bounce clearing cycles are very active, I often see the BG drop below the reduction point but the cat is not ready for a reduction. However, due to our dosing methods, we suggest a reduction out of safety because the dose can always go back up. You might find if she’s fed correctly, the drop would be slower and she wouldn’t drop so low as the bounce clears. If you have an early indication the BG is dropping fast (say a big drop between PS and +2), you might want to feed a little extra carbs (MC like 13%) just to slow it down.
5. She is losing duration and that could be due to absorption issues, the shot isn’t being given exactly subq, or the dose isn’t right. An example is on 3/1 where she went from 169 to 398 in two hours. Most people will tell you it is the start of a bounce but it’s actually loss of duration and then a bounce hits on top of it.
6.For DKA to be present, there must be infection. Did they identify this? A cat does not develop DKA in the absence of infection. And while DKA can occur in cats who look tightly regulated (I’ve seen two), typically DKA also indicates there isn’t enough insulin.
7. I absolute do not agree that any cat should be allowed to drop so low it experiences a symptomatic hypoglycemic episode. I can’t possibly know what the vet meant by allowing her to hypo but our guidelines here are reductions are earned with a drop below 50 on a human meter, 68 on a pet meter for a newly diagnosed cat like Tiger if the CG is using TR method of regulation. If using SLGS, which you should be doing since she’s eating dry food, it’s below 90 on any meter.
Until she is eating no dry, you must use SLGS method of reduction and reductions come when the BG drops below 90, human or AT meter. I see three times when this has occurred since she was dropped to 0.75u.
My gut tells me she likely needs at least 0.75u bid (because her reductions were earned when she was dropping quickly when clearing bounces) but if you aren’t able to manage her curve properly to get it to flatten out more, it’s safer to give 0.5u bid so that would be my dose suggestion for now. I also think she would benefit a lot from Lantus. PZ is not working well for her. But, even with Lantus, you have to manage the curve better or you will still get these wild dives and bounces.
