Help with stabilizing?

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Frankie Bear

Frankie Bear

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Hi there - I've been working with my vet on & off to stabilize my Frank but he's just incorrigible - his blood sugar is all over the map, all the time. I have tried keeping him on a steady dose so that he would stop bouncing but that doesn't seem to work either. The only dry food he gets is Young Again Zero - the stuff with no carbs in it (we paid an arm and a leg to ship a bag up to Canada). It's been almost 7 months since his diagnosis and still there's no hope in sight. Should we be considering a different insulin? He's been on Lantus before, and now has been on Prozinc for awhile, still with no success. Any suggestions would be greatly appreciated!
Rhonda
 
It is really hard to know without more data. I would be reluctant to Give any advice without preshot numbers. Is there a chance you could get a curve tomorrow from preshot to preshot with numbers every 2-3 hours in between? That would make it easier to know if ProZinc is just not working for him or whether there are adjustments you could make to help.

It is possible that Lantus or Levemir would work better. What were his numbers like with Lantus?

The other possibility is that he might have a high dose condition. We start to think about those when the doses are +5 or more. This thread has broken links but the general information on high dose conditions is good. Do any of the symptoms sound like your kitty?

http://www.felinediabetes.com/FDMB/...-other-high-dose-conditions-what-we-know.375/
 
Hi Sue - I had seen some stuff on acrocats before and had wondered about that... he is a big cat... I don't know, though, of those symptoms, none of them sounded 100% like Frank but then, that's normal too - it's probably uncommon to have ALL the symptoms... should I ask my vet to test him for these things like acromegaly, Cushing's disease? There has to be some explanation for why his results are so crazy.

As for the home testing - I'm confused... you mention needing the preshot numbers but we almost always do preshot numbers. On the spreadsheet, back in September when he was first diagnosed, we weren't testing him regularly. Now we're doing it usually 2-3 times/day, sometimes more, so if you look at more recent dates, you'll see all the tests, including preshots. That said, I could definitely do a curve on him tomorrow, no problem. He's just so erratic though that one day's results are not necessarily going to be a good indicator of his normal results because he has no normal. (Sorry if I sound frustrated! Trying to save his life is costing me my sanity! :-) ) Do you still think a curve is needed since the preshot #s are on the spreadsheet? Just checking that I understand... I'm home all day tomorrow so can definitely do it.

He was on Lantus originally until Dec. 17 and has been on Prozinc ever since. Both insulins gave a few good days where his BG comes down to normal, but on Prozinc he has also had some very bad days where his BG was so high, I'm surprised he's still alive. Only twice in 7 months has he ever gone quite low. Neither of them produced any consistency.

Thanks!
 
My bad. My IPad didn't show me the bottom of the page with the recent numbers.

it looks like maybe more consistency with the doses might help. For example, on 2/25 6.5 units gave you an amps too low to shoot, so it looks like that dose is too high for that range. You can use a sliding scale - with doses for each range - once you have the data to show you what the dose does. if he were mine, I would do the curve to see when he drops lowest and how low. And I would get up at night during that time range and see how low he drops at night. The night time tests are hard, but they can really tell you whether the amps is a bounce or not. Once you have some of that nadir data, I can try to help you put together a sliding scale, with doses for different preshot values. That might help flatten out some of the highs and lows and give him better cycles overall.

He is getting some decent numbers on 5/6 units. That is a good thing, but it is still more insulin than we usually see. The other variable is the food. What is he eating? Your signature says dry? High carb dry can really elevate the levels. There are ways to try to get him transitioned to wet low carb. Have you seen this website: www.catinfo.org. She has great ideas for stubborn cats. There are also lower carb dry foods, but I'd try some of her ideas for the wet first.
 
I thought more consistency would be good, too, but so far it's just been impossible. You mention that Feb. 25 the 6.5 units made his amps too low for a dose in the morning but that was the first time - I think in the whole 7 months - that that has happened. With 6.5 units at night, he's always still had a high BG in the morning. I know you know a lot more about this than I do so just wanted to check if making any judgements based on 1 occurrence will work?

And just a question: when Frank has good days, we'll see a high number for amps/pmps and then a good number in the middle of the day. Is that as good as it gets? I think that's what you're referring to when you mention flattening out some of the highs and lows - I would sure like to get there! This poor guy is going to die before we make any progress... I really like the idea of a sliding scale - kind of have tried to do that but it's just been a shot in the dark up 'til now.

He doesn't usually get very low, and sometimes, like today, he doesn't get low at all - the 6.5 units this morning only brought him down by 2 mmol/L. It's crazy. Sorry about the signature - I didn't mean to be misleading - he does not get any dry food at all. (I've updated my signature now.) I took away dry food entirely back in November but my other kitties still get it (we have a load of kitty health issues and there are just so many battles we can deal with all at once). While he used to like having a bit of canned food for breakfast, he really, really dislikes having canned food all the time. I've opened & wasted many, many cans of food, trying to find one he likes. Then he likes one for a few weeks, I buy a ton of it, and then he hates it, won't touch it. Sigh. I've tried Fortiflora too, but that backfired - it got so he would only lick the Fortiflora off the top and not eat anything. We can't get any of the low carb dry foods in Canada so that's unfortunate.

I can definitely do a daytime curve on him tomorrow but I am a fulltime student with 80+ hours of homework per week, I just don't think I'd be able to do a 24-hour curve... I feel guilty about that but I'm already not taking really good care of myself with this workload... :-(
 
You don't need to do a 24 hour curve. A daytime curve and then some nadir numbers once every few nights will give some good data.

Darn. I was hoping maybe he was eating dry as that would explain some of his higher ranges.

No, you don't base a sliding scale on one number -'that one just looked like less insulin might have given you a shootable amps the next morning. The ideal range for regulation (the first thing to aim for) is preshots in the mid 200s and nadirs in double digits (but not lower than 50 on a human meter or 68 on a pet meter). BTW, what kind of meter are you using?

Don't beat yourself up. You are doing a good job. This stuff is hard! Anyone who tests at home, feeds wet low carb is a hero in my book - so many people hear the diabetes diagnosis and put the cat to sleep.
 
Thanks for the encouragement! My first sugar cat, I couldn't bring myself to do the tests or shots - I didn't put her to sleep but I forever regret not trying to help her. Then the 2nd sugar cat was my husband's - he tried a bit to work things out but it just got bad so quickly, poor kitty was dragging around his back legs because he couldn't walk any more, was peeing all over the house (I suspect he couldn't feel anything down there), so his life ended too soon too. Now this guy, I really try thinking - 3rd time's the charm, right? Not so far! Sigh.

We're using the Accu-Check Aviva Nano - a human meter.

When you mention some nadir numbers once every few nights - do you mean just 1 test in the night? Frank seems to (based on previous curves), hit his nadir around 8 hours so I could do a mid-night test 8 hours after his pm shot? I could do one test in the middle of the night; just thought that doing it every 2-3 hours over night would kill me but one is ok, if I understood that correctly...
 
I think I'd try +8 one night and then maybe +6 another night. You are hoping to see what a nadir looks overnight so you know if it's a number low enough to cause a bounce. Some cats have very different cycles, day and night. Might be the difference in food intake or activity...
 
Ok, I could do that... maybe next weekend - I have exams this week. He's not eating at all today - he let me test him this morning with absolutely no protest and then had absolutely no interest in food after, didn't even sniff it. I'm a bit worried about him - may have to get him in to the vet for some testing because he's been very low appetite all week. :-(
 
The vet might be able to give you an appetite stimulant. What have you tried to get him to like the wet food? Some people add a little warm water to make it soupy, some sprinkle with Parmesan cheese or a favorite treat, some heat it in the microwave until nice and stinky, some use FortiFlora (a probiotic that has the animal digest that makes dry food so irrestible)
 
I've tried all of those things except the parmesan cheese :-( He won't eat canned food if it's been in the fridge, so it's always a new can. He won't eat it if there's water in it. I've tried microwaving it, Fortiflora (he just licks it off the top, and won't eat it if I mix it in), even clam juice, but he's just not nuts about anything. We have some parmesan in the fridge right now... I'll try that when he next comes around... he's just so fussy - he'll love something for awhile (e.g. Friskies turkey pate) and then when he decides he doesn't like it any more, there's no amount of time that brings it back to being a favourite. There are only so many flavours of cat food out there! Drives me crazy, this guy, ha ha...
 
Hi Rhonda! Sorry I've been AWOL...we're having some cat medical issues here, and we've been having some internet issues too! Yay weekends. Anyway, just reset my router thingie (or whatever that black box is called!) so hopefully the internet is going to work consistently.

As Sue said...if you home test, feed wet low carb, you are my hero! I know it's tough. Trust me, right now, no one gets the fear, the sleepless nights, the anxiety, and the extreme money issues that come with pet illness. Even with my sugar cat over the Bridge, we're dealing with lots of issues! BUT...it's worth it. Diabetes is tough to deal with, because you can't tell what will work at any given time. But keep it up!

I think Sue's plan for a curve is a great one. Then the occasional overnight number...I'm up at least once a night usually anyway and used to pop downstairs to test Gypsy sometimes then. Not every night...not even often...just sometimes to see where she was at. She slept through it! :)
 
Oh wow, the parmesan cheese is really doing the trick! Mind you, he hadn't eaten anything all day so not sure if it's hunger or the parmesan but he's loving the food with the cheese on it! Problem is, I just did his +2 and he was UP to 21.2 mmol/L (up to 382 from 290 earlier) even though he had eaten nothing at all between tests...
 
But he didn't eat at all, I tested him at 7 am and then gave him breakfast but he was completely uninterested; not even 1 lick. Then I tested him again at 9 am so he truly ate absolutely nothing between. Weird. Anyway, now he's eaten a fair bit so we'll see how it goes.
 
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