Hershey Questions/Issues - Please and Thank You!

[Doug N Libby]

Happy Friday!

#1 - DOSE: I'd appreciate an extra eye or two on Hershey's numbers. We thought the .8 u was going to be about right (Sunday will be a week on .8.), but his numbers are staying higher than we'd like to see. It had been suggested that we try .9 u, but we won't be here to monitor all day/night until Thursday. We are here all day, for sure, so - would it be beneficial to try .9 during the day and stay with .8 at night (since he's used to that)?

#2 - KETONES: Also, still no ketone check. Sixteen-hour litterbox vigil yesterday with no success. Got up this morning and pretty sure each of them had used the box, but not since. Even added a little water to his food each time, hoping it would help. Just had Doug put Hershey in the litterbox, hoping he'd take the hint, but all he did was give Doug the 'you're such an idiot' look and leave the box. And. so. we. wait.

#3 - WEIGHT: When we took the cats in for checks in Nov, the vet said Oreo needed to lose about 3 pounds (was 15.5) and, of course, Hershey was unweight (8.5). She didn't say how much he needed to gain, but I remember at ~12 pounds he did not seem overweight to me, so that's my goal. Anyhoo - I had never heard of or thought of counting calories with the cats; I'd just always fed however much the vet said. Well, we moved Oreo to half wet/half dry (to finish up the dry we had on hand) and he seemed to get bigger, but I had no accurate scale, so can't be for sure. Then, I learned about the 15 - 20 cal/lb, realized he was eating WAYYY too many calories and cut him back. Tonight, we bought a digital scale. It said Oreo was .1 pound heavier and Hershey had gained 1.1, now weighing 9.6! I was happy to see that I'm not imagining Hershey's weight gain, but don't know if that means he's getting regulated or what...

#4 - I've seen that some of y'all changed insulins. Why/when would you make a change? I got to wondering what if .9u still isn't right for Hershey. We've tried 1 unit and it seemed to be too much, so if not .9, then what? I know we all hope for remission for our little ones and I just don't want to mess up and not doing something that could be helpful to him. And, speaking of insulin - my vet said I could only get ProZinc from her - is that completely accurate?

Thanks so much for being such great hand holders!

Libby (and Hershey, too!)

 

[Doug N Libby]

So, Doug just came running through making a lot of noise and muttering excitedly - I thought he had hurt himself. Turns out - Hershey was in the litterbox! He managed to get the edge of the strip in the stream and it didn't really change colors, so I guess that's negative? I mean, the strip wasn't white anymore, but closer to the flesh color on the bottle, so I guess that was enough?

 

[Sue and Oliver (GA)]

It did look like the one unit was giving you low nadirs but the .8 doesn't seem to be enough. Yes, I would try to eyeball .9. I think giving it both cycles is okay, though it would be nice to figure out why he is lower at night. I think we have explored that. Could it be food and maybe you should feed fewer meals during the day? Over feeding can raise bg levels. Have you tried making the wet food soupy so it seems like more for him to eat?

Is the dry all gone?

We couldn't get a sample until we put Oliver in the room with a clean litter box filled with aquarium gravel.

It's early to give up on ProZinc. I would give it more time. It seems like forever, but it hasn't been very long and one unit is a tiny dose. Yes, I think ProZinc is available only from the vet. It is considered an animal insulin. Lantus and Levemir are human insulins which can be bought in pharmacies but in most states require a prescription.

 

[Doug N Libby]

Yes, the dry food is gone. We were feeding a can divided ~equally between shot times and +6 (total 181 - 220 depending on the flavor), but he still seemed hungry, so we added an 1/8 can at shot time, which still keeps him 15 - 20 cal/lb (total 204 - 248 depending on the flavor). So, do you think we should try increasing food at morning shot time and +6 and cutting back some at PM shot time and +6? I've been adding a little water since yesterday, mainly hoping it would make him use the litterbox so we could get a ketone reading. ;-)

So, we can start him on .9 at 3:30 tomorrow morning, but won't be here tomorrow night to monitor him after the 3:30pm dose. You think that's okay?

We're feeding him Wellness <7% carbs, should we try to find something even lower? He REALLY likes the Wellness.

Thanks, Sue!

 

[Sue and Oliver (GA)]

If he generally eats less at night and that is when his numbers are lower, you might try either reducing it a little or feeding fewer meals - whatever duplicates what happens at night. It may not help ,but this dance involves trying lots of ridiculous stuff to see if anything makes a difference.

I don't know about not being able to monitor. You sound a little worried about it and I am a big one for going with your gut. .1 should not make a huge difference and you can leave some food out in case he goes low, but if you'd rather lower the dose that cycle, then that's what you should do. Is 3:30 your usual shot time or are you changing it up tomorrow? (I am going to be so impressed if you get up at 3:30am daily to shoot!). Changing the shot time will impact the cycle.

I think the wellness is fine. We want him to eat.

 

[Carl & Polly & Bob (GA)]

We've tried 1 unit and it seemed to be too much, so if not .9, then what? I know we all hope for remission for our little ones and I just don't want to mess up and not doing something that could be helpful to him. And, speaking of insulin - my vet said I could only get ProZinc from her - is that completely accurate?

I say this a lot, but maybe you haven't seen it from me....

Two things we can't do -
Don't assume that what didn't work before won't work now. The 1u may have been too much at that time, but that doesn't mean it is too much today.
Don't assume that works today will work tomorrow. Today's dose may work crappy today and work too well tomorrow. It might give you a perfect curve tonight and a really flat one tomorrow. Unfortunately, nothing about this disease can be set in stone. All we can do is the best we can do. And I'm not trying to sound discouraging, Libby. There are some general guidelines that we all follow. But there's a whole lot of randomness in this dance. You just live life in 12 hour segments, and if you err, you try to err on the side of caution. And you lean on us for support any time you need to.

There are tons and tons of things going on in a cat's body everyday, many of which have absolutely nothing to do with how much insulin you are shooting. Dr. Lisa listed a bunch of stuff "besides insulin" in a thread a few weeks back, and I'll try to find it and post it here. How much they eat, when they eat, how active they are, how they feel in general, stress, illness, infection.....it's a long list. She also said that teeny dose increases or decreases are more or less pointless....pointless is not the word she used, but basically that's it. The difference between .8 and .9 can't be accurately measured consistently, an air bubble or two in the needle is all it would take to cause that. Any difference that you see in how the insulin works on .8 or 1.0 would more likely be due to "all the other things" going on than on the actually dose of insulin. I'll search for that post and link it for you.

And yes, Prozinc can only be bought with a vet's prescription. Ditto for PZI. The "L"s can be bought in some states without a 'script, and I think you can buy them that way from Canada, but not positive on that.
Also, I echo Sue here....it's too early to give up on Prozinc, IMO.
Carl

 

[Doug N Libby]

We usually shoot at 2:30/2:30, but since we overslept on the 25th, it moved our shot times to 5:30/5:30 and we've been slowly moving them back. We're at 3:30/3:30 now. We test - walk him around the island 25 times - feed - shoot. You should've seen me walking him this morning - I hit the wall (literally) on more than one occasion! ;-)

He eats the same amount each shot time (1/4 + 1/8) and the same each +6 (1/4 can). I thought feeding 4 meals would help keep him BG pretty level...I think they should just come with a manual. :? I'll try playing around with the amounts and see if we can find a pattern. I think I'm going to write everything out and see if I can find anything...to keep an eye on...

I am a little worried about not being able to monitor him, but think we need to do something and it seems like Thursday is a long time to wait. So, we'll try it tomorrow morning, check him a couple of times and see what it looks like.

Thanks, again -

 

[Carl & Polly & Bob (GA)]

Well, that was easier than I thought! I just try to remember one word when I want to recall a post, and in this case, the magic work was "exogenous"...

http://felinediabetes.com/FDMB/viewtopic.php?f=24&t=61241&p=663242&
Here's the part I was talking about:

carlinsc wrote:
Something that Dr. Lisa said several weeks ago keeps tugging at my brain.


Given that there are MANY things going on in the body that influence the BG level, it is my opinion that we all get too caught up in thinking that the dosage we give is so critical down to the 0.1 or 0.2 unit….and that the *only* reason a hypo occurs is because of an overdose. Exogenous insulin is only one piece of the puzzle. This is why there is always going to be a risk of hypo because what if the pancreas just decides to wake up that day and join the party…adding to the exogenous insulin? What if some infection/inflammation subsided….or stress was reduced….or the patient lost some body fat…..any of which would render the patient more insulin sensitive?
========================================================================

I have been so busy lately and have not been following Copper's saga but I want to reiterate the above because I often see folks on this board getting so caught up in the insulin dosage (down to overdone minutia....driving themselves crazy....) as if that is the only issue...and as if 0.1 (not even measurable...) or 0.2 units (highly doubtful that this level is accurately measured...) is the end all...be all...'deal breaker' for the cat's situation when it simply is only one TINY (at that level of change) piece of a very complicated puzzle.

Believe me, I completely 'get' the frustration involved with managing any diabetic cat - especially one like Copper - but I just hate to see people ripping their hair out over the dosage of insulin....down to impossible-to-accurately-measure increments of 0.1 or 0.2 units when there are SO many other factors involved in the glucose curve making that level of dosage change pretty darn moot. Yes, it would be great if we really had *that* much control over the disease process but we don't.

(Lori - I am hoping that the last statement will take pressure off of you - not add to it. Copper's body is in charge and we are just along for the ride...doing the best that we can with the ability to affect only a few pieces of the puzzle....ie....diet, insulin, constipation, body weight - in the case of an overweight cat.)

Serum glucose, at any single time point during the glucose curve, represents the sum effects in the *rate* and *amount* and *timing* of:

*Exogenous insulin absorption

*Endogenous insulin production

*Intracellular uptake of exogenous and endogenous insulin

*Insulin degradation and elimination - different for exogenous vs endogenous

*Intestinal glucose absorption

*Endogenous glucose production

*Tissue glucose uptake and utilization

and then throw in the amount of exogenous insulin....excess body fat....inflammation....subclinical infection....etc...etc....

....and then add in Copper's recent bouts with constipation (stress => increased BG) which prompted an email to Lori to get Miralax (or generic PEG 3350) into him asap before he ended up needing an enema at her vet's office...which is not easy for her to get to and I hated the thought of Copper having to go through all of this. (Dosage Rx was to start with 1/8-1/4 tsp AM and PM - mixed into food - and dose upwards to effect.)

When you consider all of the above, to me, at least, I can't get caught up in agonizing over minute dosage changes...so dear Lori....please stop driving yourself nuts over such small dosage increments.

Carl - it is great that you take the time to really think these cases through and I know that Lori deeply appreciates the time you, and everyone else here, have spent on Copper's case. He is not an easy one, that is for sure.

 

[Doug N Libby]

Thanks, Carl. No, I hadn't heard that from you, but it makes sense, thanks. I'd appreciate reading that post, if you can find it. When I went to church last weekend - eyes bloodshot from lack of sleep - people asked me if getting used to this was like when my kids are sick. I told them I think it could be worse because he can't tell me anything about what's going on with him.

Air bubbles - can you always see them? How can you minimize them?

I was asking about where I could get ProZinc, wondering if there's a less expensive place to get it. Thanks.

We'll try the .9 and maybe we can do a curve the end of the week when we're home.

Thanks, y'all!

 

[Carl & Polly & Bob (GA)]

Libby, I posted it when you were typing, so it's right above your post!

Now I understand the prozinc availability question. I'm not really sure. When you got this vial, did it come from your vet, or did she call in a prescription to a pharmacy? I'm guessing you had to buy it at the vet clinic, right? Hmmm, maybe one of the other prozinc users can help answer... I used PZI, and you get that by mail from a lab in Texas. All you need is a prescription number that they check and verify.

Here is something from the prozinc website that may be encouraging for you to read:

How long will it take to regulate my cat on PROZINC?
Every cat is an individual, and therefore each cat will respond differently to the same insulin. However, based on the results of an effectiveness field study, 76% of the cats enrolled in the study were considered a treatment success by 45 days.1,6

Here's a link to the site. You might call them and find out if you can buy it direct or from another source?
http://www.prozinc.us/

Carl

 

[Doug N Libby]

Thanks, Carl, for Dr. Lisa's post and the ProZinc information. Yes, I had to buy it at my vet's office. She wasn't very helpful, I had to pull information from her, so if there was more, I didn't get it. But, that's another thread ;-) I'll check the site and see what I can find out.

Libby (and Hershey, too!)