High BG numbers continue on high dose

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Linda and Lacey

Linda and Lacey

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Update on Lacey - we have done a couple of random BG tests and I really don't think she is under control, even at 3 units PZI twice daily. Today we tested her at 7 hours after her shot and her BG was 444. She is still drinking and peeing more than normal. I know it's supposed to kick in at 2 hours and the nadir at about 4-6 hours, so it sounds like she just isn't getting enough response. The vet said she could have one snack between meals, and I think she may be having a very small snack every 4 hours or so. We are going to get her back to the vet ASAP, but they just do shorter curves (drop off at 8, pick up at 4:30) and she won't eat for them while she's there, so she probably won't show the same results. Given what we're seeing, do you think they might put her on a different insulin, more frequent doses?
 
Linda, is she still eating WD dry? I wonder if her numbers would improve if you would drop that. It is really hard to know about her levels with just a few numbers. Can you give us an example of what a cycle is like? What is the morning number before the test, 3-5 hours later, 6-8 hours and then the evening number? It sounds like you are testing now even though it says you aren't in your signature? What dose did she start with and what dose is she on now?

It certainly is possible that another insulin would work better; it is possible that she has a high dose condition; it is possible that there is a way to make the PZI work better, but we need more info first.
 
No, we're not testing regularly - just 3 tests total since day 1. She is really hard to test - growls and whines, flips her ears around and we lose the blood drop. It takes both of us together and several tries to do it (I hold her and he sticks). We watched the videos and follow the tips, but she just doesn't like her ears being touched much less pricked.

She eats a little w/d dry for a snack (maybe 10 pieces) but mainly is still eating 1/2 can of Friskies shredded or 1 can of FF flaked foods twice daily (before shots) and picking at the leftovers during the day. We can't get her to like the pate/classic varieties. She has a chronically stuffed up nose and we think not being able to smell most food is affecting what he will eat (i.e., she eats with her eyes more than her nose, if you know what I mean). She actually started out eating/drinking/peeing less for the first week or so, but then crept back up to where she's at now. Her activity level definitely has gone up from pre-diagnosis but down from week 1.

She started at 3 units of PZI 12 hours apart, and is still getting that. The vet said she tested out to need 4, but it's so high she wanted to "under-dose" by a little to avoid crashes.
 
Hate to disagree with your vet (well not really ;)), but I've never seen a cat that "tested out" to be started at 4u BID, or 3u BID for that matter.

The AAHA guidelines for starting dose are primarily based on weight. Of course, there might be "other complications" that make a high starting dose logical, but I'd guess that would be a rare occasion.

Most cats are well regulated on insulin at 0.5 U/kg q 12 hours, with a range of 0.2t o 0.8U/kg.
The panel recommends a starting dose of 0.25 U/kg q 12 hours, based on an estimate of the cat’s lean body weight.
This equates to 1 Uq /12 hours in an average cat.
Even in a very large cat, the starting dose of insulin should not exceed 2U per cat q 12 hours.

How much does your kitty weigh? Is she underweight, overweight, or just about right?

A starting dose of 4u would be logical....if a cat's lean body weight were 33.2 pounds. Even my tons-of-fun kitty, Bob, maxed out at 22 pounds (although he was only 12 pounds when he was diagnosed).

I can't be sure, but my thinking is that Lacey has been over dose since day 1. That can cause the numbers to stay high, all day, every day if it is a chronic overdosing of insulin. I try not to question the advice of a vet, especially if it is one that a caregiver has a long relationship with. I'm just wondering if the vet has a great deal of experience and a good success rate in dealing with feline diabetes.
 
She weighs about 12 or 13 pounds. Your statement about possible overdosing is scaring me...I did some reading and am thinking about insulin resistance - she has a chronic sinus problem. We are also in the middle of deciding whether to change vets and if the first one over-prescribed, it would definitely make sense to switch. A new vet wouldn't have her records though, and our existing vet is notorious for taking 2 weeks to forward records. Maybe we should try to get her in to her original vet first? (Not even sure if they're open tomorrow)
 
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I have a feeling that if you bring her to the old vet, they are going to advise an increase in dose given her numbers. Or want to run a curve, which if done at the vet is probably not very useful. If she's stressed and won't eat while there, the numbers will be all wonky.

If going there is your only choice, maybe you can just ask how they came up with that starting dose? They might get all defensive though. Seems many vets get an attitude when you say "I read on the internet....". They think we're crazy cat people, lol.
But the chronic sinus problem might be worth them figuring out.
 
With her updated weight of 13 lbs and calculating the dose they mention of 0.5 units/kg, the starting dose isn't that far off. But the same article also suggests not more than 2 units even if cat is "very large". (Is 13 lbs "very large"??) We are going to try for the new vet and hope they take the time to talk about our concerns about insulin resistance and possible infection/inflammation. I guess it's also possible our PZI lost effectiveness due to being too cold in the fridge; we haven't shaken it, just tipped it end-over-end to mix, so it isn't that.

Thanks for the input - will post an update when we develop a plan.
 
Very large is much larger than 13 lbs. And it is "lean body weight" they reference, not current weight.
It depends on how large her frame is, age, etc as to what would be her lean body weight. I take that to mean "how much should she ideally weigh?"
The ".5" you quoted is "how much it requires for most cats to be well regulated". As opposed to " starting dose" which would be half as much per kg.
My cat started at 1u 2x per day. He weighed 12 lbs. The vet said 14 was a good weight for him. But she started him at 1u, a little less than the formula. Because it's a lot easier to start low and increase if it doesn't work, than it is to start high, and when the numbers don't improve, to figure out if you need to increase, or actually need to decrease because you "missed" the right dose.
1u didn't work for Bob. She she upped the dose. Then she started having me adjust his doses based on how high his numbers were on a shot by shot basis. He went as high as getting 4u at times.
By the time Bob was well regulated, his doses were 2u or less. Well under the ".5u per kg" referenced by the AAHA guidelines.
In case you haven't figured it out already, I love math.:D
 
I hate math, so it's good Carl is here!!

To add to what he is saying, a lot of cats are overdosed at the beginning. I understand the vet's thoughts...the higher the numbers, the more insulin should be needed. But it just doesn't work that way. The numbers are almost always higher at the vet due to stress. Food can affect the numbers too. My Gypsy was overdosed in the beginning...when I finally got here and started posting, we brought her down...and over time, I kept having to reduce dose, not increase.

If you decide to go to your old vet, you might ask if they can print out the records for you to just study at home. Just say you want to be able to look them all over yourself. I did that before I switched...even if they can't give you ALL the records, they might print out recent ones for you to provide a new vet while waiting for the rest to be forwarded.
 
Should you decide to go vet shopping, there are some Vet Interview Topics in my signature, compiled from suggestions here on the board, which you may find helpful in ruling candidates in or out.
 
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