How to schedule start of treatment?

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yukon25

yukon25

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My cat Hootie was recently diagnosed as diabetic. His vet wants him on prozinc. We had a consultation set up for yesterday, so I could learn how to do shots etc. I'd also scheduled to work from home today and tomorrow, so I would have 4 days to watch/test before I had to go out and leave the house for any length of time. For assorted reasons, vet changed the appointment to next Monday. :mad:

I'm now trying to figure out when to start Hootie on insulin (after Monday's consult of course).

Do I need to be home all day beyond the first day? Should I schedule several days at home in a row or what? I don't want to delay much longer starting him on treatment, it's been 2 weeks already since diagnosis. I can be home the first day of treatment next week (Tues), on second day (Wed) I'll be away from about 9:00-1:30. Third day however (Thur), I'll be at a client office all day. Fourth day (Fri) I can arrange to be home all day, and then we'll be at the weekend (when I'll be home all day both days).

Is that a schedule that will work for Hootie's first week of treatment? Or should I delay a few more days until I can be home about 5 days in a row?

Both cats currently eat throughout the day (nibble at will). Both are fed canned with 1/3 cup dry (total, they share it) at night. The kitten eats most of the dry, from what I've seen. Right now it's unlimited canned as Hootie needs to eat (per the vet). Canned is Fancy Feast classic with a random Friskies pate tossed in. Again, per vet. I'm slowly weaning off the dry (we're down from 1 cup daily to 1/3 cup). He will be treated with ProZinc.

I've been reading up on stuff but I haven't yet found a simple answer for this. I'm sure it's out there and I'm just not recognizing it. :cat:

Thanks!
 
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I think I replied to your other post.

Insulin is given every 12 hrs. So pick times where you are usually home. What dose are you starting with? An automatic feeder is very handy when your working or can't be home.
 
I'd want to be home the first day, just in case something unexpected happens. After that, a pre shot test two times daily and extra data whenever you can get it. Sometimes it takes a week for their body to start to work with the insulin, sometimes longer, sometimes they have an immediate response.

What dose does the vet want to start with?

I assume if you've been looking around, you've seen the Protocol and Beginner's guide above. If not, they are in my signature in blue.
 
Sorry to not pop back in sooner. Hootie has his consult tomorrow afternoon and that's when I find out his starter dose. The vet mentioned the every 2-hr testing and tracking the #s. For some reason I thought that was Day One. But from what I'm reading, it appears that should really be done after he's been on a starter dose for 5-7 days. Unless I'm misunderstanding that? That's what was confusing me. Regardless, I'll be working from home for his first day and just a half day for his second day, so I think we're good to go for now.

I did manage to get both cats off the dry food finally!
 
Congratulations on getting everyone off dry! That will be a huge help.

If he were mine, I'd plan to get pre shot numbers every am and pm and at least a few mid cycle numbers every cycle, at first. That'll show you from the beginning how the dose is working. Once you have home testing down, then the curve would be easier for you both. Some cats react right away to the insulin; some take a few days, some a week. The pre shot tests and nadirs will let you know which he will be.

I hope your vet will start on a low dose, especially as the wet food may have already lowered his levels. 0.5 or one unit would be good.

Best of luck - you sound prepared!
 
It's my understanding that this afternoon's appointment will inlcude showing me how to do all the needed things so I plan to test him at the vet office. I'm seriously considering waiting until Friday to start him on treatment though. I can schedule to be home at least 5 days that way and can do any and all testing needed. Plus it sounds like I need to get him on a feeding schedule (instead of free eating all day) so that may take a couple of days. He's eating and peeing fine, playing with the other cat, etc so I'll check with the vet about Friday. I'd feel better being here. But I don't want to delay if it will be bad for him.

What does "OTJ" mean?
 
The last test when he was diagnosed was 310 I think (maybe 315). He's lost weight but he's eating regularly and playing with the other kitten. Since the dry stopped, he's not peeing quite as much (it's more than normal but less than it was if that makes sense).
 
Was that number from the vet? If so, it could have been high because of vet stress.

Are you home testing? If not, we really encourage it. A test at home now would give you some idea of how the food has helped.
 
I'll be home testing after the vet visit this afternoon :-) The original # was from his senior panel at the vet. And yes, he was definitely stressed.
 
Okey dokey. Vet is starting with one unit twice daily. She said it was ok to let him graze all day, but I'm confused on one point:

  • The proper sequence for dosing insulin is: Test/Feed/Shoot. In the beginning, if your cat’s BG is not up to at least 200 mg/dL {11 mmol/L}, if your schedule allows, you can stall (without feeding) for 20+minutes, then retest the BG. You are looking for a number that is rising, not falling and up to 200 mg/dL {11 mmol/L}. If you stall once, but can’t do another round of stalling and your cat hasn’t reached a BG of 200 mg/dL {11 mmol/L}, you’ll need to skip the dose and wait until the next cycle. NOTE: Because pet-specific meters (such as the AlphaTrak2) often read higher than human meters, you may want to adjust the NO-SHOOT number to 225 mg/dL {12.5 mmol/L} or even 250 mg/dL {14 mmol/L} This gives you an added margin of safety when using an AlphaTrak2 or other pet-specific meter.
  • IMPORTANT NOTE: Do not feed your cat within the two-hour window right before the scheduled dose time; doing this can raise your cat’s blood significantly, giving you a higher BG number based on food. This could result in your giving insulin when you should not, or giving more insulin than you should.
The vet said I only need to test once weekly. She said I could test more often but didn't have to test before each dose if all looks normal (activity, eating, peeing etc). I'm to do the q2 hr curve test in a week. She also said it was ok to keep him on his current grazing schedule (canned food out all day). But for now, if he's going to graze, how do I handle the point above about not feeding within a 2 hr window before the daily dose?
 
I like the starting dose.

Some people let their cats graze; some feed two meals a day with a snack near nadir. It depends on your life and your cat. But yes, we suggest you pick up the food two hours before the shot. If you aren't around, you might use an automatic feeder. You can set them to close up two hours ahead.

We really suggest you test before each shot. Just look at some of the spreadsheets of cats on this forum where they were 400 for amps and 200 for pmps. Giving the same dose for both those numbers can take the levels too low. Or some cats surprise with an amps of 140 when they have been above 250 for days. There is just no way to observe a cat and know whether your dose will be safe.

Nadirs are very useful to see how low the insulin takes them. When you see a high preshot, you might think the dose is too low. But if their nadir is low and they have bounced up for the pre shot, you'd know not to raise the dose.

We think the way to effectively deal with this disease is to gather data by hometesting, so you are aware what is happening and can keep your cat safe.
 
The vet likes the idea of him grazing for now since he's used to that and usually paces himself (does not inhale the full bowl at one sitting). She wants him to eat more too since he's lost a good bit of weight. She does not want me adjusting the dose at all until the curve has been done and they review it.

They also said don't give a shot if BG is 80 or under, not 225 that has been mentioned here. So I'm totally confused now :(
 
I know it's hard to hear advice that is different than your vet. All I can tell you is that this forum is over 15 years old and we deal with hundreds of diabetic cats a week, and have a high success rate. Do you know how many diabetic cats your vet has treated and what his success rate is? To be fair, most vets see a few diabetic cats a year. They usually get one workshop in diabetics. And they have to treat many different species for many different diseases. They can't be a specialist on everything.

As far as shooting at 80 and over, I think that is a very dangerous number. 50 on a human meter and 68 on a pet meter is considered hypo range. If you shot an 80, you don't have much room to drop before he is in dangerous numbers.

You don't need permission to test your cat at home. And you can shoot at levels that feel safe to you. You are your cat's best advocate; you can make decisions to keep him safe.
 
I'm actually good with using the 225 # this board recommends (I'm using an AlphaTrak meter). I'd rather err on the high side than the low side (and from reading up, 80 did sound a bit iffy even to a newby like me). I don't mind the daily testing either, it makes perfect sense to me, at least for the first few weeks. His vet is a cat only vet, but I don't know how many diabetic cats they treat. From today's "orientation", I'm inclined to think they don't have all that many.

So the grazing food is ok, then, as long as I pull up the bowls 2 hrs before? He really does need to gain some weight back and the vet has me increasing his daily quantity.
 
yukon25 said:
So the grazing food is ok, then, as long as I pull up the bowls 2 hrs before? He really does need to gain some weight back and the vet has me increasing his daily quantity.
Click to expand...

You got it! And you can also try a higher calorie, lower carb food if you want. Check out some options on Dr. Lisa's food chart.
 
I'll echo what Sue has said about vets and their experience with diabetic cats. It's hard at first for the human to hear one thing from the vet and something different from others here on FDMB. I was conflicted myself when I first joined FDMB. I joined because my vet (who's great by the way) suggested only a very small decrease in ProZinc dose when Teasel had a very low BG number on a preshot test. I wasn't even doing preshot testing at that time but my gut told me that I should based on some hit or miss testing I'd done in the few days prior. I lowered the dose even more than what my vet suggested, realized that I needed much more guidance than my vet's assessment of our once a week BG curves and came here to FDMB.

Also relevant: I wasn't a feline diabetes newbie - Teasel was diagnosed at the end of January 2016. We really weren't getting anywhere with his diabetes by following the sequence of BG curve, vet's advice on dose change, wait a week, another BG curve, vet's advice and so on ... for months on end. Something had to change and I've learned so much more about my cat's physiology and reactions to insulin than would ever have been possible the other way.
 
And you can also try a higher calorie, lower carb food if you want. Check out some options on Dr. Lisa's food chart.

They're both on FF Classic, compliments of Dr. Lisa's chart. I toss in Friskies Pate for a little variety. Hootie won't eat the pricy stuff like Blue Buffalo and a few other brands. So FF it is.

I can already tell the morning food hold will be an issue. So I'm wondering if leaving food out until midnight, then no food after will work? That way I can feed/test early in the a.m., most mornings that would be around 7:00. Or does he need food overnight? I can't really find anything definitive on overnight food (yet anyway).
 
Have you looked into an automatic feeder? I love my PetSafe5. It has 5 slots so you can spread the food out, and have the last slot close 2 hours before the pre shot test. If he is fidgety in the am/pm, you can give him a few low carb treats while you test.

Overnight food is that pesky ECID (every cat is different). Some cats stay lower if they have a little food overnight; some stay higher. For some, it makes no difference. Another one of those things you get to find out about your individual cat's patterns.
 
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