Increase dose- advice on when and how much

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Julie & Bones

Julie & Bones

Member Since 2020
Hello. My cat Bones was diagnosed 5/1/20. I have been learning so much already on this site and I do not feel comfortable with the vets treatment plan. His initial blood work glucose was 456 and his UA showed Glucose strip 3+ (HIGH) but negative for ketones. The vet started him on 2 units of Prozinc 2x a day. After one week they did a glucose curve and he increased the insulin to 3 units AM and 4 units PM. He was on that for 2 weeks and then had a fructosamine test (5/23/20) which was 533. The vet now wants me to increase the dose to 5 units 2x a day. I told the vet I was worried about such a large dose so he said I could do 5 units AM and 4 units PM. I did increase to 4 units 2x a day. Home BG testing was never mentioned and once I asked about it I was told to test before giving the injections (no fasting required) and just one test at +6 during the day. I have been doing the pre shot testing with 2 hours fasting and I need to get more readings throughout the day. At the time of the diagnosis the vet suggested that he change to the hills w/d. So he has been eating dry and wet w/d. I specifically asked about switching to a low carb food and the vet said that it wouldn't make a difference.

I want to switch him to a low carb wet food (maybe leave out the suggested low carb dry food at night) before increasing the dose anymore. I know that changing his food will require a change in the insulin dose but I don't know where to start or how to adjust the insulin. I am worried about his numbers being so high. He seems to be sleeping most of the day and he is suffering with bad neuropathy (I have ordered zobaline and will be starting asap)

Thanks for any advice and support. I'm feeling totally overwhelmed.
 
Hi Julie and Bones and welcome to your both!:)
I’m really glad you have found this site.
And I’m really wondering how much your vet actually knows about feline diabetes. Your instincts are right. Having a diabetic cat up to 5 units twice a day after only 4 weeks is dangerous.

First of all the W/D food is very high carb and very low in moisture. 7% moisture against 78% for canned.
The dry is 36.9%carbs. Just look at the ingredients.
Out of the first 8 ingredients 5 are carbs ...brewers rice, corn gluten meal, wheat gluten, while grain corn and while grain wheat. Then there is powered cellulose which is basically sawdust. The other two are chicken meal and chicken.
The canned food says it is 50% carbs.

Diabetic cats need 10% or under carbs..around 4-7% is good. And canned is much much better for cats as they need the added moisture.
If you are feeding the w/d it is like feeding candy. No wonder you have been getting such high numbers.
Swapping to a low carb diet will make a big difference.
You will need to be testing frequently, to see that the change over in diet does not drop the blood glucose too low.
I’m so glad you are home testing. Always test before every shot and again during the cycle. Don’t neglect the pm cycle. It is just as important. Try and always get a before bed test in and if it is lower than the preshot, test again later to see it hasn’t dropped lower.

I’m not a Prozinc user so I can’t offer advice except to say that please don’t increase any further. We increase the doses in 1/4 unit increments so that it is safe for the cat and we don’t go past the best dose.
If you are going to swap over to a low carb diet and I would strongly recommend you do, you will probably need to reduce the current dose.
I’m going to tag @Deb & Wink about the prozinc. And how you are best to tackle the swap over to the low carb while using Prozinc. Dont start until someone is helping you.
What I would do is buy a bottle of Ketostix so that you can test for ketones while you are reducing the dose of insulin. It is a safe guard which is well worth while doing. You can buy them at a pharmacy or Walmart.
Also stock up on some low carb cans. I will post a link.
Also get some higher carb foods in case they are needed for low numbers. And always have honey or karo at home I case it is needed.
Here is the food link
https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

Here is another useful link
http://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

Keep asking lots of questions. We are happy to help
Bron
 
Julie & Bones said:
Hello. My cat Bones was diagnosed 5/1/20. I have been learning so much already on this site and I do not feel comfortable with the vets treatment plan. His initial blood work glucose was 456 and his UA showed Glucose strip 3+ (HIGH) but negative for ketones. The vet started him on 2 units of Prozinc 2x a day. After one week they did a glucose curve and he increased the insulin to 3 units AM and 4 units PM. He was on that for 2 weeks and then had a fructosamine test (5/23/20) which was 533. The vet now wants me to increase the dose to 5 units 2x a day. I told the vet I was worried about such a large dose so he said I could do 5 units AM and 4 units PM. I did increase to 4 units 2x a day. Home BG testing was never mentioned and once I asked about it I was told to test before giving the injections (no fasting required) and just one test at +6 during the day. I have been doing the pre shot testing with 2 hours fasting and I need to get more readings throughout the day. At the time of the diagnosis the vet suggested that he change to the hills w/d. So he has been eating dry and wet w/d. I specifically asked about switching to a low carb food and the vet said that it wouldn't make a difference.

I want to switch him to a low carb wet food (maybe leave out the suggested low carb dry food at night) before increasing the dose anymore. I know that changing his food will require a change in the insulin dose but I don't know where to start or how to adjust the insulin. I am worried about his numbers being so high. He seems to be sleeping most of the day and he is suffering with bad neuropathy (I have ordered zobaline and will be starting asap)

Thanks for any advice and support. I'm feeling totally overwhelmed.
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Does he have any infections going on? Can you post a copy of his lab reports?
 
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Bron and Sheba (GA) said:
Hi Julie and Bones and welcome to your both!:)
I’m really glad you have found this site.
And I’m really wondering how much your vet actually knows about feline diabetes. Your instincts are right. Having a diabetic cat up to 5 units twice a day after only 4 weeks is dangerous.

First of all the W/D food is very high carb and very low in moisture. 7% moisture against 78% for canned.
The dry is 36.9%carbs. Just look at the ingredients.
Out of the first 8 ingredients 5 are carbs ...brewers rice, corn gluten meal, wheat gluten, while grain corn and while grain wheat. Then there is powered cellulose which is basically sawdust. The other two are chicken meal and chicken.
The canned food says it is 50% carbs.

Diabetic cats need 10% or under carbs..around 4-7% is good. And canned is much much better for cats as they need the added moisture.
If you are feeding the w/d it is like feeding candy. No wonder you have been getting such high numbers.
Swapping to a low carb diet will make a big difference.
You will need to be testing frequently, to see that the change over in diet does not drop the blood glucose too low.
I’m so glad you are home testing. Always test before every shot and again during the cycle. Don’t neglect the pm cycle. It is just as important. Try and always get a before bed test in and if it is lower than the preshot, test again later to see it hasn’t dropped lower.

I’m not a Prozinc user so I can’t offer advice except to say that please don’t increase any further. We increase the doses in 1/4 unit increments so that it is safe for the cat and we don’t go past the best dose.
If you are going to swap over to a low carb diet and I would strongly recommend you do, you will probably need to reduce the current dose.
I’m going to tag @Deb & Wink about the prozinc. And how you are best to tackle the swap over to the low carb while using Prozinc. Dont start until someone is helping you.
What I would do is buy a bottle of Ketostix so that you can test for ketones while you are reducing the dose of insulin. It is a safe guard which is well worth while doing. You can buy them at a pharmacy or Walmart.
Also stock up on some low carb cans. I will post a link.
Also get some higher carb foods in case they are needed for low numbers. And always have honey or karo at home I case it is needed.
Here is the food link
https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

Here is another useful link
http://www.felinediabetes.com/FDMB/threads/new-how-you-can-help-us-help-you.216696/

Keep asking lots of questions. We are happy to help
Bron
Click to expand...


Thank you for all the great info!
 
JanetNJ said:
His wbc is high. He looks to be fighting an infection! Get that taken care of and the numbers may improve. Diabetics are prone to uti. I'm going to tag someone good at reading labs to see what she thinks. @Marje and Gracie

Ditch the dry and switch to all wet low carb.
Click to expand...

Thanks. The vet said there was no sign of infection, I'm assuming this was the result from the culture which I don't have the report. I do agree that the high wbc indicated that something is going on. I can ask if the vet will treat as if there is an infection even if he doesn't think there is.

I will be switching to low carb as soon as I know how I should adjust the insulin. As of yesterday I have stopped giving any dry food only giving the wet w/d. His numbers today have been in the 400's instead of the 500-600's

I am sure it is preference but any advice on how often I should give the wet food or just leave it out all day would be much appreciated.

I still have a lot to learn about how the BG numbers should fluctuate throughout the day and what I should be looking for. I understand why they should be fasting before the pre shot test but If I do leave wet food out all day should I be concerned that if he eats close to when I do a test that he will have a higher reading?
 
Julie & Bones said:
Thanks. The vet said there was no sign of infection, I'm assuming this was the result from the culture which I don't have the report. I do agree that the high wbc indicated that something is going on. I can ask if the vet will treat as if there is an infection even if he doesn't think there is.

I will be switching to low carb as soon as I know how I should adjust the insulin. As of yesterday I have stopped giving any dry food only giving the wet w/d. His numbers today have been in the 400's instead of the 500-600's

I am sure it is preference but any advice on how often I should give the wet food or just leave it out all day would be much appreciated.

I still have a lot to learn about how the BG numbers should fluctuate throughout the day and what I should be looking for. I understand why they should be fasting before the pre shot test but If I do leave wet food out all day should I be concerned that if he eats close to when I do a test that he will have a higher reading?
Click to expand...
Your numbers are so high I don't think there's any risk of going too low in numbers going from the wd to a lower carb food. You can feed at shot times and any other times... Just no food at least 2 hours prior to the preshot test. It's fine if they eat by mid day tests. The problem with feeding before a preshot test is you don't want that number influenced by food or you may think it's safe to shoot, but then when the food wears off they drop lower then you expect. Does that make sense?
 
JanetNJ said:
Your numbers are so high I don't think there's any risk of going too low in numbers going from the wd to a lower carb food. You can feed at shot times and any other times... Just no food at least 2 hours prior to the preshot test. It's fine if they eat by mid day tests. The problem with feeding before a preshot test is you don't want that number influenced by food or you may think it's safe to shoot, but then when the food wears off they drop lower then you expect. Does that make sense?
Click to expand...

The fasting before preshot test makes sense so you know without food influence if they are at a safe number to give insulin. I was asking if eating throughout the day was an issue with the mid day tests since yesterday (between +2 and +4) and today (between +4 and +6) he had a small amount of wet food and his numbers increased. It might be because the wet food is high in carbs and I also don't think I have gathered enough data to determine when his nadir is. Thanks for clearing that up I have been stressed about the times he's eating and if my tests are accurate.
 
Julie & Bones said:
The fasting before preshot test makes sense so you know without food influence if they are at a safe number to give insulin. I was asking if eating throughout the day was an issue with the mid day tests since yesterday (between +2 and +4) and today (between +4 and +6) he had a small amount of wet food and his numbers increased. It might be because the wet food is high in carbs and I also don't think I have gathered enough data to determine when his nadir is. Thanks for clearing that up I have been stressed about the times he's eating and if my tests are accurate.
Click to expand...
eating mid day will effect the numbers to a degree, but won't effect if the dose is safe. Most of us feed several small meals throughout the day. I feed in the morning, and go to work leaving it out to graze on, feed in the evening, with a little extra before bed. Some use a timed feeder so they don't have to get up at like 4 am to pick up food. haha
 
JanetNJ said:
eating mid day will effect the numbers to a degree, but won't effect if the dose is safe. Most of us feed several small meals throughout the day. I feed in the morning, and go to work leaving it out to graze on, feed in the evening, with a little extra before bed. Some use a timed feeder so they don't have to get up at like 4 am to pick up food. haha
Click to expand...

Great, Thanks! I would not want to get up that early either :)
 
Julie & Bones said:
I was asking if eating throughout the day was an issue with the mid day tests since yesterday (between +2 and +4) and today (between +4 and +6) he had a small amount of wet food and his numbers increased. It might be because the wet food is high in carbs and I also don't think I have gathered enough data to determine when his nadir is.
Click to expand...
We expect any mid-cycle tests to be influenced by food. So no problem on feeding during the cycle. Make notes on the SS, in the far right "Remarks" column on when you feed, as that can be helpful for us to see.

Wink was on the dry and wet W/d. He was a dry food addict, so the food switch was not easy. Soon as I got him off that high carb food, and eating low carb, his BG levels dropped dramatically.

Hill's W/d dry is 37% carbs, the wet/canned is 26% carbs. (per the little sticky note I keep right by my computer, on the "sold through vets" foods vets love to "prescribe" for diabetic cats)
 
Deb & Wink said:
We expect any mid-cycle tests to be influenced by food. So no problem on feeding during the cycle. Make notes on the SS, in the far right "Remarks" column on when you feed, as that can be helpful for us to see.

Wink was on the dry and wet W/d. He was a dry food addict, so the food switch was not easy. Soon as I got him off that high carb food, and eating low carb, his BG levels dropped dramatically.

Hill's W/d dry is 37% carbs, the wet/canned is 26% carbs. (per the little sticky note I keep right by my computer, on the "sold through vets" foods vets love to "prescribe" for diabetic cats)
Click to expand...

Thankfully Bones likes wet food so it hasn't been hard to switch him. I want to change from the w/d to low carb asap. I am not sure how i should adjust his insulin. He is currently on Prozinc 4 units am/pm.
 
Deb & Wink said:
Do you have a few days off, so you can monitor him more closely? If so, then you could reduce the dose in half, make the food switch, and see how Bones does with his BG levels after the switchover to all low carb canned food.

No history of ketones or DKA?
Click to expand...

I am not working at this time so I will be home to monitor him. No history of DKA and his last blood work 5/1/20 was negative for ketones. I have not been home testing for ketones.

Would it be best to switch his food over a few days. How often should I be testing while making the switch.
 
Good idea to test every pre-shot. Always, to make sure the BG is high enough to give insulin in the first place.

Then with the food switch, I'd say test at least 1 or 2 times in each cycle. If you get a low number, <100 mg/dL, post for help on the Feline Health forum and change the title on your thread to reflect that you need help. Or if you get a low number early in the cycle, before +4, post for help.

Why don't you try that thread title change now, so you know how to do it when needed.
 
Thank you so much!! I am nervous to make changes (in case he does get low) but also excited since I think it will help a lot. Just without dry food his numbers have been in the 400's today instead of the 500-600 it has been. I will start tomorrow with the 2 unit dose and do 1/2 old food and 1/2 new food so it doesn't cause any GI issues.

I did change the title now to see how it works. I will change it again if I need advice on his numbers

Thanks again!!
 
@Julie & Bones

Sorry for the delay; I’ve been off the board a few days.

Eosinophils can be elevated due to allergies and I don’t get too worried about those. My cats’ go up and down. But the other elevations in WBCs indicate infection. Because there are so many things that can cause these to be elevated, you really need to work with the vet to figure out what it is.

Everything else looks fine to me but it’s very helpful if you can put these numbers on his lab tab. That way, we can compare future tests.
 
Marje and Gracie said:
@Julie & Bones

Sorry for the delay; I’ve been off the board a few days.

Eosinophils can be elevated due to allergies and I don’t get too worried about those. My cats’ go up and down. But the other elevations in WBCs indicate infection. Because there are so many things that can cause these to be elevated, you really need to work with the vet to figure out what it is.

Everything else looks fine to me but it’s very helpful if you can put these numbers on his lab tab. That way, we can compare future tests.
Click to expand...

No problem, Thank you for taking a look at it. I will speak to the vet next time I take him in to try and figure out the cause. I will add these results and I have a prior blood test I can add. Thanks for the suggestion I totally missed the lab section on the spreadsheet.
 
Today has been the first day of bones being on 100% low carb food (wellness core Chicken 8%). I spent 2 days transitioning the food so there was no GI issue. I decreased his insulin dose from 4 units twice a day to 2 units twice a day when the food change started (5/31). His numbers have slightly lowered but he is still in the high 300- low/ mid 400. I wanted to get some advice on when I should increase the dose. Not sure if I should give him a few more days on the low carb/ 2 units before increasing and whenever it is time how much should it be increased.

Thanks
 
I'd give it at least a couple more days on the low carb wet food with Bones, to see how his BG numbers react to the diet change, before you start to think of an increase.

When you do increase, we change the dose in 0.25U increments. Think you could practice measuring those "in between the lines" doses?

Do you use syringes with 1/2 unit markings on the barrel?

Are you testing for ketones at all? It's a good idea, especially since Bones is in the higher BG ranges, the pinks and reds mostly.

Last question for now. Since Bones' BG levels are so flat, are you sure you are getting the insulin into his body, subq? Not just beneath the skin, but into the fat layer a bit. If you could describe your technique for shooting the insulin, we could double check things, see if it sounds right.
 
I have order syringes with 1/2 unit markings but have not received them yet. I purchased the strips today to test for ketones just waiting for him to use the litter box.
I usually give the injection around the shoulder. I pinch the skin and pull up to create a tent, holding the syringe parallel to his body i push the needle into the center part of the tent and inject. He has long hair so i cant see the needle pierce the skin but can feel it. I usual feel the area after to see if its wet (not sure if it would feel wet with a fur shot)

He seems off today. He has not been interested in food. He will eat a little here and there when I bring it to him. I have seen him drink a few times but he's not peeing as much as he was.
 
Are you able to tempt him with some treats?

Off how?

It's been a long time since I used Prozinc and smelled it. What does the Prozinc smell like, if you sniff the syringe after the shot?
(Lantus smells like the adhesives in bandaids)
 
I have never smelled it, I will tonight after his om dose.

He doesn't want any treats. He usually isn't very active since it's hard for him to get around because of the neuropathy but he will get on the couch to relax/ sleep. He hasn't been on the couch today and just seems to be even less active then before. He just want to lie on the hardwood floor. He has only been eating a little and that's when i bring the food to him. not peeing as much as other days.

He hasn't completely stopped eating and I have seen him drinking. I don't know if sometimes they have off days or if it's something more serious that I should be taking him to an emergency vet right away
 
Check him for dehydration. Do the "skin pinch" test first, pulling up a fold of skin. It should spring right back into place if Bones hydration is good. You can check the gums too. Press a finger on the gums, it should turn white and then pink right back up. If it feels "tacky", that is a sign of dehydration.

Bowel movement normal today?
Take a BG test. Don't wait until your normal time. See what the BG level is right now.

Julie, you know your cat Bones better than we EVER will.
If you think his behavior warrants a vet visit, then act on your instincts.
You could at least call and talk to someone at the 24 hour emergency vet, right?

Cats that are eating canned food get most of their water needs from the moisture in the food. I remember switching my civies (non-diabetic cats) to canned food and it was a major event when one of them took a drink of water from the water bowl.

Is it hotter where you are, so the hardwood floor feels a bit cooler for your Bones?
 
The elevation in WBC was thought to be some type of infection, at least that was Marje's comment.
Infection + not eating enough + not enough insulin can lead to a cat burning fat and/or muscle to produce energy and a toxic byproduct of that is ketones.

Smell his breath. Does it have a fruity odor, like overripe bananas, kind of a sweetish sickly smell? A little like nail polish remover?
 
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