Intro and looking for some expert opinions :)

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Holli & Lucky

Holli & Lucky

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Hi,

I posted this earlier in the health forum, but someone suggested I might post in this forum since I'm using such low dosages of PZI. I'm pasting the message from the other forum below:

Hi,

I'm going to try to make a long story short with this intro. My cat, Lucky (he's a neutered male, 13 years old, never any serious health problems, always ate premium dry food) was diagnosed with diabetes on April 18, 2012. I have 3 other cats the same age who are fine (I used to volunteer with a rescue and ended up with these guys). Lucky was getting stressed for some reason and licking off his fur last year. I can't remember all the dates and things, but he ended up getting two steroid shots (that together equaled a normal one-time dose) and was put on amitriptyline once daily. He also had a blood test in January of this year and everything was fine. He got the second steroid shot at the same vet visit. By March I noticed that he had lost a lot of weight and was drinking and peeing a lot, but since he had just had a blood test, I thought he was fine. When he continued to get worse, I took him to the vet and when he tested him this time, his BG was over 400. Yikes! He was definitely diabetic. After they stabilized him that night, he went home with me for a weekend and I found all this feline diabetes information. I knew I wanted to change him over to wet low-carb food, but I waited until he went back to the vet to do it. He then stayed at the vet for about 4 days getting regulated, eating nothing but EVO no-grain and Merrick no-grain, and he ended up on 3 units twice a day on PZI human insulin. He gets pretty stressed about going to the vet though. Brought him back home and tried to keep him on that dose, but I kept giving fur shots, so he sporadically missed some doses. Wasn't testing any during this time. Finally started getting the hang of giving him shots, and the day I bought a meter, I came home right after he had a hypo seizure where I went into panic mode and filled him up with honey and sweet chex mix. Took his reading and it was at 29. Didn't give him anything that night and it was up to 374 when I took him to the vet the next morning. Since then, we knocked back the dose, but he's still going hypo. I've kept knocking it back, but he still keeps going really low. I'll post the results of all the blood tests below. He has such massive dips when he takes the insulin. Is that normal? I'm also going to tell my vet all this information on Monday, but I wanted to get your opinion too. However, I have to go back to work on Monday, and I want to make sure he doesn't go hypo with him going too high either. This stuff is so confusing!

5/2/12 9:00 AM 374 Came back from vet. Ate well. Gave only 1 unit because I would be gone all day. Didn't want to risk hypo.
5/2/12 9:00 PM 149 Ate well. Level was so low, didn't give any insulin. That was a mistake!
5/3/12 9:00 AM 348 Ate well. Gave him 2 units.
5/3/12 11:00 AM 138
5/3/12 1:00 PM 21 Hypo. Very groggy and stumbling. Gave 1/4 teaspoon honey and a bit of dry food and a lot of wet low-carb.
5/3/12 3:30 PM 49
5/3/12 7:30 PM 192 Ate well. Gave .5 unit insulin. Snuck and ate a tiny bit of dry food between this reading and the last.
5/4/12 12:30 AM 120
5/4/12 9:00 AM 242 Ate well. Gave .5 unit insulin. Didn't want to risk another hypo.
5/4/12 11:00 AM 283 Definitely not going hypo, so gave his ears a break.
5/4/12 9:00 PM 153 Didn't eat that much. Gave .4 unit insulin. (How is this number lower???)
5/4/12 11:00 PM 57 Was hungry. Ate some of the food he didn't eat earlier.
5/5/12 1:00 AM 52 Gave him a couple low carb treats and some more of the food he didn't eat earlier.
5/5/12 3:00 AM 91
5/5/12 9:00 AM 169 Didn't eat well. Had to tempt him with low-carb treats. Left about half his food. Gave him .4 unit insulin.
5/5/12 1:00 PM 52 Finally got him to eat the rest of his food around 10:30am. Gave a few low-carb treats and little wet food.
5/5/12 3:00 PM 80
5/5/12 5:00 PM 120
5/5/12 9:00 PM 145 Think he's sick of Merrick. Only wants the Wellness Core fish. Ate that pretty well.

Opinions? Do these numbers look promising since I have to keep lowering the dose? Are those big dips normal? Since he only tested at 149 tonight, I was thinking about dropping it down to .2 units, but I don't think constantly changing his dosage is good either. I just hate that his numbers keep going so low!

Thanks!
Holli
 
Hi Holli,

Glad you made your way here. As I said, it is a smaller forum, so be sure to come back and check in for new replies. You might also check some of the spreadsheets of other users. Pixie girls and boy is a new user, giving small doses, as is Nancey.
 
Hi and Welcome,

You have done the right thing by lowering your dose. Many PZI kitties are micro dose kitties.

Sue and Oliver are our resident experts at setting up a spreadsheet so maybe you could get with her and get one going so we can all see it.

The no shoot number for a new member is a bg of 200 until you have enough data to know that it is safe to shoot under that number.

The other thing that jumps out is that licking off their fur is a symptom of HyperT, has he ever been tested for that?

Welcome to our little group. Glad you're here.

Robin
 
Thanks guys! I just checked out your spreadsheet and that's cool. I downloaded an excel one I found and it charts it out in a graph, but since it's excel, I can't really post it anywhere for anyone to see. I ended up giving him .2 tonight because every time I skip a dose, he goes really high. That last time I skipped at that level, he shot up to around 350 by the next morning. Guess we'll see how he does on this does. If HyperT is hyperthyroid, yes he was tested for that and just about anything else you can test their blood for. Thanks for the suggestion though!

Holli
 
Yep, HyperT = Hyperthroid.

If you go to the Tech Forum there are directions to set up a ss to attach to your signature like we have. That way your ss will show up every time you post.
 
I posted in your Health thread, but I'll post it here too!

Hi Holli,

Just to add to what Sue has said,
5/4/12 9:00 AM 242 Ate well. Gave .5 unit insulin. Didn't want to risk another hypo.
5/4/12 11:00 AM 283 Definitely not going hypo, so gave his ears a break.
5/4/12 9:00 PM 153 Didn't eat that much. Gave .4 unit insulin. (How is this number lower???)
5/4/12 11:00 PM 57 Was hungry. Ate some of the food he didn't eat earlier.
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Sue mentioned always making sure his number was rising when you shoot, especially when you are shooting low numbers. That 153? It was lower because he was still dropping from the dose that morning. It could also be due to his pancreas doing the job by itself. And that's why he dropped even lower two hours later. You had some insulin overlap so that .4 was added to whatever was still happening from the .5 12 hours earlier.

Good news.... I think Lucky might not need insulin, or if he does, he's only going to need really tiny amounts. It sounds like you might have a case of steroid induced transient diabetes.

and he ended up on 3 units twice a day on PZI human insulin.
Click to expand...
Nitpicking, but PZI isn't actually a human insulin. It's made from bovine pancriatic tissue and it is specially designed to be used only on cats. Prozinc is recombinant human insulin, but not intended for human use, but again, designed especially for use with cats.

And the initial dose of 3u BID? Probably too much, but that's water under the bridge. But that's why he kept crashing so low.

filled him up with honey and sweet chex mix.
Click to expand...
LOL, I think that's first.... never seen chex mix used to bump up the BG!

He has such massive dips when he takes the insulin. Is that normal?
Click to expand...

Not normal on such tiny doses, no. But I think that is because he probably doesn't need any. It might also be a domino sort of effect. When cats go really low, they can be more sensitive to insulin for 12-24 hours afterwards. So even though you are shooting extremely tiny doses, the effect is greater due to the sensitivity.

A dose that is too high with PZI/Prozinc can act two different ways. One, it can make the BG drop too low at the normal 5-7 hours past the shot time frame. The other thing it can do is make the cycle run excessively long. On the days where the PMPS is lower than the nadir, or drastically lower than the AMPS number (like you saw on 5/2, those numbers indicate a dose that is too high.

Here's something I think you can try. The next time you get a preshot number below 200, just feed him and hold off on the shot. Then check his BG an hour later. You should see an increase from the food. Then test him an hour later and see if the number has dropped. If it has, then that's him trying to self-regulate. If that is happening, then it's likely that he either won't need insulin, or that he might, but really minute doses, and probably not every 12 hours.

Are you using U40 syringes? You may want to pick up a pack of U100 syringes. Those can be effective when shooting really tiny doses of insulin. If you want to try that, there is a conversion chart you can print out so that you get the doses correct.

Carl
 
I second Carl, I'd like the see what he does being fed with no insulin.

Break his meals down so he has 6-8 meals a day and feed one of these when he's below 200 at ps, test an hour later, then 2 hours later. Looking for a steady holding number or a good drop. It is possible you might need some small doses of insulin to help him along still, but I agree that this looks like the diabetes might have already resolved at this point. Hope so at least!

Cathy
 
Hi Holli! I'm Holly and like you, I have a cat that would often go VERY low on insulin. She started out on 3 units BID also and I quickly had to lower her insulin with each time I made a food change. She went from 3 units to just under .5 units in about 3 months and recently went OTJ. My spreadsheet is in my signature if you want to check it out.

I think Carl's advice about Lucky maybe being diet controlled is excellent. I would try that and see what happens. Hypos are scary. Josie had very low numbers a LOT but never had symptoms. It's nothing to mess with. So I would try food only and see what happens. If a cat IS diet controlled than breaking the meals up into six small meals per day can work VERY well. That's what I did to get Josie OTJ. I feed her every 4-5 hours. If it turns out he's not diet controlled than you can always start back up on a very small dose and work your way back up as needed. Particularly since your cat is having actual hypo episodes, I think it would be best to exercise as much caution as possible. We want your cat to be safe and for you to be as stress free as possible!
 
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