Intro and would like some expert opinions :)

[Holli & Lucky]

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. Depending on what he tests tonight, I was thinking about dropping it down to .2 units, but I don't think constantly changing his dosage is good. 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

Opinions? Do these numbers look promising since I have to keep lowering the dose? Are those big dips normal? I'm still holding out hope for remission eventually.

Thank you so much for your time!
Holli

 

[Sue and Oliver (GA)]

Welcome Holli and Lucky. It sounds like you are doing lots of things right. So glad you are hometesting and caught those low numbers.

We often see transient diabetics caused by steroids. It could be that bouncing is causing the higher preshots followed by low ones. They can bounce when they get a low number because their body reacts to a low number by releasing extra glucose. So you might see a number around 50, then he bounces up to 300.

You are getting such low numbers on tiny doses. I think I would be tempted to stop the insulin for a few cycles, testing often to see where his numbers are. If he goes above 150 or so, go on the PZI forum and ask for mini dose advice. (We consider a kitty in remission if they range from 40-120 off insulin.). But we are very cautious about shooting low numbers without a lot of data.

If and when you do dose, one rule you want to follow is to always shoot a rising number, not one going down. So anytime you get a number under 200, test again, without feeding, to be sure the number is going up.

 

[Holli & Lucky]

Thanks Sue! I'm sorry to hear about Oliver. That's such a cute picture.

I tested him again, and his number is only at 145, so I'm not sure what to do. Every time I skip a dose, it seems to go sky high, and then we start all over again. He was liking the Merrick food, but now not so much. He only wants these low-carb treats I got and this Wellness Core food that's all fish. I read somewhere that you weren't supposed to feed them fish that often, but I guess if that's all he'll eat, it's better than nothing?

Think I'll go post these numbers in the PZI forum like you suggested and see what they say.

Thanks again!
Holli

 

[Sue and Oliver (GA)]

You are supposed to stay away from fish very often. Have you tried Fancy Feast classics - lots of people feed those. Not eating can bring the numbers down. I wouldn't shoot until he eats.

The PZI forum is a small friendly group(I post there also). Busiest in the am and pm. If you need an immediate answer and no one is there, come over to Health and post.

 

[Carl & Polly & Bob (GA)]

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.

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.

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.

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?

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

 

[Holli & Lucky]

Thanks again Sue. Yes, I read something about that somewhere, and I was trying to limit it. Now I can't remember why it was bad though. Hopefully, he'll like some of the other chicken flavored stuff I bought him. I'll have to check out FF. I just noticed that your avatar is Niko. He's a cutie. Sorry about that!

 

[Holli & Lucky]

Hey Carl,

Thanks for the great advice! Guess I missed your post earlier.

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.

Ah... Okay. That makes sense. It's been pretty consistently going up or down in a curve other than that time it seemed. I do think the steroids had something to do with this. It was too much of a coincidence.

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.

Thanks for the info! I just read what it said on the box. Ha!

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.

At first he was on 2u BID, but at the vet his numbers never dropped, so they had to up it to 3u BID there. I really think stress played a part in that though.

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

Yeah, I was laughing at myself for doing that later. I was just trying to think of the sweetest stuff I could get him to eat. He always liked potato chips, and I would give him one every now and then, so I figured he would like that. He ate a ton of it too. Coming home and seeing him after that seizure, I went into total freak out mode. Lol

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.

Thanks for the explanation!

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.

I gave him .2u tonight, so I will definitely test him in the morning and try this and see how he does. This is great information!

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.

I was using U40, but I was finally able to find U100 with half unit markings at Walmart today, so I started using those tonight. None of the drug stores carried them. Yes, I've been using the conversion chart.

I hope you're right Carl, and he won't need this insulin much longer. I'll keep you posted and thanks again!

Holli

 

[Holli & Lucky]

I'm glad I took all of your advice! His BG tested at 152 this morning before eating and I just tested him again before feeding him tonight, and it was only 98. Woohoo! I think he's OTJ! Of course, I'll have to keep feeding him the low-carb wet food, and as soon as I'm out of all the dry, all the other cats will be put on it too. I really can't thank the resources on this site enough for their help in getting him into remission so soon.

Thanks again!
Holli

 

[Carl & Polly & Bob (GA)]

Holli,
Great to hear you got such low numbers! We consider a kitty to be "off the juice" if he/she can go 14 days without insulin, with BG numbers in the normal range (50-120) most of the time during that 2 weeks. Make sure to keep checking the BG like you have been doing. Even if he does end up needing more insulin in the days to come, it won't be a lot, and probably not every 12 hours, but you will want to keep a close eye on it just in case.
And yes, he'll need to eat low carb food for the rest of his life. Kitties are always "diabetic" once they become that way. They're just "diet controlled" once they get off the insulin.
Keep us posted!
Carl

 

[Holli & Lucky]

Ah... Okay. I'll definitely keep an eye on him and keep testing him. I'll be talking to the vet tomorrow too. Hopefully, it will be permanent!