Introducing Klinger & food question

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Marcy & Klinger (GA)

Marcy & Klinger (GA)

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I would like to introduce my kitty Klinger. We found out that he had diabetes in February 2010. Brought him in to the vet for another reason and his blood test showed a BG of 570. Klinger weights in at a whopping 20 lbs and is 13 years old. We started him on Lantus at 3 units 2x's a day and went up to 6 units. Then his numbers started sliding all around the scale. We do home test for his BG. We switched him to Prozinc and he is now up to 7 units 2x's a day. His vet does not think this is a huge dose because of his weight. His numbers are starting to slide all over the board again. Saturday, 8/21, I did the preshot blood test and it was 220. Klinger has been going hypo recently and I decided not to give him his a.m. shot. When I tested him in the evening his number was 570 - gave him 7 units. This morning it was at 420, gave him 7 units. I just tested him for his pm shot and it's 120. Skipping the shot tonight.
So, my vet thinks he has pancreatitis, which sounds likely from what I've read on other posts here. I want to ask a question about his food. He has been eating wet food - FF beef or chicken and sometimes oceanfish prior to the diagnosis. When he was diagnosed, my vet had me switch him to kitten FF wet. It seems like an unlikely choice because I have not seen it mentioned on any of the food lists posted. I'm thinking that it has too much fat (5% crude fat) for his pancreas. Any thoughts?
 
Welcome to the board! :)

I've been feeding my sugar cat FF Turkey & Giblet, which is 3.9% in carbs. I also treat her with raw and boiled chicken (in water, I don't use oil of any kind). Here's a link to the food guide that may be helpful for you and Klinger:

http://binkyspage.tripod.com/CanFoodNew.html

The one thing that I can suggest is get a spreadsheet started so that those that are more knowledgeable than I can see how you're doing with Klinger.

I was a former ProZinc user, however, her #'s went all over the place, and now she's been on Lantus since July 25th. We're finally breaking into the yellow 200's, and this is the 2nd day in a row of yellows (thank goodness).

Good luck, and be patient. :) Klinger will settle down soon with the help of these wonderful people. :)
 
Hello and welcome! I'm not sure if you've posted your question in the Health Forum too, but that's a good place to go to get questions answered about food and possible pancreatitis. There are also other factors that might make a kitty "high dose."

7u of ProZinc does seem like a lot to me. Testing before shots is great! But frequently midcycle spot checks are also very, very important. It very well could be that dose of insulin Klinger is taking results in rapidly lowering blood sugar or very low midcycle blood sugar levels. Either situation could trigger "rebound" or extra high preshot numbers. If you set up your data in a spreadsheet and link it in your signature, it can make it easier for others to help.

Here's instructions from the tech forum on how to set up a spreadsheet: viewtopic.php?f=6&t=18207. I haven't been through them lately, things may have changed since they were written. If something doesn't make sense, ask more questions!


Gotta run! Good luck!
 
Hi & welcome!!!

I would lower the dose. The idea is to get shootable PSs every 12 hours. If some are too low, that typically means the dose is too high. Then you are seeing some really high #s, which suggests he may be bouncing around between low & high #s, often a sign of a dose that is too high.

Generally speaking, rather than alternating between skipped shots and then 7u shots, it would make sense to me to even it out, maybe 3u at each shot (that is if the PS is over 150 or maybe even 200, if it is low I would retest in a hour or so & if it's high enough, give the reduced dose at that point), and see if that gives you PSs that are more middle ground. That is just a stab in the dark - if you can post all the #s you have, that will help us give you more specific advice on where to go with the dose. It seems clearcut to me though that you need to lower it.

And you said he has been going hypo lately (? do you have more info on what you mean, i.e. does he have symptoms? and at what point in the cycle is it?), so that seems pretty clear to me too that the dose is too high. I'm not at all sure why your vet wouldn't have you lower the dose if he has hypo'd on this dose....?

Anyhow, that is my take! Please keep us updated, and post any questions you have! :-D
 
Thanks everyone. I've posted our spreadsheet. Tested Klinger again tonight - pre-shot and he's at 118. I think I will test him again in an hour and if his number is higher, I'll give him 3 or 4 units to get him through the night. I think I will try and give him a reduced amount of insulin from now on and see how he does. So, each week, my vet had me increase the number of units...how often do you increase????
I also work 10 hour days and I'm really gone for 11.5 hours. So, it's hard to test other than pre-shots and on weekends. I've only started to test pre-shot by reading other posts here. Makes a lot of sense. I wonder why my vet didn't recommend doing that. She only told me to test on the weekends. Hmmm.
When he's gone hypo, he walks around like he's drunk and he eats everything in sight.
Thanks again!
 
Hello!! welcome!!!

I agree the dose is probably too high. We will know more as you can do more spot checks...
From what I can tell you started at 3 units.....SIZE of cat has nothing to do with size of dose :) dogs are dosed by weight..not cats. You could have missed a perfect dose somewhere under that. Normal is to start at 1 unit and go up from there.
Rebound can cause wonky numbers...the body tries to flood the system with glucose when it goes too low...
Make sure he has access to food all the time when you are gone...hopefully he can self treat a hypo...but they can't always.

Big hurray for you that you are hometesting....The fact that your vet wants you to even home test on the weekends is an improvement over most vets. Mine was not on board at all at first..then had no idea what we were doing...he was just happy we were getting normal fructosamines (a measure of the last 3 weeks BGS).

FYI..there are other conditions like acromegaly than can cause the need for high amounts of insulin...Spunky had this...but your numbers don't support that yet. You need to try lower doses and not have hypo episodes...acro cats RARELY hypo...

I'd personally like to see you start at 1 unit 2x day if you have not tried that yet..It's really where everyone should start.. with other insulins too

Remember, spunky's sliding scale was for only him.....he required large amounts of insulin....and never ever hypo'd....every cat is different
 
Fabulous that you are home testing. You've mastered the hardest part of this.

I agree, if I were you I would drop down to 1 unit twice a day and start over. You may have missed the perfect dose by starting too high.

Peggy and Mickey just started over and are getting some good results.

The most I've ever shot was 1.4 and that turned out to be too much.
 
The rate of dose increases can really vary, and depends a lot on your data. A lot of times I have seen around 3-5 days recommended. 3 days being on the side of a cat who is more ill and can't wait, or if it's clearcut the dose is too low, 5 days being reasonable for a cat who is doing better, or when you need more time to see where a dose is going before making a decision. Some people wait til they can do a curve on a weekend, so may be at a dose for a week or so, til they have the data to evaluate it. There's no hard & fast rule - vets often wait 1 week or 2 weeks, but with home-testing you can be more flexible.

The rule of thumb though is to start at 1u, and then raise in only 0.5u increments, or even only in 0.2u increments depending on how things are going. If you started at 3u and moved up in 1u increments, it's pretty hard to know what dose might be right. Could be anywhere in there really. I think the only thing you know beyond a shadow of a doubt is that 7u is absolutely too much insulin. It's hard to tell how much of what you are seeing is rebound, and how much is actual insulin need, so hard (for me at least!), to tell from the data what he actually needs.

Just wanted to clarify too when I said try 3 or 4u units I meant that as a general reference point, like "a lot less than 7u!!!". The 1u do-over is fine, I would just say not to take a long time in dose raises if that proves to be too little. It's a bit of a guessing game really - going back to 1u is a pretty safe way to make sure you don't repeat the hypos, which sound scary - if they are showing symptoms, that's definitely not something you want to repeat. If you drop down to 1u and the blue #s go away, then I would raise in 0.5 increments every 3rd or 4th day or so, going slower (every 5-7 days, and/or 0.2 increments) if you start getting to better #s, or if you need more time to collect data.
 
Thanks for the great advice. I've decided to re-do and start at 1u and go from there. He was at 490 this morning, gave 1u, tested just now and he's 460, gave 1u.
We'll test him again in an hour to see what his number is then.
I do free feed because I am gone so long during the day and if he does go hypo when I'm not home, I hope that he will get to his food.
I'll keep you posted on how things are going.
Thanks all!
 
I think that's a great decision.

Although the #'s are high the 1 unit did pretty good today. You want your AMPS & PMPS to be about the same, that tells you that that dose brought Klinger down from 490 and back up to 460 within the 12 hour cycle and your down 30 points, data gathering.

With Prozinc they tend to rise the first 2 to 3 hours so don't panic over that when you test.

I work full time plus too so I understand the schedule thing.

Give Klinger a little time to work through the rebound, take a deep breath, give both of you a treat.

You deserve it.
 
Klinger vomited a small amout of foamy liquid late this afternoon. It really makes me think that 1u isn't doing enough for him...but I'll stick with it if it's better for him in the long run.
 
I don't know about the vomiting. You may want to post on Health about that, I know that I've read about the clear liquid vimiting before. At least you will get some feedback on what others have experienced. There is alot of knowledge on this board.
 
When you reduce the dose, the key is not to stay too long at the lower dose. I did that, so I can say from experience, raise up fast if you need to. Start Low Go Slow is ideal if they are new to the insulin - when they are already on it and you've gotten some results, it changes the picture a little.

I agree with your move up to 1.5. I would continue in .5 increments every 3rd day or so until you see blue #s for nadirs. If you can get a mid-cycle test in sometimes, that is how you can best evaluate the dose - the combo of PSs and nadirs.

The fact that he survived 7.5u and his #s weren't lower than what you saw on 7u makes me suspect he'll need a dose that's on the higher side - definitely lower than 7u, but possibly a lot higher than 1u. (just a guess) If they only need a low dose like that, you should see better results pretty quickly when you lower the dose, and you aren't.

I would try to get a mid-cycle check in though as soon as you can - something in the +6 zone. If that's a blue # vs. a red #, makes a big different in interpreting the PSs.

If you want, start a new thread every day with his #s and we can try to help you figure things out.
 
p.s. I'd also keep an eye out to be sure he's eating ok, and make sure you test for Ketones daily. If you have problems getting him to eat or if ketones show up you may need to raise the dose even faster than that. If he's ok-ish though, I'd say the 3 day 1/2unit plan is ok. It's more aggressive than some strategies, but not super-aggressive.
 
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