Kitty chaos and trampolines

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Alexi

Alexi

Member Since 2016
One month in. The vet had suggested I have another go at increasing Cappuccino's dose which I did last week. This week has been busy and one of my other cats got a urinary infection and had a trip to the vet. In between giving him antibiotics, chasing him around and out of the house to stop him turning the entire house into a litter tray and two of the others deciding to leave food because the weather has been warmer it all got a bit crazy.

At first the numbers started looking better but then she did a massive bounce, without any hypo symptoms appearing so I have reduced her dose again to get her back to better numbers. She had also been eating all the other cats food when my back was turned...

Good news is that the combination of food and insulin has meant she has put on weight and is just about at target weight, bad news is that the drops in sugars are still huge and she is still demanding food every opportunity she gets.

Even better news is that she is much more lively and happier than she has been since before diagnosis, just need some time to settle her sugars again. I am learning a lot more about how she responds to the insulin and more comfortable about changing doses now. Onwards and upwards.
 
I think I'm seeing a duration issue with the insulin wearing off by +10 hours.
Is there any way you could shoot every 8 hours?
What about switching to ProZinc which tends to last longer than Caninsulin?
 
I agree with BJM. I would ask if you could swap to either Prozinc, Lantus or Levimir.. And start off with a lower dose.
Cats don't have to reach hypo territory to bounce. They only have to go down to numbers they are no longer used to or they may have dropped too quickly or too much in a given time.
She is really hungry because her body can't absorb all the nutrients from the food because of the high BSLs....once the BSLs are more under control, she will not be as hungry.
 
Hi Alexi,

Just had a gander at Cappuccino's spreadsheet and, upon seeing her data, another FDMB kitty came to mind. Kako's Tux had data which looked very similar to Cappuccino's when he was on Vetsulin. Kako recently started treating him with Lantus and he's starting to do much better on it. It might be helpful to you to see the difference so here's a link to his spreadsheet:

https://docs.google.com/spreadsheets/d/1GyQXS7WLvC3HF72FDHWJtkJDD0-Rak3ky3Sb1caQHYU/pubhtml

If my kitty were in Cappuccino's numbers I'd be looking to try a different, longer-lasting and gentler insulin as Bron and BJ have suggested above.


Mogs
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Thanks. It's really disheartening that she was doing pretty well then a huge bounce which is going to take several more days to get under control. @BJM I struggle to give every 12 hours so 8 hours would be impossible due to my work schedule. Today for example it was 13 hours between AM and PM doses, other days it can be 12 or even 11 hours. I am starting to suffer sleep deprivation and had a 5 am smack in the face today for food which didn't help! She does drop quickly as all her home curves have shown, except when she was in lower numbers, but possibly I missed the nadir - usually it is around 5 hours. @Critter Mom you have mentioned the UK cascade rules - is there a link anywhere as I can't seem to find them. Also - just how do you persuade a UK vet to change insulins? I am thinking about booking an appointment with the senior partner at the practice to discuss a change of insulin, as it happens I saw him last week with one of my other cats so he does know about Cappuccino's diagnosis and trusts me to know what I am doing. I am worried she will start losing weight again and we will be back on the roller coaster, at least if she hold her weight it will be easier to make adjustments.
 
Hi Alexi,

Here are the drug cascade rules:

https://www.gov.uk/guidance/the-cascade-prescribing-unauthorised-medicines

Essentially the vet needs evidence that a treatment approved for veterinary use is not working. When I sought Saoirse's Lantus Rx I provided the vet with Saoirse's spreadsheet. The Caninsulin BG data showed that she was not in remission but the Caninsulin produced too steep a drop to administer safely. Also, I provided the vet with a diary of Saoirse's clinical signs which proved that the Caninsulin was making her feel really poorly for 18-20 hours a day. The vet was also confident of my ability to use the Lantus under his supervision (they retain responsibility for the use of the medicine). That was sufficient for our vet to prescribe Lantus on the grounds that it was in the interest of Saoirse's welfare.

When I asked for Saoirse to be prescribed Lantus Prozinc hadn't been approved. Now that it is approved if one is looking to switch from Caninsulin I don't know whether a vet may be legally required to prescribe Prozinc before being permitted to prescribe Lantus or Levemir. Perhaps your vet may be able to advise you further on this. If you do want to switch to a depot insulin perhaps it might be possible to argue that an in-out insulin like Prozinc was unlikely to keep a cat in regulated numbers for a full 12 hours (brainstorming here).


Mogs
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Thanks - that is really helpful. I have the evidence from the spreadsheet that she does get huge drops from the Caninsulin which makes it difficult to get her regulated as I cannot be with her 24/7 and there is a real risk of hypos. My interpretation is that the next step would be ProZinc as that is licensed for use in cats but I could argue for Lantus on the basis that it gets a higher percentage into remission and she has been diagnosed recently enough for this to be a possibility. I have looked into changing her to a lower carb food but I already go through nearly two huge boxes of sachets of food a week for my cats and the cost differential is substantial as I would need to change them all - plus I have one who refuses all wet food. I am not prepared to go down the prescription diet route for cost reasons as well. In other respects she has done ok on Caninsulin but I think that is more to do with my time investment in getting her there than the actual insulin. I need to order more insulin this week and can't make a change as yet as I am due to be away for a few days this month and next and can't ask a cat sitter to start making dose adjustments, it is going to be enough just to get them to do some pre shot readings. She has never boarded so that is not an option either. It's really hard knowing what to do for the best.
 
I will be away for max 5 days at a time, I will look at changing food, I was thinking of a swap to Sainsbury's pouches in jelly which look the same but seem a lot lower in carbs, I have tried pate type foods in the past and just get dirty looks as if I'm trying to poison them so I have to be careful not to make too big a change.
 
Be careful of the Sainsbury's foods. I contacted their customer care centre to request more detailed information about one of their cat foods and when the info came back it listed carrageenan as one of the ingredients; it wasn't listed as an ingredient on the pouch itself.

One food that's quite reasonably priced from Zooplus, fairly good quality (compared to the likes of Granatapet) and very low carb is Smilla Kitten Food with Chicken. It comes in a can and has a 'meaty' texture.


Mogs
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A thought:

Zooplus sell via two sites in the UK; zooplus.co.uk and bitiba.co.uk. Prices are cheaper on Bitiba but they have a narrower product range, they only sell in bulk, and there's a higher minimum order value before one qualifies for free delivery (by Yodel IIRC). Zooplus do smaller trial packs of foods (e.g. 6-off) which is very helpful when trying to find cat foods that our little furry treasures will actually consider eating ( :rolleyes: ). If you did find something on Zooplus that is (ahem) 'acceptable' and it was also offered on Bitiba you'd be able to get a better bulk price on the latter site.

Here's a link to the wet cat food index page on Bitiba for you:

Bitiba Wet Cat Food Range


Mogs
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Yodel delivery is a no-no for me - have had really bad experiences in the past. Meanwhile this morning she is still running high and I had another 5am wake up call. This is the fifth cycle since I reduced her dose and I'm not sure how much longer to give it. Just check at +2 and she has dropped 16 points, and she is starving again. I have just given her some more food.

ETA Have a vet appointment tomorrow morning to discuss changing insulin.
 
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Alexi said:
Yodel delivery is a no-no for me - have had really bad experiences in the past.
Click to expand...
Ditto (hence my mention of them above ;) ).

Alexi said:
Just check at +2 and she has dropped 16 points,
Click to expand...
Struth! This BG roller coaster can't be doing Cappuccino any favours. :( Is she lethargic or withdrawn at all when the dose is active in her system?

How much and how long before dosing do you feed Cappuccino, Alexi?

Perhaps you could use the wild swings in BG on Caninsulin to argue against being prescribed another in-out (Prozinc) and ask your vet for a depot insulin Rx instead (e.g. Lantus)?


Mogs
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Mornings are a bit hectic in my house! Usually I give insulin 30 mins post food when she has walked away from her breakfast which is a sign she is full. Sometimes when she is finishing it off. Today she was looking rough after breakfast which is why I did a +2 and decided to give her more food. By then she was back to her normal self! I have had to leave the house now but have asked my mum to get a +5 if she can and just check her as that should be her low point. The past few days if I hadn't known she was running high I wouldn't really have noticed but today she wasn't herself. No ketones this am but I will check again when I get home this evening. my mum knows to scoot her to the vet if she isn't right but I'm hoping I can keep her going until her appointment in the morning.

ETA usually feed 2 pouches, often she leaves some and finishes it off later.
 
PDF on TR published study attached. Might be helpful at the vets.

Remission rates quoted in the above for recently diagnosed cats are significantly higher with Lantus and Lev (>80% ) cf. Prozinc (think that's in the 60% range); another potential argument in favour of a depot insulin.


Mogs
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After 5 cycles she finally seems to have come down off her trampoline (fingers crossed), she was fed at +2 and still dropped by a total of just over 27 points by +5, not sure what would have happened if she had not had food and I had not been around this morning. As it was today away from her was very stressful. She is now having a snooze and wondering what all the fuss was about. Still not back to her usual self, she must have been feeling pretty rotten the past week.
 
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