Meals, increasing weight, other issues

First, my apologies to any/all of you who were trying to help me the past couple of weeks and I may have come off as brash and not listening to sound advice you have been giving. Believe me...I am. I sit here in tears writing this as I am not sure what I am supposed to be doing next. Here is Howie’s current status:
1. Went in Wed for his first fructosamine that came back at 598 and a huge shock to us all. Also Talked to the vet about reducing dose to 3 units instead of 6 which I’m doing.
2. Thurs went back to the vet for a low dex test to rule out Cushings as he was concerned about that as a possible complication. Waiting on result this week.
3. Fri I was able to work from home thank goodness. He was really lethargic and slow to eat but was eating almost all food and drinking Ok. I first thought it was due to stress of being at the vet all day Thurs. I finally found ketone strips and did a test last night when I finally caught him peeing. He was somewhere small-moderate. I also started seeing weakness in his back legs.
4. Sat (today) I called the vet as soon as they opened about his keytones. Because he is eating &drinking fine, they set me up w/giving sub Q fluids with potassium at home due to the holiday weekend (30 mL twice a day through at least Mon). The nearest emergency hospital is over an hour away so am praying these fluids keep things at bay until my vet reopens on Tues if his keytones level doesn’t drop to trace.

After all these appts this week, I also found out he has lost 1.7 lbs since Aug. 17 when he was last weighed (down to 8.5lbs) which is very concerning. Here are my questions:
1. He obviously has not gotten anywhere below 200 even with dropping to 3units twice a day. I know this adjustment takes time. Should I be doing anything different with his dosages right now or let the change settle in? My vet has also talked about switching insulin types depending on the Cushings results. He was diagnosed on 6/23. Is that too soon to consider switching? Of course I just got a new bottle of Prozinc from Chewy I couldn’t return (haven’t started on it yet)!
2. Based on Howie’s current spreadsheet, should I adjust his mini meal times? He’s currently eating/shooting at 8am/8pm and gets mini meals at +2 and +5 per recommendations I got on here. His nadir (at least during the day) is not very consistent.
3. I obviously want to try and get some weight back on. How do people do it without sending their digestive systems into overload? He’s currently eating 300 calories of 1.5 cans of high protein/low carb food every 24 hrs. When I was feeding him upwards of 400 calories of 2cans (11oz total) not long ago, he had bad diarrhea that smelled awful. The vet said he was getting too much protein. I have an auto feeder that I can do up to 5 mini meals. Of course his ravenous appetite is coming back now that I’ve cut down on his insulin.
4. Most importantly...for people who have had too high of dosages and lowered them to find the correct dosage, how did you do/achieve it? How long did it take? How did you figure it out? Should I be exploring a dosage less than 3? He started out at 2 units at diagnosis which I read was common in the 2018 article in diabetes management.

Thanks for reading this novel and helping me find a way to get Howie back on track and back to himself. I want my playful, cheerful lap kittie back!

 

Tagging
@Panic
@Deb & Wink
@JanetNJ
for Prozinc dosing advice.

When you're down, always remind yourself that feline diabetes is a marathon, not a sprint.

 

I'll let @Deb & Wink comment on the dose. I'm not used to seeing Prozinc keeping the numbers in flat yellows. You can always switch to Lantus/Levemir if you like, most cats do better on it than any other insulin. I have no experience with Cushings so can't comment on it. Did you already check with Chewy's customer service about returning? I've heard they are very good about returns but have never had to return anything from them.

Mini meal times seem fine to me so far. Can't comment on the diarrhea but new diabetics often need 2x the regular amount of food. Since Howie is losing weight I wouldn't restrict him any. You can add more mini meals if you like. Try to keep them toward the first half of the cycle.

My cat was bumped up very quickly, a couple members were discussing her dose and when I was making the switch to Prozinc we went from 4u down to 2, but that was also with a LC diet change, so a lot of things were in play. It took about a week before seeing some promising numbers. Every cat is different though!

 

Cushing's is not very common. Agromegaly and IAA ( Insulin Auto Antibodies) are much more common. But we don't suggest testing for those conditions until your cat is at 5-6U for each dosing cycle.

+2 and +5 are good times for feeding. That of course is in addition to his main meal at insulin shot time. You might want to add more meals. See comments below.

The Purina Pro Plan True Nature cat foods are not really high in protein. In the 35-40% range which is what you want. Not sure why your vet thought he was getting too much protein. He needs more calories to get the weight back on. So he needs to eat more food. Simple as that (or as difficult). Try adding at least one more meal, at around +1 in the auto feeder. Maybe another one at +3. You can try some canned pumpkin, about 1 teaspoon to firm up his stools.

Finding a good dose for your cat involves a lot of trial and error. Getting those mid-cycle tests to see how low a particular dose is dropping your cat and then following the dosing protocols we use here are how most people find out how the dose is working for their cat. ECID

I do not think that a smaller dose, a dose reduction, is in order for Howie. He probably needs a dose increase instead. Consistency with insulin is key. We don't dose based on the pre-shot tests, and do a greatly reduced dose, unless the BG's warrant it. Under 150 at pre-shot would be your stop and think about the dosing. We don't use a sliding scale, like your vet has you doing, with so many units if the BG is in this range, but half the dose if the BG is in another range, but on the mid-cycle nadirs or lows for the cycle.

So I'd recommend you go up to 3.25U per cycle. You've got plenty of leeway with those yellow BG ranges to increase the dose. Sometimes, those dose increases need to be faster than the standard 7 days also, even with SLGS (Start Low, Go Slow).

Do not limit his food intake. He needs to eat whenever he wants to. If he is begging for food, then try to get a BG test as you give him a small snack. Many cats will seek out food when their BG levels are low. Plus, with the ketones, you need him to be eating more food, so he is not burning up muscle and fat to get the energy his body needs. When his body burns muscle and fat tissue, that produces ketones as a toxic byproduct.

The diarrhea could have been a particular flavor of food. Or it could have been the sudden transition from his old food to the new food causing some digestive upset. Or it could have been many other reasons too. Like a food allergy.

How are the ketones today? How is Howie doing? How are YOU doing?

 

Chewy unfortunately won’t return any prescriptions. It’s already in their website FAQ I’m definitely seeing a string of mentions of more mini meals so will try that...thanks!

 

Th

Thanks, Deb! Since he was at 6 units since early August and it wasn’t making his #s budge, that is why my vet wanted to start testing for other conditions. He has been in this Purina Pro Plan food since diagnosis so would assume his diarrhea isn’t because of a food switch. I only feed him chicken/liver and chicken/turkey. He had normal BMs about a week ago and when he started the food and most of the summer. So I don’t think it’s his food. Due to some digestive issues even before diagnosis, they are thinking it’s possibly IBD. I currently have him on S. boulardii for the diarrhea. As for the keytones, I do believe they’ve lessened and are closer to trace thanks to the fluids I’m giving him at home!! It also means I’ve been a home body this weekend and have just been pricking his ear and following him to the litter box! I’ll start giving him some more mini meals and increase him to 3.25U (I have U40 syringes so will have to eyeball the .25 increase??). Thanks for the assistance! Me personally...I’ve been better. I spend all free time trying to learn more, worry about him, and stress about him when he’s not in an OK state. I got him in March when his owner passed away and have dealt with removing all his teeth, switching food that didn’t go well, mysterious other illnesses, ear infection, and him adjusting to a transition and still grieving his Dad. I love him dearly but would like a week when he’s not at the vet or I’m not calling. I had a CKD kittie for 14 years I had to put down a few years ago and this is taking me straight back to those times.
Question on Mini meals: if I add in 2 more mini meals (1/8 of a can each mini meal) for a total of 4 each cycle instead of just two at +2 and +5, what Time increments would you recommend for the additions?
Question on his food: according to Dr. Lisa’s chart, his food is 36-37% protein. Should I be finding a food that has even more protein?

thanks!

 

You can offer it for a small sum plus shipping costs or for free to another Prozinc user by starting a thread in the Supply Closet.
Supply Closet - For Sale or Free

 

If you think the GI issue may be IBD, you may want to consider giving Howie novel proteins. Trying to avoid food that contains gums or carrageenan is also helpful. I have an IBD (non-diabetic) kitty. I found this website, Raw Feeding for IBD Cats, to be very helpful. (They also have a Facebook page.) You don't have to provide raw food! There are come commercial low carb, high quality foods that are helpful for IBD. I often use a combination of homemade raw and canned ZiwiPeak (venison, rabbit + lamb) since I have a hard time sourcing novel proteins. I also use a pre-mix (EZ Complete from FoodFurLife) to supply all of the necessary nutrients.. There are also commercially prepared raw diets (e.g., Hare Today) and freeze or air dried raw (Stella & Chewy's or ZiwiPeak, respectively).

FWIW, my IBD kitty was raised on chicken and turkey. It's now eliminated from his diet.

As for weight gain, the issue is the calories. I think you're OK on the protein. Most cat foods aren't all that high unless you're feeding a raw diet. You may want to look at foods that are also higher in calories since you'll get a bigger bang for the buck. You can offer food at pretty much any time but try to not feed Howie within 2 hours prior to shot time. Depending on how he responds to food, some cats will do better if. you give food before nadir since there's more insulin available to help offset the effect of the food.

I also agree with Deb. I've been hanging around here a long time. We've only seen a very small number of cats with Cushings. You'd likely see symptoms like very fragile skin that can tear easily. It's fare more common to see either acromegaly or insulin resistance. These are assessed by sending a blood sample to the veterinary lab at Michigan State -- it's the only lab that runs these tests.

 

Thanks for the tips on the IBD food! I had been reading about carrageenan and trying to find a decent food that doesn’t cost a ton that is free of those things. He’s currently on S. Boulardii and pumpkin to try and get this diarrhea/super soft stool under control. He doesn’t go often, but when he does, it’s not great!

 

Question for anyone who can help: I increased his insulin to 3.25 units this AM (eyeballed as I have u40 syringes). His AMPS was 316 and his 2 hr tests have shown that he’s only dropped to 311 since +2. However, I also just added in extra mini meals at +3 and +4 so he’s now getting 4 mini meals from +2 to +5 (mini meal = 1/8 can). I’ve also started giving him pumpkin (1 tsp at breakfast, +2 and +3) along with his S. boulardii for diarrhea as I’m not sure how much pumpkin is too much in a day. So lots of changes today but he’s never had a day ever when he hasn’t dropped below 300 at some time (nadir is normally +6 to +8). Are these extra mini meals and pumpkin throwing him off? The good news is that he is pretty much negative to maybe a small trace of keytones today!

 

Fancy Feast Classics is carrageenan-free but it has guar gum. I think most canned food is going to have one or both in the ingredients, at least from the ones I've been reading up.

I think you don't want to give more than a tablespoon (or two?) of pumpkin a day.

With some cats it can take a few cycles before you see the full effect of a dose increase. Sounds like it's going to be a quiet cycle this time. Normal.

 

You might want to eliminate the pumpkin. Pumpkin can work to either reduce diarrhea or prevent constipation. It can go in either direction. I generally start with 1/4 of a capsule of S. boulardii and then increase to 1/3 then 1/2 if there are still problems. Another member likes Jarrow's S. boulardii + MOS which she says works better than the plain S.. boulardii.

@Panic - ZiwiPeak doesn't have gum or carrageenan but it's pricey!

 

I am using the Jarrow’s brand. He’s been on it since Fri but no reprieve yet. I started with the 1/2 capsule twice a day hoping that would do it (therapeutic dosage). Today I’m doing 1/4 capsule each time he eats up to 2 capsules total (it looks like that is acceptable for emergency stopping of diarrhea). But I don’t know how long he can really be on that dose. That’s why I started the pumpkin as well. Thanks!

 

If you look on the Raw Feeding website, they have a section on dealing with diarrhea -- there are two links. This is the link to the Meds & Supplements section where you can find the info.