My vet didn't explain this well...

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Bron and Sheba (GA) said:
Its not a bounce to 90. it would be a drop.
I have no real idea what he might do as we really haven't seen any data yet.
What I would do is give the 1 unit if the preshot is 200 or over 30 minutes after the preshot meal.
Then I would get a +1 and a +2 to see how he's going. I will be around so post the BG and we can see when you should next post. Give him snack at +2
I used to set the alarm when I needed to test at night. Trying to stay up all night will make you exhausted. If you think you might sleep through the alarm put it further away from the bed so you have to get up.
How does that sound
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sounds like a plan to me! i really appreciate your guidance. can you explain what a bounce is please?
 
Katsallday said:
sounds like a plan to me! i really appreciate your guidance. can you explain what a bounce is please?
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Sure.
A bounce happens when the BG drops too low, too fast or lower than the kitty has been used to.
The cat then panics and thinks it has to save itself and dumps stored glucose and regulatory hormones into the system which sends the BGs up high.
Bounces can last from 1 to 6 cycles and there is nothing you can do once it ha happened except wait it out.

So if for example you are only testing the preshot and not at all during the cycles, you don’t know if the BG is dropping during the cycles.
You might only see high BGs and think the dose needs to be increased, when in fact the BG could be dropping really low during the cycle and bouncing back up at the next preshot.
Another example is if the cat goes to the vet for the day to have a curve done and the cat is in the middle of a bounce but no one knows this because there is no testing at home. So the BGs are all high and the vet says to increase the dose. But the dose should have been lowered because the BGs had dropped too low at home and caused a bounce. Does that make sense.
 
Bron and Sheba (GA) said:
Sure.
A bounce happens when the BG drops too low, too fast or lower than the kitty has been used to.
The cat then panics and thinks it has to save itself and dumps stored glucose and regulatory hormones into the system which sends the BGs up high.
Bounces can last from 1 to 6 cycles and there is nothing you can do once it ha happened except wait it out.

So if for example you are only testing the preshot and not at all during the cycles, you don’t know if the BG is dropping during the cycles.
You might only see high BGs and think the dose needs to be increased, when in fact the BG could be dropping really low during the cycle and bouncing back up at the next preshot.
Another example is if the cat goes to the vet for the day to have a curve done and the cat is in the middle of a bounce but no one knows this because there is no testing at home. So the BGs are all high and the vet says to increase the dose. But the dose should have been lowered because the BGs had dropped too low at home and caused a bounce. Does that make sense.
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thats what i thought great! this was his chart today, i went a little crazy with the amount of testing

-2 416
0 439 (preshot)
+1 483
+1.5 468
+2 400
+3 318
+4 263
+5 234
+6 239
+7 219 (fed a can of food tikicat)
+8 233
+9 244
+10 291
+11 299 (preshot)
 
.His nadir was quite late for vetsulin but that could be because he was coming off a bounce.
Did you feed in between the preshot meal and the nadir?
Time will tell. I’m going to ask @Bandit's Mom to have a look at the SS as I can’t see any of the BGs in there. She should be around soon.
 
Bron and Sheba (GA) said:
.His nadir was quite late for vetsulin but that could be because he was coming off a bounce.
Did you feed in between the preshot meal and the nadir?
Time will tell. I’m going to ask @Bandit's Mom to have a look at the SS as I can’t see any of the BGs in there. She should be around soon.
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i only did 3 meals today i was a bit late to the nadir meal but he got it around 7 hours instead of 6, should i stall the shot or go forward with the 1 unit?
 
Bron and Sheba (GA) said:
299 is fine to shoot. Make sure he eats well before hand and wait the 30 minutes. Then make sure to give him a snack at +2 and +4
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what would you consider a snack? like a tablespoon of wet food or a few freeze dried treats?

should i be snacking him only at +2 and +4? or should i also snack him at the nadir
 
Katsallday said:
what would you consider a snack? like a tablespoon of wet food or a few freeze dried treats?

should i be snacking him only at +2 and +4? or should i also snack him at the nadir
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I would give a tablespoon of wet food. Do you give a treat when testing? The dried food is good for then.
 
Katsallday said:
i think i fixed the issue? mind checking again for me?
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You did! Well done! this will make it much easier to help you now.
If you can always keep the SS up to date, that would be super thanks as we always look at it when we help you.
I’ll watch out for the +1 and the +2. He had a bit of a food bump at+1 and +1.5 last cycle so let’s see what he has in store for us this time.
 
Bron and Sheba (GA) said:
You did! Well done! this will make it much easier to help you now.
If you can always keep the SS up to date, that would be super thanks as we always look at it when we help you.
I’ll watch out for the +1 and the +2. He had a bit of a food bump at+1 and +1.5 last cycle so let’s see what he has in store for us this time.
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i hate when he naps after the injection. its so scary. about 20 minutes until his +1 test
 
Bron and Sheba (GA) said:
You did! Well done! this will make it much easier to help you now.
If you can always keep the SS up to date, that would be super thanks as we always look at it when we help you.
I’ll watch out for the +1 and the +2. He had a bit of a food bump at+1 and +1.5 last cycle so let’s see what he has in store for us this time.
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327 at +1
 
Bron and Sheba (GA) said:
I would get a +6 if you can. It will be useful data. If the +6 is not dropping I think you could leave it until the next preshot test.
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I couldn't stay awake unfortunately. I was awake for 18 hours my body gave out and made me sleep. I'm still driving my cat with pneumonia 30 min away to get nebulization 2x a day too. I could definitely use a vacation
 
Deb & Wink said:
Starting dose for Prozinc is not based on weight either. It's better to start the dose low, and then increase as needed. We use 0.25U increases, not whole units.

My recommendation would be to start Tuna a no more than 1U of Prozinc.
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Why does everyone want to start so high?
 
Katsallday said:
Why does everyone want to start so high?
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I don't know why your vets want to start the dose so high. Perhaps they can explain it to you, and you would pass that information on to us.

p.s. When you do switch to Prozinc, be sure to update the SS (spreadsheet) so the current insulin says Prozinc instead of Vetsulin.
 
Will absolutely update! The vet said based on tunas readings and fructosamine test that's where she wants us to start. He is almost obese so idk. He managed to gain .9 pounds in a week with exercise every day
 
I agree with @Deb & Wink with the starting dose of 1 unit. You are swapping over and have been giving 1 unit of the Vetsulin so that is what is normally done.

I have no idea why the vet wants 4 units either.
It’s good you have the Prozinc though!
 
Bron and Sheba (GA) said:
I agree with @Deb & Wink with the starting dose of 1 unit. You are swapping over and have been giving 1 unit of the Vetsulin so that is what is normally done.

I have no idea why the vet wants 4 units either.
It’s good you have the Prozinc though!
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I'm worried I'm missing something as to why they want to start this high. I asked if they have any diabetic cats in remission and he said he can think of 3 off the top of his head. My fiance desperately wants me to trust this vet, I only want this cat in remission
 
Katsallday said:
I'm worried I'm missing something as to why they want to start this high. I asked if they have any diabetic cats in remission and he said he can think of 3 off the top of his head. My fiance desperately wants me to trust this vet, I only want this cat in remission
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Katrina I understand your position having a partner who wants to believe the vet. You are not the first person in this quandary.
All we can do is tell you from our experience, and we have been here for years and have looked after our kitties 24/7, that starting at a high dose will not achieve a faster result, but there is the real danger of a hypo.
Sadly vets do not get much training with feline diabetes at Uni. And treatments have progressed in recent years. Vets have a lot to keep up with to stay current with all the animals they treat, and most don’t seem to have been able to stay abreast with current treatments for diabetic cats. . I can’t tell you the number of kitties I have seen arrive here having suffered a hypo, sometimes severe with seizures. It alarms me greatly that any vet would want to start a cat on 4 units of insulin.....cats are not little dogs and they metabolise insulin differently.
It is far, far safer to start at a lower dose and move gradually up in dose while monitoring the BGs. You also do not run the risk of passing the best dose for your cat

Prozinc is a much more suitable insulin for cats...vetsulin is an insulin which was made for dogs. You should get a better duration with the Prozinc and not such a harsh drop.

Here is the American Animal Hospital Association Guidelines for cats and dogs....make sure you are reading the parts relevant to cats. On page 4 it clearly states the starting dose is 1 to 2 units.
https://www.aaha.org/globalassets/02-guidelines/diabetes/diabetes-guidelines_final.pdf

Here is our information on dosing with Prozinc.

The basics https://www.felinediabetes.com/FDMB...-the-prozinc-basics-please-start-here.164995/

Dosing with Prozinc https://www.felinediabetes.com/FDMB/threads/prozinc-dosing-methods.225629/

Please keep posting and asking questions. I can see you love Tuna and wants what is best for him.
Bron
 
thank you so much for your support. heres my plan, i get the new insulin tomorrow so tonight i still have to push the vetsulin. i want to do the 1.25u dose with the vetsulin considering how harsh it is. im open to upping the dose of the prozinc since tuna isnt responding well to the 1u of petsulin. we are barely past nadir and his BG is 297.

tomorrow i would like to try for 1.5 of the prozinc. does this sound like a reasonable plan? im worried about accuracy ofc with my u40 needles as well.
 
Katsallday said:
thank you so much for your support. heres my plan, i get the new insulin tomorrow so tonight i still have to push the vetsulin. i want to do the 1.25u dose with the vetsulin considering how harsh it is. im open to upping the dose of the prozinc since tuna isnt responding well to the 1u of petsulin. we are barely past nadir and his BG is 297.

tomorrow i would like to try for 1.5 of the prozinc. does this sound like a reasonable plan? im worried about accuracy ofc with my u40 needles as well.
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I’m going to tag @Deb & Wink about the dose you would like to start on. I don’t use Prozinc either.
it sounds like a reasonable plan but let’s see what Deb thinks.
What is worrying you about the u 40 syringes?
 
You will need u40 syringes for Prozinc so I think it would be worth while getting the 1/2 unit syringes. It will make dosing easier as we recommend going up and down in1/4 unit increments.
 
If you go with 0.1U per pound of weight, that is only 1.8 units if you use the lower end of the scale.
The most important thing when giving insulin is to keep the cat safe.
With Prozinc, you don’t have to feed half hour before the shot. You can test/feed/ shoot in that order one after the other.
 
Bron and Sheba (GA) said:
If you go with 0.1U per pound of weight, that is only 1.8 units if you use the lower end of the scale.
The most important thing when giving insulin is to keep the cat safe.
With Prozinc, you don’t have to feed half hour before the shot. You can test/feed/ shoot in that order one after the other.
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I will not shot the 4u until I talk to the vet and get a clear answer on why we should start so high now that I know the exact scale vets use for dosage. Why aim for the high end so fast, vets are like on speed, go fast and take drugs.
 
Please do start at the lower end. Safety must be the first priority. And you will get there just as quickly.
I would test for ketones though, if you are not already. Ketones can form in unregulated diabetic cats and a simple urine test is all that’s needed with a bottle of Ketostix from Walmart or a pharmacy.
 
Bron and Sheba (GA) said:
Please do start at the lower end. Safety must be the first priority. And you will get there just as quickly.
I would test for ketones though, if you are not already. Ketones can form in unregulated diabetic cats and a simple urine test is all that’s needed with a bottle of Ketostix from Walmart or a pharmacy.
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I got it already but I have not caught him peeing yet. With 16 cats I have 10 litterboxes too :eek:
 
Bron and Sheba (GA) said:
Please do start at the lower end. Safety must be the first priority. And you will get there just as quickly.
I would test for ketones though, if you are not already. Ketones can form in unregulated diabetic cats and a simple urine test is all that’s needed with a bottle of Ketostix from Walmart or a pharmacy.
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Also what do you think is the best way to tell/convince my vet of the lower dose? I don't see the problem with starting low but there is a chance of hypo starting high. I wonder why to them it's even worth the risk? I mentioned hypo today and they told me "don't worry we've never seen a cat with hypo" yeah probably because they passed away because you're telling people not to worry about it...
 
Katsallday said:
Also what do you think is the best way to tell/convince my vet of the lower dose? I don't see the problem with starting low but there is a chance of hypo starting high. I wonder why to them it's even worth the risk? I mentioned hypo today and they told me "don't worry we've never seen a cat with hypo" yeah probably because they passed away because you're telling people not to worry about it...
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A lot of vets tell their caregivers they don’t need to hometest and just give honey is hypo symptoms occur. The problem with that is by the time a cat is showing signs of a hypo, they are very very low.
We rarely get hypos in a cat that is being home tested, because the caregiver can see the BG dropping and do something about it. ie give some food.

The head in the sand attitude is very scary. For them to say they have never seen a cat have a hypo, when they prescribe large doses of insulin is unbelievable.
I have helped many cats who have arrived here in very low numbers because the cats has been prescribed too high a dose, and I will do whatever I can to convince caregivers to take the necessary precautions so that doesn’t happen to them. It is very scary having a cat showing signs of a hypo, which can be twitching, shivering, walking like a drunk, becoming starving hungry, having a seizure, becoming unconscious.... just to name a few.

As far as telling your vet about the dose you want to give ......you can either say nothing and just give the smaller dose, and just say when you see her, you had to reduce the dose becasue the BG dropped.
Or just say you are not comfortable giving that much insulin. You want to start at such and such a dose.
Remember you are Tuna’s advocate, you are paying the bill, you have the final say.
 
Hi Katrina
Personally i agree with everybody else here and say the dose given by your vet is too high. When my Duke started on Prozinc in January the vet gave us a starting dose of 1.5U and that was too high and he nearly had a hypo on the first day so we had to reduce that and build up slowly to his required dose. Looking at Tuna's SS his numbers are very similar to what duke's were when he started on his insulin.
It's easier to start on a low dose and build up rather than risk a hypo and bouncing all over the place.
As for syringes i use Prozinc U40 syringes that have 1/2 unit markings, i have found this one in the USA but there will be many other sites that sell them as well.
https://www.valleyvet.com/ct_detail.html?pgguid=fa6db1a3-6eac-45d4-a304-d395c5a01dcb
Just one more thing with the syringes when you are using them, check the syringes before you use them as they can vary slightly as can the U100 syringes.
See this post where i had problems with syringes.
https://www.felinediabetes.com/FDMB/threads/help-regarding-dukes-numbers-please.243125/#post-2744357
I just sort them all out before i use them so i'm not messing about at shot time, three separate bags with the plunger at the top, middle and bottom of the zero line, i then use all the syringes with the plunger at the top, then the middle and then the bottom. This way i can give more or less the exact dose each time, and i adjust the dose very slightly when i use the ones where the plunger goes to the middle and bottom of the zero line, but still the same dose if you see what i mean.
 
Last edited:
Teetee (UK) said:
Hi Katrina
Personally i agree with everybody else here and say the dose given by your vet is too high. When my Duke started on Prozinc in January the vet gave us a starting dose of 1.5U and that was too high and he nearly had a hypo on the first day so we had to reduce that and build up slowly to his required dose. Looking at Tuna's SS his numbers are very similar to what duke's were when he started on his insulin.
It's easier to start on a low dose and build up rather than risk a hypo and bouncing all over the place.
As for syringes i use Prozinc U40 syringes that have 1/2 unit markings, i have found this one in the USA but there will be many other sites that sell them as well.
https://www.valleyvet.com/ct_detail.html?pgguid=fa6db1a3-6eac-45d4-a304-d395c5a01dcb
Just one more thing with the syringes when you are using them, check the syringes before you use them as they can vary slightly as can the U100 syringes.
See this post where i had problems with syringes.
https://www.felinediabetes.com/FDMB/threads/help-regarding-dukes-numbers-please.243125/#post-2744357
I just sort them all out before i use them so i'm not messing about at shot time, three separate bags with the plunger at the top, middle and bottom of the zero line, i then use all the syringes with the plunger at the top, then the middle and then the bottom. This way i can give more or less the exact dose each time, and i adjust the dose very slightly when i use the ones where the plunger goes to the middle and bottom of the zero line, but still the same dose if you see what i mean.
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Bron and Sheba (GA) said:
A lot of vets tell their caregivers they don’t need to hometest and just give honey is hypo symptoms occur. The problem with that is by the time a cat is showing signs of a hypo, they are very very low.
We rarely get hypos in a cat that is being home tested, because the caregiver can see the BG dropping and do something about it. ie give some food.

The head in the sand attitude is very scary. For them to say they have never seen a cat have a hypo, when they prescribe large doses of insulin is unbelievable.
I have helped many cats who have arrived here in very low numbers because the cats has been prescribed too high a dose, and I will do whatever I can to convince caregivers to take the necessary precautions so that doesn’t happen to them. It is very scary having a cat showing signs of a hypo, which can be twitching, shivering, walking like a drunk, becoming starving hungry, having a seizure, becoming unconscious.... just to name a few.

As far as telling your vet about the dose you want to give ......you can either say nothing and just give the smaller dose, and just say when you see her, you had to reduce the dose becasue the BG dropped.
Or just say you are not comfortable giving that much insulin. You want to start at such and such a dose.
Remember you are Tuna’s advocate, you are paying the bill, you have the final say.
Click to expand...


Tunas nadir was past 300 today should I take him to the vet?
 
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