Need advice - high BGs x5mos, mom & tomcat distressed

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Amy- I might go with the 0.5u increase at this point - first because he's over 5 units, but even at smaller doses we say if the nadir is above 200 to increase by 0.5u instead of 0.25 units. Especially because you are limited on mid-cycle testing during the week so your dose changes can't be as often as might be ideal, you might want to take advantage of the time to monitor this weekend and do a larger increase.

Very good, understanding the reasoning you explained, as well as the % of increase that Kris stated -I am not an educator (accountant), but so very glad that many of you are! :cat:
Tom was 451 at AMPS and received the 6.0 units, hoping for good #s today.
 
The timed feeder might be the perfect thing - it would help him not "scarf and barf" but still give him access to regular snacks throughout the day. Cats do need a lot of extra calories when they are in high numbers to try to hold off the weight loss, so keep feeding him lots, but as you mentioned, he needs it slowed down a bit so he doesn't get sick from it.

Great job getting that curve in. It shows that he is responding to the insulin which is great, so it's just a matter of getting in some more increases. Also, as you're about to hit six units, it might be worth considering the IAA/Acro testing to figure out which condition(s) you're dealing with. Have you had a chance to do any reading about those? There is an ISG for that here: http://www.felinediabetes.com/FDMB/forums/acromegaly-iaa-cushings-cats.12/ but it's not very active. It's a good place to read and maybe do an initial post depending on your test results. Most folks who deal with those conditions are over in the Lantus/Levemir group (usually using Levemir). You could stay with Prozinc, but as you've noticed, it gets expensive at higher doses.

Good luck with the increase (whichever amount you choose) and the curve today!

How was your time at home?

Still thinking about the timed feeder, hoping our other Kitty won't gobble up Tom's in between portions - Tom will Bogarde his way over to her plate (so that she'll leave) when he hasn't finished his- smart Tom, not so polite though.

I will read up at the link today-thank you. Will have to make a list for the vet, hopefully she'll be ready for all of our questions!

Tommy rode home in the harness and seatbelt tether next to the teenager. He had the gabapentin at breakfast but we noticed him facing rear staring at the seat. Our chihuahua does this when he's carsick so we gave Tom cerenia about +2. He was high the rest of the way home, poor baby, but was happy to get home. He went in the closet twice last night, laid down and came back out. He went through the house laying down for a bit then moving. I assume he was still a bit groggy from the ride and magic dust.

We've noticed some dandruff on his backside near tail and assumed because he's not cleaning himself so much with not feeling good and that's ok, he loves to be brushed, but I did see him giving Kitty a bath last night? I know he is happy to be home, he's been very mellow which is not unusual for his personality, just hoping it's the meds and traveling, not that he doesn't feel good. Let's see what numbers the day brings!
 
Like you said, most likely woozy from the drugs and the car ride. Make sure he doesn't go off his food though - stress and insufficient calories can trigger ketones so it's something to watch for until he's feeling better.

Sam likes the tethered harness option in the car too. He looks much more comfortable just sitting on the seat instead of caged. Atticus is the opposite though - he feels safer in his carrier. Ah kitties...always have to be opposites!
 
OMG @Djamila @Kris & Teasel - just opened the new AT2 test strips and when putting the empty container into the recycle, realized these different codes. We initially had our AT2 meter set to 22 CAT as that is what came with our starter kit. I'm trying to insert a pic from this iPad, but the 2nd bottle we've used all 50 strips at 22 instead of 8 CAT. Now the new 3rd bottle says 7 CAT. Has this affected our numbers? :nailbiting:

I did notice diff numbers on the video I watched about poking with just the lancet /without the clicker, but that was about all I did was notice. Teenager programmed the AT2 when we got it for the accompanying 22. I'm assuming this is something I need to check and learn myself to program the meter every new bottle of strips.

Tommy's +2 looked good coming down to 274 but now the +4 is 353.
 
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OMG @Djamila @Kris & Teasel - just opened the new AT2 test strips and when putting the empty container into the recycle, realized these different codes. We initially had our AT2 meter set to 22 CAT as that is what came with our starter kit. I'm trying to insert a pic from this iPad, but the 2nd bottle we've used all 50 strips at 22 instead of 8 CAT. Now the new 3rd bottle says 7 CAT. Has this affected our numbers? :nailbiting:

I did notice diff numbers on the video I watched about poking with just the lancet /without the clicker, but that was about all I did was notice. Teenager programmed the AT2 when we got it for the accompanying 22. I'm assuming this is something I need to check and learn myself to program the meter every new bottle of strips.

Tommy's +2 looked good coming down to 274 but now the +4 is 353.
It's possible that using the wrong cat code can affect the BG values. All you can do now is input the proper code and go from there. Lesson learned! ;)
 
I found this on the main forum, saying the code should be checked every time a new bottle of strips is opened, and also that a control test should be done:

http://www.felinediabetes.com/FDMB/...phatrak-help-needed-asap.153275/#post-1612789

I did the control test mentioned in the thread and it was in the acceptable range. So unfortunately it probably hasn't affected Tommy's numbers. You're right, it did give the learning opportunity to flip through the "long version" of the instructions instead of the "quick start" guide. I remember we were excited to use it after 5 weekly Vet payments for accucheks (ouch).
 
Glad to hear you got safely home! Tommy probably just needs some time to relax and get used to his home surroundings again. Keep an eye on him, but don't worry too much (easy for me to say!).
 
Glad to hear you got safely home! Tommy probably just needs some time to relax and get used to his home surroundings again. Keep an eye on him, but don't worry too much (easy for me to say!).

Thank you Rachel, I'm sure you are right. Mom needs a rest now too, even though I wasn't he one getting poked 87times today o_O
 
We are done with today's curve with the +0.50 dose increase, yahoo! I think I received hisses every other poke and not the PM injection. Tommy slept a lot today. It seemed like he only woke up every two hours for a poke and snack, but he ate well and no vomiting so far :cat:

Please have a look at his updated spreadsheet and let me know what you think. I think it looks like he still needs more insulin. I also entered the data from 2017 albeit is sporadic. I still need to enter labs.
 
We are done with today's curve with the +0.50 dose increase, yahoo! I think I received hisses every other poke and not the PM injection. Tommy slept a lot today. It seemed like he only woke up every two hours for a poke and snack, but he ate well and no vomiting so far :cat:

Please have a look at his updated spreadsheet and let me know what you think. I think it looks like he still needs more insulin. I also entered the data from 2017 albeit is sporadic. I still need to enter labs.
Yes, I think his dose will have to go up.
 
Yes, I think his dose will have to go up.

We could do more. Does it look like any progress with the yellows? How much increase after how many cycles? I will be working from home Wednesday and could get some mid-cycle tests, but that is 6 cycles from now.
Will hopefully communicate with Tom's vet on Monday. Now that I think back about our convo this last Monday, I believe she is leaning more towards changing insulin. I was hopeful today's curve would show some improvement that prozinc could still work for him, but still worried.
 
You can typically increase every three cycles, but there should be more than one cycle of data in those three since sometimes the kitty won't respond much the first cycle, but will on the 2nd or 3rd cycle. Or sometimes they'll respond on the first and then less on the next couple, or high and flat on the next couple. So ideally if you could get a +6 or +7 (it looks like his lowest number was on the later side of the +6 time) today, that would be great.

Since you're still well over 200 on the nadir (your lowest number), I would say to do another 0.5u increase. You could do it tonight if you can get a mid-cycle test tonight. If you can't, then wait until Wednesday when you can.
 
$2-3 dollars (or I'm sure you can buy those at WalMart as well).
There are even lancets at the supermarkets for under $2. Just don't get the 33-gauge micro-thins even though they come in pretty colors. I have a hard time getting a blood drop from them and have wasted test strips because of it.
 
You can typically increase every three cycles, but there should be more than one cycle of data in those three since sometimes the kitty won't respond much the first cycle, but will on the 2nd or 3rd cycle. Or sometimes they'll respond on the first and then less on the next couple, or high and flat on the next couple. So ideally if you could get a +6 or +7 (it looks like his lowest number was on the later side of the +6 time) today, that would be great.

Since you're still well over 200 on the nadir (your lowest number), I would say to do another 0.5u increase. You could do it tonight if you can get a mid-cycle test tonight. If you can't, then wait until Wednesday when you can.

Now also remember vet said if he went under 300 to test every hour, probably to nail down that nadir. I can get a +6 and +7 today but he will want a reward after the +6.
I'm not positive that I can get a mid-cycle tonight if we increase.
 
How much Prozinc do you have left in your vial? Any idea when you'll be needing a new one?

Almost half in the current vial, then have two more vials - one has at least two doses and the other probably has 2 days' doses. I think if we continue with the increases and not seeing significant response at the end of the main vial, we will have to try something else. These high #s can't have been good for his body this long.
 
There are even lancets at the supermarkets for under $2. Just don't get the 33-gauge micro-thins even though they come in pretty colors. I have a hard time getting a blood drop from them and have wasted test strips because of it.

I was contemplating getting the higher gauge #, smaller gauge because I can hardly get a sample from Tom's capillaries after a few pokes I end up poking the vein and have overflow! :(
 
It might be worth starting the conversation with your vet about Levemir so you have time to order it and learn about it before you run out of Prozinc. Most folks with higher dose cats prefer it because it stings less than Lantus when given in larger amounts.

Of course it's always possible that Tommy will surprise us, 6.5u will be his magic dose, and he'll start to come down, but better to start planning under the assumption that he's going to need more insulin still.
 
It might be worth starting the conversation with your vet about Levemir so you have time to order it and learn about it before you run out of Prozinc. Most folks with higher dose cats prefer it because it stings less than Lantus when given in larger amounts.

Of course it's always possible that Tommy will surprise us, 6.5u will be his magic dose, and he'll start to come down, but better to start planning under the assumption that he's going to need more insulin still.

Good idea Djamila, thank you again. It's good to know the Lantus stings at higher amounts, making a note for discussion with vet hopefully tomorrow.

Tom was 262 at +6 and 297 at +7 with no food between, so mid-cycle definitely seems to be his nadir (please correct if wrong). He is still sleeping a lot today, but was playing with his mouse last night so no concerns about his activity. I will get a +4 or +5 tonight but that may be as late as I can push myself, maybe I can up to the 6.5 Tuesday evening, we will see.
 
Tom's vet called today after I emailed his spreadsheet. She did not mention noticing that I increased him to 6u, but discussed changing his insulin to Vetsulin and starting off with 1u twice daily. She said we need to him regulated and/so we can get him in for a dental cleaning. I am all for that after reading about the effect bad dental can have on the BG. She said yes we know he has the pancreatitis that can affect his BG. I asked what she thought about testing for acromegaly and IAA. She said if we can't get him regulated on the Vetsulin then we can consider that as the tests are very expensive. She is just out of the Vetsulin but will receive more by the weekend. I need to pop over to the Vetsulin forum and do some reading. Should I continue with another +0.5 increase to the 6.5u on Wednesday?

Tom vomited this morning at +5 (I believe) because adult kids were not up to feed him - definitely ordering the auto feeder this Friday as we are not going to make this a habit! He had some fancy feast broth and then some cod/sole/shrimp to be sure he ate. Next he had some constipation and was actually grunting to poop which the poop was very large I was told. What could cause this? Did I supposedly over feed him again on Saturday's curve?
 
but discussed changing his insulin to Vetsulin and starting off with 1u twice daily.
Did she explain her reasoning for putting him on Vetsulin? And on a much lower dose? Yes, do go read the yellow info stickies on the Caninsulin/Vetsulin forum. Some cats do well on it but there are some important differences between it and ProZinc:
  • it tends to be faster in onset and can drop BG down more strongly (that might be where she's coming from)
  • it can have shorter duration than ProZinc - 8 to 10 hours as opposed to 10 to 12 hours
  • it can increase bouncing in bounce prone kitties because the BG can drop quickly and fairly low as a result of its stronger action.
 
If the constipation continues, try miralax 1/8-1/4 tsp once or twice a day. Put it in his food and add water. My cat has recently started having the same problem and that seems to work best.
 
Did she explain her reasoning for putting him on Vetsulin? And on a much lower dose? Yes, do go read the yellow info stickies on the Caninsulin/Vetsulin forum. Some cats do well on it but there are some important differences between it and ProZinc:
  • it tends to be faster in onset and can drop BG down more strongly (that might be where she's coming from)
  • it can have shorter duration than ProZinc - 8 to 10 hours as opposed to 10 to 12 hours
  • it can increase bouncing in bounce prone kitties because the BG can drop quickly and fairly low as a result of its stronger action.

No she really didn't. I said I thought we were talking about the lantus or levemir but I don't remember her response ...always quick conversation or visit, I tried to take a note (lucky I got down the name vetsulin). I called back to inquire about the cost since she last week she had said one of the other options was much more expensive. The tech said vetsulin is $58, I am paying $150 for the prozinc. I asked if it would be the same 40u needles but she didn't know. I really am trying to avoid unnecessary paid visits, but we are obviously going to have to talk longer and hopefully slower. I am gone from home approximate 12 hrs on weekdays so not sure how that 8-10 hr time frame could work. She did say we would need to take a curve at the start and when # drops below 300 to test every hour - I did neglect to do this on Saturdays curve.

Tom just vomited again :( we are at +1. Should I take his BG and/or give him a half a cerenia? I need to look to see if constipation is a side effect of cerenia.
 
No she really didn't. I said I thought we were talking about the lantus or levemir but I don't remember her response ...always quick conversation or visit, I tried to take a note (lucky I got down the name vetsulin). I called back to inquire about the cost since she last week she had said one of the other options was much more expensive. The tech said vetsulin is $58, I am paying $150 for the prozinc. I asked if it would be the same 40u needles but she didn't know. I really am trying to avoid unnecessary paid visits, but we are obviously going to have to talk longer and hopefully slower. I am gone from home approximate 12 hrs on weekdays so not sure how that 8-10 hr time frame could work. She did say we would need to take a curve at the start and when # drops below 300 to test every hour - I did neglect to do this on Saturdays curve.

Tom just vomited again :( we are at +1. Should I take his BG and/or give him a half a cerenia? I need to look to see if constipation is a side effect of cerenia.
I’d give him the Cerenia.
 
If the constipation continues, try miralax 1/8-1/4 tsp once or twice a day. Put it in his food and add water. My cat has recently started having the same problem and that seems to work best.

Thank you Sharon, making a note to pickup some miralax. It really is a strange thing, I kept asking the kid how was he grunting?
 
Thank you Sharon, making a note to pickup some miralax. It really is a strange thing, I kept asking the kid how was he grunting?

My cat grunts when he’s constipated too. The miralax has helped him. Unfortunately for my kitty I think he’s developing magacolon which many cats with acromegaly develop.:(
 
My cat grunts when he’s constipated too. The miralax has helped him. Unfortunately for my kitty I think he’s developing magacolon which many cats with acromegaly develop.:(
Aww poor Colin! I saw on the MSU form that the acro test was $58 but am assuming since the sample has to be sent cold that is why Tom's vet says it's very expensive?
also I saw your post on the caninsulin thread for the Abyssinian about the zobaline. Of course I forgot to ask the vet today about B12 shots, but is this relatively the same thing? Tom is not up on his toes as much lately, I know that with his breed his front legs are shorter than hind, but I keep thinking his hind feet are going down. Shawnee had said above that the B12 helped her kitty with the pancreatitis /intestines healing and with the BG regulation with prozinc. I'm sure it has multiple benefits, just have to remember everything sheesh.
 
Yes the cost of the acro test comes from the overnight cold shipping + whatever your vet charges to draw the sample. For neuropathy, the methyl B12 and folic acid to aid absorption is supposed to be best. You can find cheaper options, but be careful that there are no sugars (including artificial). Zobaline is easy because it’s made for diabetic cats, so no worries about ingredients or dosage, and it’s easily crushed and mixed in food. My vet recommended shots too, but I didn’t want to stick Colin any more than I had to.
 
Good morning everyone! Its been a long week and today could be the start of really regulating Tom's diabetes, we are hopeful! I spoke with his vet on Thursday after emailing his spreadsheet. She said don't increase Tom to 6.5, I said too late I did on Wednesday in hopes of a change (we didn't really see any). She advised on our starting the vetsulin at 1u twice daily and to let it get into his system for about two weeks, then we will need to get a curve on him. I let her know that I will still be doing AMPS & PMPS testing as well as mid cycle checks due to the fast onset of the vetsulin, she said if he will let me. :rolleyes: I am going to pickup a Relion confirm or prime this weekend and use both it and the AT2 for a couple of tests just to compare and have the data. We are also still thinking about the arthritis/joint treatment, maybe will try some cosequin capsules since he scarfs & barfs the glycoflex treats.

@Kris & Teasel i read the the yellow sticky on the vetsulin forum, good information! Also read the whole manufacturer insert... Scary stuff when they're talking about hypos in their clinical trials. We have compiled our hypo supplies in case *crossing fingers we don't have to use them*

@Djamila i ordered the timed feeder, it will be here tomorrow. I am excited to set it up so that Tom will not have to rely on the kids, and also so that he could eat during the night as he is usually so hangry in the AM. Do you have any tricks for keeping wet food portions cold until dispersion?

@Sharon14 i ordered the zobaline, vet had not heard of it but said ok if made for diabetic cats. Also have been giving the miralax at AMPS & PMPS feelings since Thursday pm. Tom had a few large hard pebbles in the litterbox last night but is still tight in the abdomen. It says it works in 1-3 days, this AM was 4th dose, so hoping to see softer stool soon.

I guess we will be heading over to the vetsulin forum, but want to thank all of you again for your help and advice in our journey to controlling Tom's DM :bighug:
 
If you lower the dose that much when you switch, please be sure to check daily for ketones. Also, add plenty water to his food as the miralax works by drawing water into the intestines. Good luck with the vetsulin.
 
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