? Need Help/Advice

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Kris & Teasel

Kris & Teasel

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Hello all,

I've been lurking here since late January 2016 when my cat, Teasel, was first diagnosed. He was on Lantus at 1.0 units BID for 2 months (unsuccessful - huge deltas, bouncing, then high flat curve, no ability to fraction dose properly), suffered an $$$$ DKA at the end of March 2016 and has been on ProZinc since the beginning of April 2016. I've been working hard at getting him regulated through bouncing episodes and insulin resistance due to glucose toxicity. I'm doing home testing (Alphatrak 2 meter) but not according to the FDMB suggested protocol - that will change. My vet has been as helpful as she can be but I need more "handholding" now that we seem to be getting somewhere. Here's the general outline:

  • He began at 1.0 unit of PZ twice a day and has worked up to 3.6 units twice a day - probably needed to clear longstanding glucose toxicity.
  • I use U100 syringes so that I can change doses by small fractions.
  • His daily routine is very regular: he eats only low carb wet food (DM pate and a little Fancy Feast or Friskies low carb) in set amounts at scheduled meal times. I have 2 other cats so no free feeding.
  • He's been on 3.6 units BID for almost 3 weeks, getting tested occasionally, had one full BG curve done by me 2 weeks ago. This showed good duration, a nadir of 4.4 (79) at +6, and an average BG over 12 hours of 11.8 (212). Delta was a bit high at 12 (216).
  • Yesterday he was in some very good numbers most of the day, ranging from 5.7 (103) at +3 to 7.3 (131) at +11. However, his +4.5 value was too low (2.9 on AlphaTrak - 62 in your units). Because he was only at 7.3 (131) at +11, I fed him, waited an hour, tested and saw a value of 11.9 (214). I gave him a slightly reduced dose of 3.2 units but wasn't confident about this. I tested at +1 after this dose and it was 16.4 (295). At +4 it was 11.6 (209). Crossed my fingers and went to bed.
  • When I tested him before feeding/shooting this morning his AMPS was 6.9 (124) so I withheld his injection, as per the ProZinc "protocol". I'm hoping his insulin needs are dropping but don't feel confident to navigate this territory. I need some coaching. I also am a newbie at posting on a forum, setting up a spreadsheet, etc.
  • It is now 2 hours post a.m. feeding and his BG is 15.2 (274) with no a.m. insulin given.
 
Hi and Welcome!

First, if you haven't, take a look at the protocol we put together for ProZinc. It is in my signature in blue.

It does look like he has started responding well to the insulin. Since your 3.2 units last night gave you an unshootable preshot this morning, I'd consider lowering the dose a bit more. You could shoot now - two hours after he ate - and he is high enough and far enough away from the time he ate. But it would mess up your schedule, causing the next shot to be 12 hours from now. If that is a possibility, you might try 2.6? I am thinking 3 units might still be too much...It is easier to raise a dose if it is too low than try to figure out how much to reduce if the dose is too high.

If you need to maintain your schedule, I'd say wait till tonight. He should be high enough to shoot early tonight (an hour early is acceptable with ProZinc). He is likely to be high, as he will have been 24 hours since the last shot, but I'd still reduce.

Looks like you have done great, working your way up till he "broke through" and now need to maneuver your way down.

The spreadsheet is a little tricky. Be sure to go with the World version so your ranges will convert. Instructions are here:
http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

If you need help, just ask.
 
OMG, Sue, I'm so glad you replied so quickly! I follow your comments religiously since Teasel has been on ProZinc. Yours is a voice of experience, calmness and reason and I need that right now. Yes, I think we've broken through the glucose toxicity ceiling? floor? It's easier for me to keep things on a regular schedule so I'll wait until tonight and go with my usual p.m. dosing time. I know he'll be too high and I hope that doesn't set us back too far. I'd like to try 2.6 units this evening. What do you think?

Meanwhile, I'll test him periodically through the day and continue wrestling with the spreadsheet. I'm using the World version.
 
Hi Kris (is that your name?) and welcome to the forum!!
we'll anxiously await your spreadsheet - you do want to avoid having to skip too many doses with the history of DKA
I see Sue did suggest 2.6
where are you from? Teasel is beautiful
 
Hi Carol,

Yes, my name is Kris and I live in Canada. Teasel is 6 years old and is one of 3 littermate kittens I took home as my "gift with purchase" (as I call it) when I bought my horse from Teaselwood Stables near here. The other boy cat is Woody and their sister is Meadow. They are simply the best!!!

I've succeeded in entering the data I have on a World version SS and have saved it on my iMac desktop. I've just noticed that the link to Teasel's spreadsheet has appeared at the end of my messages. Hurray! I've been at this for 2+ hours. I hope someone has time to have a peak. I'll definitely be giving him his shot this evening because I worry about DKA. I think I'll follow Sue's suggestion of 2.6 units. Any other advice? No -I have tried putting a Ketostick under him when he pees ...
 
Spreadsheet looks great!

Oliver would never let us watch him pee. We got a sample by filling a clean box with aquarium gravel and leaving him in a room with it. He'd have to "christen" the clean box and we'd swoop in to get a sample.

Other people have had success with sticking a ladle under the cat as they pee.
 
Hi Kris Where in Canada (just so we know your time zone)
Your spreadsheet works great - there are a few amps and 1 pmps numbers that are missing (says value) It is important to be able to test for ketones
If urine is a problem, there are meters using a drop of blood that measures ketones before they show up in the urine @Bobbie And Bubba has one
 
Hi Carol and Sue,

I'm in Ottawa, Ontario, so Eastern Time on DST right now.

Yes, I know there are couple of missing AMPS and PMPS. That's because today was the first time I did an AMPS. My vet wasn't telling me to do that on BG test days, only to test shortly after feeding and shot. I was trying to follow her recommendations while keeping an eye on FDMB. I now have "gotten religion" so to speak because we seem to be treading that knife edge of better numbers requiring a drop in dose.

I'll start by trying some aquarium gravel in a clean litter box to test for ketones and might invest in a meter. I don't want to invite any litter box avoidance issues.
 
Kris - I understand trying to keep the vet happy - but most people find that the vets soon realize that you know what you are doing in regards to dosing -
Good luck with the aquarium gravel - I don't think Murphy would go for that
 
Not surprised to see a high value just now (20.9 or 376) because his last shot was last night about 16 hours ago. I'll just grit my teeth and wait until this evening's dose. Will try 2.6 units at that time and hope for the best. Teasel is a cat that usually rebounds easily from low numbers (until recently) and then gets stuck at high values when his BG is elevated too long. I hope a dose reduction won't plant him in that territory. Any comments are welcome.
 
Hi Kris, if you are unsuccessful with getting a urine sample ( I had a hard time of it) I bought the Abbot Precision Xtra Ketone meter. It's not very expensive, maybe 35 bucks but the strips are pricey. The best place to purchase the strips are from Universal Online Pharmacy there is Canada. If you decide to use one and need help, just tag me. Welcome to the Forum!
 
Hi Kris! Welcome to our little forum! Since you've been lurking you probably already know but if you ever have an emergency we suggest posting here and on Health. We're a small group and you'll get more eyes that way. I like to give that disclaimer just in case...

2.6 makes sense to me. He is going up but that makes sense with no insulin. With 3 bringing you that unshootable number today, I'd still reduce tonight in hopes it will give you a good number that you can still shoot tomorrow.
 
Hi Kris, welcome with your beautiful kitty Teasel.
You are doing great so far, not even with any help since the beginning off Januari, good for you!
Indeed I would also reduce the dose because if a kitty shows a preshot number that isn't shootable, he/she deserves a reduction! GO Teasel!
We are all here to help you if you need some tips or advise :bighug:
 
To all of the kind people who have responded so far: thank you so much! I felt quite stranded and a bit desperate this morning, having to think my way through this phase of Teasel's journey. That's why I finally decided to become a member of FDMB, start his spreadsheet and ask for help. I'm not that comfortable "going public" but this is a great group.
 
Hello! I'm new here and new to FD - so you sound very experienced to me. I'm not sure if this will help. But after having 1-2 hour stand offs at the litter tray (it was like high noon) o_O I ended up doing it the easiest way I could find.

I placed cling film over the clean litter and kitty obliged within minutes, as soon as I heard her start scraping ( was in the next room) I went out the wee collected in the cling film and I just dipped the stick in. My kitty is really fussy about litter and how it feels under her paws so I was surprised when I got no protest and she kept her dignity.
 
Hi Tara,

Thanks for this tip. It could be tricky because Teasel shares a huge litter box with his brother and sister. Maybe I could set up a smaller one for him in the bathroom while he's eating (I separate all 3 for feeding and that's "his room") in case he's willing to use it with cling film over the litter.

BTW, you're doing amazingly well with your kitty Tempest considering that you're so new to this game. Congratulations! I totally understand the nerves you experienced in deciding on dosing when kitty's BG is low. I'm there now with Teasel and it's a nail-biting time for sure.
 
krisu said:
Hi Tara,

Thanks for this tip. It could be tricky because Teasel shares a huge litter box with his brother and sister. Maybe I could set up a smaller one for him in the bathroom while he's eating (I separate all 3 for feeding and that's "his room") in case he's willing to use it with cling film over the litter.

BTW, you're doing amazingly well with your kitty Tempest considering that you're so new to this game. Congratulations! I totally understand the nerves you experienced in deciding on dosing when kitty's BG is low. I'm there now with Teasel and it's a nail-biting time for sure.
Click to expand...

It's not much but it might be worth a try :) my old boy was great I just set down an empty clean tray for him and he would just climb in and oblige with me standing there. If only Tempest was the same lol

I think your plan to put a tray in the room he eats and keeping him in there for a while would work. Especially if it's in the morning time as I find they are more willing to go then but every cat is different.

Thank you! I'm even more anxious than normal at the minute after losing my old cat just before new year and my dog is not well, she's a cavalier King Charles and has a heart problem, she also old for a cav so the vet said she could go anytime. I really couldn't cope if I ended up losing them all this year. That would be my entire family gone (well the furry ones that live with me).

You seem like you are doing really well too! :) And your kitty is beautiful! She reminds me of a cat I knew 25 years ago called suzanna. She lived to 29 I think it was. She was boarded at the vets I worked at (when I was in school during the holidays and weekends.) she was one of my most favourite kitties to look after as she was so affectionate! Ahh the nostalgia. I hope Teasel lives as long!
 
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