Need Help in Regulating PZI!

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kdamav57

Member Since 2014
Hi all,

My name is Kelsi, and my 11 year old tabby cat, Leo, was diagnosed with diabetes about one month ago. However, this is not his first DM diagnosis. He was actually diagnosed with Diabetes about two years ago, but after a change in diet to all wet food and after about 2 weeks of NPH insulin treatment (2units BID), he went into remission and his blood sugars evened out. About a couple of months ago, unfortunately, I started noticing he was losing weight despite eating very frequently. One day last month, he stopped eating all together and was acting very lethargic and weak. I freaked out and took him to the vet. And as I had started to suspect, his blood sugar was in the 400's, and he had diabetes again. :( I am now trying to regulate him, yet it is very hard. I switched over from NPH insulin to PZI because the NPH was not lasting him the full 12 hours between blood sugar checks and insulin administration. However, I can't seem to get him regulated- now matter how hard I try! I need yall's help please! I attached a spreadsheet with some recent blood sugar #s. He is always in the 400-500's by the time I check him 12 hours later. I did a glucose curve two days ago and attached the results. Also, if yall could help me with what times I should be feeding him, maybe that will help me regulate his sugars. He eats only wet food- Fancy Feast Classic cans. I am feeding him now about one can 2-3 times a day- about 30 minutes after AM bs testing and insulin administration and about 30 minutes after PM bs testing and insulin administration. I also feed him about 6-7 hours (nadir time) after the AM testing time for a snack. He is ALWAYS hungry and follows me around the house!

Any help would be greatly appreciated. I was hoping he'd go into remission again like last time, but his blood sugars only seem to be getting higher. :( As you can see in my spreadsheet, I have tried different PZI doses but nothing seems to be working..

Thanks so much,
Kelsi and Leo
 

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Hello Kelsi and Leo, and welcome to FDMB!

I think your insulin dosage is actually too high.
You're getting some low numbers there mid-cycle. (And if Leo has dropped lower at times than the numbers in your data then he may well have dropped into hypoglycemic numbers.) Then Leo is 'bouncing' up from those low numbers.
What blood glucose meter are you using? Alphatrak or a 'human' meter?

'Bouncing' or 'rebounding' happens when the blood glucose drops too low or too fast, or both.
"Too low" doesn't necessarily mean 'hypo low'. It can just mean that the blood glucose has dropped too low for the cat's current comfort level. (Cat's get used to high blood glucose levels and can need to re-learn what is normal.)
Bouncing also happens when the blood glucose drops too fast, and Leo has had some pretty steep drops at times.
When the BG (blood glucose) drops too low or too fast the body can respond by putting out more glucose into the system. It can also release counter-regulatory hormones the purpose of which is to keep the blood glucose high. This causes temporary insulin resistance. When that wears off the cat once again becomes responsive to insulin, and, if the dose is high, can drop a lot, and fast too.

I would say more but have to make this reply short because I'm about to dash out. Sorry about that.
But, in a nutshell, I really think the dose needs to be reduced.
How did you arrive at your current dosing? Was 3 units the starting dose? Or did you start lower and work up?

Eliz
 
Thanks for the help!

Eliz, I am using a Relion meter from Walmart. It's working great. I started off originally with 3 units BID per the vet's recommendation. Today, I reduced the dose to 1.5 units BID. I will let yall know the results. Hopefully it helps get Leo more regulated. I'll post a new spreadsheet tomorrow or Sunday.

Thanks again for the help
 
Elizabeth,

No, things aren't going so well. I am still having so much trouble regulating Leo. See my attached flowsheet- I added in the results of the last few days. I tried lowering the dose to 2 U PZI, but it seems like he's still dipping too low then bouncing back up. I just now tried to reduce him to 1.75U, hopefully that'll work. We'll see. My flowsheet is kind of a mess. Sometimes he's too low to even give any insulin, and I have to wait until AFTER the 12 hour mark, but sometimes he gets too high too quickly, and I'll have to give him a shot early. You'll see this in my flowsheet. For example, yesterday, I gave 2 units later on in the day because he was good in the morning, but he stayed good until +22 hours later! I don't understand how that works. I am so confused...

Would appreciate any recommendations or help!
~Kelsi
 

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[Glucose reference ranges are unsubstantiated and have been removed by Moderator]

* * * * * * * * * * * * * * *​
Examples of using the chart:

Ex. You are a new insulin user and you test your cat before giving insulin. The test is 300. It probably is safe to give insulin.

Ex. You are an established user of Lantus, following the Tight Regulation protocol. You've tested around +5 to +7 to spot the nadir. It is 200 mg/dL. You probably need to increase the dose, following the instructions for the protocol.

Ex. Your cat is acting funny. The eyes are a bit dilated. You are concerned and test the glucose. The number is 35 mg/dL. ACK! The cat may be in a hypoglycemic state. You quickly follow the HYPO protocol linked in the glucose reference values chart. (which we really, really, suggest you print out and post on your refrigerator.)
 
Hi Kelsi,

kdamav57 said:
I tried lowering the dose to 2 U PZI, but it seems like he's still dipping too low then bouncing back up. I just now tried to reduce him to 1.75U, hopefully that'll work.
Click to expand...
Well done for lowering the dose! I think the dose may still be a tad too high though overall, and see that you have already made attempts to lower it further sometimes. (Incidentally, were all the 1 unit doses given at +8 in the cycle?)

Yes, it does look like Leo is still dropping low (and fast) and then bouncing.

I'm wondering too if he actually reaches nadir (lowest number of the cycle) quite early in the cycle (maybe +4 - +5) but it's hard to be sure given the amount of data.

Some folks use food (a small snack) early in the cycle in order to slow the drop, and possibly also reduce the amount of the drop. (This is a fairly common practice with the faster-acting insulins such as Caninsulin/Vetsulin). Giving a snack a couple of hours into the cycle could help to slow Leo's BG descent and flatten out the curve a bit more. It might also reduce some of the bouncing.
If you are not able to be at home to give a snack you may find a timed feeder helpful...?

kdamav57 said:
Sometimes he's too low to even give any insulin, and I have to wait until AFTER the 12 hour mark, but sometimes he gets too high too quickly, and I'll have to give him a shot early....
Click to expand...
By using food to slow the drop, and by further reducing the dose, you might find a dose that you can give 12 hours apart (but there are no guarantees).

And regarding dosage, some of us use sliding scale dosage (based on the cat's preshot number) rather than fixed dosage. (I've always used sliding scale for my cat.) And that might be something that you could consider in the future if Leo's blood glucose patterns warrant that.

kdamav57 said:
...For example, yesterday, I gave 2 units later on in the day because he was good in the morning, but he stayed good until +22 hours later! I don't understand how that works. I am so confused...
Click to expand...
Are you saying that Leo went without insulin for 22 hours in good numbers (I couldn't quite follow the info in your chart)?
If this is the case then it may be that Leo's pancreas was producing insulin of it's own and, once the numbers were lowered, just 'picked up the ball and ran with it'... And this may also be the reason that Leo has been too low to shoot at +12 on other occasions...(although this could also be 'carryover' (effects lasting longer than the insulin's typical duration).
It would great to see more data, especially from the first few hours of the insulin cycle.

In a nutshell though I think that, at this stage, reducing the dose further may help, coupled with possibly giving Leo a snack of ordinary low carb food early in the cycle.
But let's see what others think...?

Eliz
 
I think Elizabeth is right on track - lower the dose, several small meals during the cycle. If you can get a curve sometime soon, that will give you a clearer picture of what is actually happening - when he starts to drop, how low he goes and when he starts back up. That should let you know if he seems to be bouncing.
 
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