New here. Diabetic since May 2015 Need Advice

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Damsel

Damsel

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Hello;

I have posted an introduction post and now am not sure how to start here. I have so much to say and don’t know how to present to you 1 year and 4 months worth of history in a concise message. Until I can get my spreadsheet converted to yours, I’m going to zero in with the chain of events since starting ProZinc at the end of August.

I have two cats; one is diabetic, Morgan.

He is 8 years old, (very cute and sweet), diagnosed last year, May of 2015. Started on Lantus, went up to 7 units; rarely got out of the 300’s. Numbers hardly changed and in August started going into the 400’s.

Started ProZinc on August 29, 2016.
He has never been regulated. I'm told he is a "healthy diabetic". Has had full blood work done twice, last in November, 2015.

Since diagnosed, I have tried relentlessly to convert him to wet food. He refuses no matter what I’ve tried. For the past year, I would put 45 minutes into many mealtimes sprinkling freeze tried treats, toppers, anything healthy to entice him. He is not interested. He is eating Young Again Zero mature. Daily, I continue giving him some canned foods. Occasionally he licks or actually eats about a teaspoon of canned food (Nutro soft chicken loaf).

I'm desperate for guidance. My vet wants me to increase to 3 units again, but we had an incident last week and I need advice before I do something my non-diabetes-educated instincts are telling me not to do.

On August 29, 2016, my vet converted Morgan from 3 units Lantus to 3 units Prozinc.
First off, I test at home. On 8/29, Morgan’s BG started at 440. The next three days, it started coming down. On 9/2, I did a preshot test: 159. I didn’t want to give a shot. The vet told me two hours later to drop down to 2 units and still give a shot. By PM shot time, he went down to 101. I did not give a shot.

The next morning on 9/3/2016, preshot test was 230 - Gave 2 units .

By evening shot, preshot test was 400. – Gave 2 units.

The next 3 days, the preshots for AM/PM were: 314/208; 171/191; 233/195.

On 9/7/ his 7:00 AM preshot was 63. I did not give a shot and called the Vet. The vet wanted me to test every hour and report back to him. Next hour, 8:30AM BG was 71, then at 9:30 it was 113. Per the vet, gave 1 unit. Same day BG result at 2:37 pm BG was 304. Vet said we should have stayed with 2 units even though his BG was 63. Two days later, AM Preshot BG was 395; went back to 2 units. Vet told me not to test for two weeks. He said I was going to drive myself crazy. (Too late for that.)

Sept. 21, 2016; preshot was BG 395. Vet told me to go to 3 units. This is when the incident occurred. I could kick myself for not doing a preshot, but on 9/22/2016, AM and PM shot times, I gave 3 units. Around 11:00 PM, I realized Morgan hardly ate anything (after eating like a mad man for weeks, I wasn’t really checking). He was very lethargic. I tried putting food in front of him and he wouldn’t even look at it. He was lying down, but with his chest and head upright. I took BG, it was 124! (The way he was acting, I was afraid it was 30.) This is three hours after his PM shot. Long story short, he was ok; I kept an eye on him. He woke up normal. I had to play games with his food, but he ate more than the day before. Preshot BG test that next morning was 178; I went back to 2 units. BG later that day at 2:00 pm – 216. Next day preshot BG test was 473 and has stayed in the 400’s.

Now, my vet wants to go back to 3 units. He wants me to do preshot tests and 1 mid day test (as of yesterday) for the next couple of days and report back to him.
I haven’t increased the dose from 2 units because I’m afraid he will have another “episode”. What does all this bouncing of his BG mean? It looked like finally, his numbers might actually come down and I was hoping, stay down, but instead they’re higher than ever?

Thank you.
 
Hello and welcome! There are lots of friendly people on here who can give you dosing advice and I'm sure given time and patience you will get kitty regulated! :)

I have a question mostly out of curiosity :) when you give your shots they are always at the same times? 12 hours apart?
 
Hello! I've been patient for 1 year and 4 months and keep renewing my patience daily! :bighug:
Yes, shots are at 7:00 AM and 7:00 PM. I have been very diligent about being on time. He's worth the stringent schedule.
Thank you!
 
Damsel said:
Hello! I've been patient for 1 year and 4 months and keep renewing my patience daily! :bighug:
Yes, shots are at 7:00 AM and 7:00 PM. I have been very diligent about being on time. He's worth the stringent schedule.
Thank you!
Click to expand...

:bighug: I really do belief if you follow the advice on here you will see big changes - the folks on here helped me and Tempest was in remission in 4-6 weeks so I have every confidence in the advice given. Hoping you find the same even if it takes a bit longer than me.
 
Hi and Welcome!

It does seem like the ProZinc works to bring down his levels, which is great. But it seems like he is bouncing all over from highs to lows. Bouncing is when their body perceives a blood glucose level lower than it is used to and releases extra sugars to bring the level up. Then the next test, and sometimes the next cycle is higher than it would have been, without those natural sugars. Sometimes they clear a bounce in a cycle, sometimes it takes six cycles.

And anytime you get a nadir 50 or under on a human meter or 68 on a pet meter (5-7 hours after the shot) it is a good idea to lower the dose. If you get a pre shot too low to shoot, because of a longer than usual cycle or a low nadir and a slow rise, it may be wise to drop the dose.

If he were mine, I think I might do a restart with one unit. Get a pre shot test always and a nadir when ever possible. Hold the dose for a few cycles and see what he looks like over time. If his pre shots are in the 300s and his cycle is sort of flat, increase by 0.25 or 0.5 on a cycle when you can monitor. Slow increases may give you a better picture of how the insulin works for him. If you want, post here daily and give advice on your dosing.

And I would set up a spreadsheet so we can really see his numbers. It is so easy to see the patterns when they are in the color coded sheet. Here are the directions:

http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

Take a look at other people's spreadsheets and see how they are dosing. Have you seen the Protocl and Beginner's Guide for ProZinc? They are in my signature in blue.
 
I'm with Sue. I'd do a restart an see if we can get in better numbers. We generally increase in smaller increment s so it may be that you've jumped past the ideal dose.

We'd love to help! Let us know what questions you have. :)
 
TempestsMum said:
:bighug: I really do belief if you follow the advice on here you will see big changes - the folks on here helped me and Tempest was in remission in 4-6 weeks so I have every confidence in the advice given. Hoping you find the same even if it takes a bit longer than me.
Click to expand...

Thank you, Tempests Mum. That is a great testimony and it definately gives me hope! When Morgan's numbers went into the 100's and then 63 & 71 so early into changing insulins, I felt we were on the right track.
I'm very happy for you and Tempest. I'll fall over if we have such a happy result! Thank you too, for the well wishes!
 
Thank you, Sue and Oliver, and Rachel for the advice. I read your comments last night, so this morning, I took a pre-shot. It was 342.
Then, per your advice, I lowered Morgan's dose and gave him 1 unit.
I don't have a lot of time today or tomorrow, but I will work on learning the lingo and download, learn and transfer my numbers onto your spreadsheet.
Do I continue to post results and my spreadsheet here in this thread?
Thanks again for everything. I feel like a weight has been taken off my shoulder.
 
I can't access your apreadsheet. It takes me to goggle drive. When you get it set up, choose Share with Anyone with the Link. Then Publish to the web will give you an URL. Copy it and paste it in your signature.

Yes, continue with this thread until you get things set up. Then, if you want, post daily with his numbers. You can do that on a single thread until it becomes too long, or start a new thread daily - your choice. If you ever need help right away, post here and on Health with a title that tells what the issue is and what you need.
 
Sue and Oliver (GA) said:
I can't access your apreadsheet. It takes me to goggle drive. When you get it set up, choose Share with Anyone with the Link. Then Publish to the web will give you an URL. Copy it and paste it in your signature.

Yes, continue with this thread until you get things set up. Then, if you want, post daily with his numbers. You can do that on a single thread until it becomes too long, or start a new thread daily - your choice. If you ever need help right away, post here and on Health with a title that tells what the issue is and what you need.
Click to expand...

Hi Sue and Oliver;
Thanks for the response and information. Not sure what I'm doing, but I made a second attempt; hopefully, this time it was a success.
Next challenge will be finding it again and transferring my data.
 
There it is! Great job getting it set up.

It looks like 2 units may have been a good dose for the higher preshots but maybe too much for the lower ones.

It may be that one unit isn't enough but it's hard to tell without the that midcycle number. If he was high and flat, then the dose needs to be increased. If he dropped in the middle, the black could be a bounce. Can you get a curve this weekend? That's when you get a test every 2 hours. That would let you know when he starts to drop and how much. If he needs an increase, then we suggest increasing by 0.25, hold 3 days or so, getting a nadir whenever you can.

This process is about gathering data and interpreting it.

In general, we think a cat is regulated in they are in the mid 200s at preshot and low 100s or double digits at nadir. But not below 50 on a human meter or 68 on a pet meter. That's the first goal. Then you start to fine tune the dose.
 
Thank you, Thank you!
I work from home, so I'll do a curve tomorrow and post the numbers as I go along.
I never knew what conditions needed to be met to be regulated; now I know thanks to you!
Your guidance is really appreciated.
 
Hello;
Did the curve yesterday. AM presot 321; 401, 381, 443, 393, 336 PM preshot 428.
This morning's preshot was 363. It's on the spreadsheet. So, I guess I should stick with 1 unit and monitor for a few days?
 
That is pretty flat and high. How about increasing to 1.25 and be sure to get a nadir? My thinking is that past cycles two units looked a little too high, so maybe somewhere between one and two. Start with 1.25 and then if not much movement after a couple days, 1.5

Great job on the curve!
 
Thank you. Doing a curve on a work day makes for a very busy day!

OK. Tonight I will increase to 1.25; I will try to get a nadir this weekend; if not, then Monday.

Thanks so much for your help!!!!!
 
The safest way to increase is to do it on a cycle you can monitor - at least get a few midcycle numbers. If you won't be around, I think I'd wait to increase on a cycle when you are.
 
To make sure I completely understand, you're saying I shouldn't increase unless I can get an afternoon BG. I give his shots at 7:00 AM & PM, so I shouldn't increase the insulin unless I know that day, I can take his BG around 1:00 pm?
Also, not sure I understand what defines a cycle; a 12 hour period from the AM shot to the PM shot?
 
Yes a cycle is a 12 hour period from one shot to the next
Sue is saying that it is safest to increase when you will be available to get an afternoon test - or how about on a Saturday night, you could shoot at 7pm and get a test at midnight or 1am? Would that work?
 
Ok. Thank you. I assumed that was the definition of a cycle, but thought I should make sure.
I'll do the increase tomorrow morning and make sure I'm around for the afternoon test.
Thanks again!!!
 
Yesterday, Sunday morning, I increased the ProZinc to 1.25 units. Morgan's 7:17 AM Preshot was 392; at 1:45 PM, 315 and then evening Preshot was 415. This morning, his preshot was 437. I was so encouraged yesterday with the 315 nadir; then it went up. I'm still learning, but thinking this was a bounce from the 315. So, pursuant to your previous instructions I'm thinking I should stay with the 1.25 units for two or three days full days and then increase to 1.5 on Wednesday if the numbers don't come down.
 
I think that's a good plan. There could be a lower number hiding mid cycle somewhere that is causing a bounce. It'd be nice to know that. Just to be sure, could you try for some other numbers - maybe +5 during the day and a nadir at night sometime, before the next increase?
 
Yesterday's AM Preshot- 437; PM Preshot - 387; 5 hours out from PM shot: 362
Today: AM Preshot 363; +5 hours - 338; +10 hours - 340, PM Preshot: 369 - All on spreadsheet
Tomorrow AM, will increase to 1.5
 
Thank you for the responses! This morning's Preshot was 382 - increased dose to 1.5 in AM. Got BG at +8 = 317, PM preshot was 414.
These numbers are practically identical to October 2nd when I increased the does from 1 to 1.25. Hmmmm
(Oct 2nd was: AM preshot 392; +7=315; PM preshot 415)
 
Ok. Thank you. Your support is awesome! I haven't input all my numbers from May 2015; not sure it's necessary since we've switched to ProZinc on August 29, 2016. From May of 2015 until June 30, 2016, we never did Preshot tests so that data is unknown.
 
I think what you have on the SS is fine. History is important but you have a month or so on there already.
 
I know that it is hard to be patient, but now that you are on the board, he will be on the best path to regulation
The Young Again Zero Mature is very low in carbs - so while you do need to keep working on finding that magic wet food Morgan will eat to get more water into him, at least he is on a low carb food. My Murphy was dx 8/2015 and is still not regulated, but he is certainly healthier in many ways than he was pre-diabetes.
Hang in there :bighug::bighug:
 
Thank you Rachael. That's good news! Transferring that data would be alot of work, but if needed, I would do it.

Carol, thank you for the pep talk; I needed it. I checked out Murphy's spreadsheet; wow, his numbers certainly have improved! I'm waiting for that day. 1 year and 5 months of roller coaster emotions has been difficult. It definately helps encourage me to see my cat is not the only one struggling with numbers and that others were in similar circumstances and saw the light at the end of the tunnel!
Regarding food, I'll keep trying with the wet food. Lately, Morgan doesn't want to even lick the Nutro I give him at meal time, but then he'll eat his brothers food (Nutro & Fancy Feast Classic) out of his brother's dish (in another room). It's funny, but if Morgan feels good about eating his brother's food, so be it. I'll have to install a surveillance camera at the food dish to make sure poor Reilly gets his share of wet food because Reilly actually loves his wet food! Lol
Thanks again for all the support! Keeping my hope!!:cat:
 
Yesterday's AM Preshot was 384; PM Preshot, 346
Today's AM Preshot 343; +10 was 376 and PM Preshot was 359. This is at 1.5 units. I was unable to get more numbers. This is day 3 of 1.5 units.
 
I'll be in and out tomorrow so I could increase in the AM at 7:00 and check once or twice in the afternoon. Sounds like a plan.
Thank you!
 
Hello. I increased to 2 units on Saturday, 10/8/2016 and just was able to update my spreadsheet.
I was happy to see some 200's. Should I stay with 2 units for another day or two or increase slightly?
Thank you.
 
Ok. Thank you. I feel like I have a fairy godmother. I type our progress and presto, chango, I receive a response.
Thanks so much for being there!!!!!!!!!!!!!!!!!!!! I will increase.
 
Thought I'd give an update. I just updated my spreadsheet. Did a "curve" on 10/20 and was thoroughly discouraged with the numbers. Morgan is back to the same pattern of stagnant numbers like he was with the Lantus. My vet called me on Friday saying he was leaving for vacation for a few days; he wants to discuss Morgan's situation with the other vets in his clinic for the next best course of action. Morgan is losing weight and is giving me a really hard time about eating his young again zero food now. He was eating a little of the Nutro and Fancy Feasts, but isn't bothering with the wet again (nothing new there). All he wants is his EVO dry food which I've just been crushing and adding over his YA food to get him to eat, but he doesn't fool easy and will only eat a few EVO covered YA kibble and looks at me and cries. When I give him 2-3 EVO kibbles; he gobbles them down. I know the EVO used to be "pretty good" for a dry food, but then the carbs went higher. The EVO will increase his BG, but at the same time, he lost 1.5 pounds since 10/14!

I increased his insulin .25 on 10/21 and honestly haven't checked his numbers. He's starting to run from me when he sees the dish with test "tools" and I feel like I hate making him go through this when nothing seems to change his numbers. His numbers haven't changed in 1 year and 5 months. Coming out of the gate with the ProZinc made a difference initially, but now we seem to be in the same pattern.

My Vet said some cats and dogs are just resistent to insulin. He said that he has, in the past, mixed insulins. He said they referred to that as a "cocktail". I think he returns to the office on Tuesday, so I'm waiting to see what he has to say.
 
I would get more aggressive with the dosing, if he were mine. But to do this, you'd need to test enough to keep him safe. Are you giving him a treat he loves every time you test? That is usually the secret to testing.

You can increase by 0.25 every six cycles. His numbers aren't awful. They just need to drop some. But I wouldn't do it without regular testing.

We generally don't think of high dose conditions until the dose is increased to 6 units or so. I have never heard of an insulin cocktail - it sounds like a volatile idea. Sometimes a vet will use R insulin in addition to the usual insulin to bring down very high numbers, but only temporarily, usually very carefully and usually only in an emergency situation in a clinical setting.
 
Hey there, so sorry that Morgan is running from you at test time. Have you tried a low carb poke treat to entice him a bit more? Poach chicken or YA makes zero carb treats that my gang ( dogs and cats ) love! It is so important to be testing because you never know when they are going to decide to drop like a rock.

It would be really helpful if you can get some night time test in as Morgan could be going much lower at night ( a lot of cats do) and then bouncing upwards for the AMPS. Tests that would be really helpful would be to get a +2 to see how active the cycle is going to be. If it's the same number as the PMPS or lower then you'd need to test more to keep him safe. And a before you go to bed test would be great information also. If those numbers looks the same as the daytime cycle then insulin resistance could be a factor here.

Perhaps what your vet was talking about was for you to use a short acting in/out insulin like Novolin R along with the Prozinc to help pull down the numbers. But, you would want to have guidance with that as it can be dangerous if given to high of a dose and bouncing could get worse. I used it with Bubba along with Lantus and had the guidance of two people in Lantus that are very knowledgeable using a bolus insulin.

See about some more night time test too to fill in the pieces to the puzzle.
 
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Thank you Sue and Bobbie. I never thought about giving him a treat at test time; he likes the dried chicken and turkey treats so I'll try that. Neither cats like the YA treats unfortunately (I still have an entire bag).

The weight loss has me very upset. He's been great up until lately. His weight was around 15 pounds pre diabetes; went to 19 pounds when getting 7 units of Lantus and as his dose went down (because his numbers were not changing), he slowly lost that weight and looked great for a while. Now, he's starting to look thin at 13.4 pounds. He is a big, long cat. He weighed 14 pounds when he was 2 years old. He is now 8.

Ok. I'll test him tonight and try to pick myself back up and stay positive.
Bobbie; did the dual insulins reduce Bubba's numbers? How did that work?
Thanks again for your help.
 
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