New here -- looking for dosage advice

[DL&Snowball]

Hi, here is the background info about Snowball, our 11 year old male cat. He was diagnosed with diabetes the beginning of October after we noticed him losing significant weight. He was definitely overweight at 20+ lbs! He was probably diabetic for a number of months and had increased thirst over the summer, but we didn't realize the problem till he started losing weight. His initial BG at the vet was 343. We chose not to go the insulin route and she suggested a change in diet to all canned food, which we started immediately. Soon after that I discovered the Young Again Cat Food website and Snowball has been free fed the Zero Carb Mature food as well as a can of Fancy Feast Classic daily. He continued to lose weight however, and we went back to the vet in early Dec. His BG that day at the vet was 373. We purchased a Relion Prime BG monitor and started occasionally testing him at home. Numbers were usually in the 300's.
By the time we got through the holidays and he was continuing to lose weight, we decided to try insulin. In early January he was down to 10.2 lbs. The vet prescribed 2 U of Prozinc twice a day. I showed her the monitor we were using, but she did not really encourage home testing, and said we would be able to tell how he was doing by his thirst, urination, etc.
I've gained a lot of info through this forum and created the spreadsheet. We are generally only able to test mid cycle on the weekends, so I don't have a lot of nadir numbers. I am wondering if starting him at 2 U was too high, and if the 400's and 500 are a result of him bouncing? I tried reducing to 1.5 U but am not sure where to go from here. Any advice would be appreciated!
On a side note, Snowball has been acting great since when he first started losing weight. He's much more active than when he was so overweight. We are concerned because he's become skin and bones, but he seems happy for the most part. The other issue he has is difficulty moving his bowels. When he gets blocked up he hides under the bed and licks himself. It seems it's not so much constipation but the lack of muscle tone to push it out. Hoping this improves as he becomes regulated and gains some weight back. Is this common with a diabetic cat? Was occasionally giving him Miralax but the vet advised not to.

 

[Kris & Teasel]

The vet prescribed 2 U of Prozinc twice a day.

Our usual recommendation (backed up by many vets) is to start at 1 unit twice a day.

but she did not really encourage home testing, and said we would be able to tell how he was doing by his thirst, urination, etc.

You can see from your reading on FDMB that we're big proponents of home testing. Those clinical signs are too vague to base dose assessment on. I'm very glad you took matters into your own hands and are testing BG at home and have your spreadsheet set up.

We are generally only able to test mid cycle on the weekends,

That's fine. Just make sure to get a pre shot test every AM and PM. Cats can, and do, surprise us with their responses and you need to know that the planned dose is safe to give. On work days aim to get a before bed test every day. If your schedule permits an "in the door" test when you get home from work is good data too.

I tried reducing to 1.5 U but am not sure where to go from here. Any advice would be appreciated!

You're getting a decent response from 1.5 u but there is room to increase. I'd eyeball 1.75 u, not jump to 2 u.

I suggest you set up your signature so we have some key info at hand when you post here:

• click on your name in the upper right corner of this page
• click on "signature" in the men that drops down
• type the following in the box that opens: kitty's name/age/date of diabetes diagnosis/insulin you're using /glucose meter you're using/what he eats/any other meds or health issues he has.

That's a start I think!

 

[Kris & Teasel]

The other issue he has is difficulty moving his bowels. When he gets blocked up he hides under the bed and licks himself. It seems it's not so much constipation but the lack of muscle tone to push it out. Hoping this improves as he becomes regulated and gains some weight back. Is this common with a diabetic cat? Was occasionally giving him Miralax but the vet advised not to.

Constipation can be helped by feeding more wet food and adding water to it to promote better hydration. Too much dry food, even if low carb like the YA, will aggravate the problem. Many people here use Miralax regularly. Did your vet explain her objections to its use? Adding plain canned pumpkin in small amounts to his wet food can also help. I don't have experience so can't advise on amounts. Diabetes can cause neuropathy, usually seen as hind limb weakness but it could possibly be affecting his ability to poop. You could try giving a B12/folate supplement. Many people use Zobaline that can be bought online: https://www.ilifelink.com/zobaline-for_diabetic_cats-3_mg_x_60_tablets.html

 

[Djamila]

Hi there, and welcome! Kris has given you great advice already.

Miralax is perfectly safe for cats in proper dose, so if that was helping, I would resume it. Pumpkin can be given - it is a carb so be conservative with you. I've found that a teaspoon of it once/day doesn't seem to impact my cats BG. Every Cat Is Different (ECID) so you'll have to experiment and monitor BG levels to know for sure for Snowball.

And YAZ is well known to cause intestinal issues, so if there is a way you can get Snowball off of that, it will likely help. It's fine to free feed with wet food, so if Snowball is eating FF, I would start to work on reducing the YAZ and increasing the canned until it's gone altogether, or just used as post-testing treats in very small amount. Adding water to the canned is common around here since it helps with constipation, and keeping our cats well hydrated helps make testing easier (they bleed more easily when hydrated) and helps avoid ketone build up as well. My cat didn't like the extra water at first, so I just added a little more slowly over a few weeks until he now happily laps up his food with about 3-4T of extra water. Now he doesn't like it if it's not soupy enough!

 

[Rachel]

Hello and welcome! Yes, extra water would most likely help...even if the problem is he has a hard time just pushing it out due to muscle tone, I would think making the poop a little less hard would help make it slide out easier. Did the miralax help with that? A good idea for that is to get a water fountain to help encourage them to drink. Cats tend to not drink as much as a lot of animals so adding water to canned food helps get some in them and I found that my cats are more likely to drink at a water fountain. It keeps the water fresh for them (and provided a fun toy when it first arrived and they couldn't figure out what was going on!).

 

[DL&Snowball]

Thanks everyone! Yes, we add water to his moist food and he does drink quite a bit of water from his bowl. The vet said that the Miralax could cause the red blood cells to rupture. From everything I had read online, it seemed safe for cats. He actually first started having trouble with constipation even before we started the YA food, although he would have been having dry kibble back then. We'll see how he does with increased moist food and less of the YA.

So when I test for the pre-shot, is it important that he hasn't eaten for 2 hrs prior? I don't think that's an issue for the 7 am test, but he's always begging for food around 6 pm, so he has food in his system prior to the 7 pm pre-shot test. Also, how should I adjust his dosage according to the pre-shot BG numbers?

 

[Kris & Teasel]

Also, how should I adjust his dosage according to the pre-shot BG numbers?

We generally keep the same dose AM and PM unless the pre shot BG is much lower than usual. The PS is tested in order to determine whether it's high enough to support the planned dose. We look closely at how low a dose had dropped the BG in order to assess the dose.
This gives a good overview of ProZinc is dosed: http://www.felinediabetes.com/FDMB/...prozinc-pzi-insulin-for-diabetic-cats.164995/

always begging for food around 6 pm, so he has food in his system prior to the 7 pm pre-shot test.

It's best to withhold food for 2hours prior to the PS test so that the BG isn't food inflated. If his hunger causes him to be squirmy and reluctant to allow testing give him a couple of teaspoons of his wet food right at PS time and test him immediately. It takes a good 15 to 20 minutes for food to get into the bloodstream.

 

[Djamila]

Snowball is so pretty!!! I was looking forward to seeing your picture when I saw his name . I love white cats.

Adding to the new things to do....as much as possible you want to get a before-bed test. Even if it's just +2 or +3, anything you can get at night helps. Or if you go to bed right after shot time and can get a +8 or +9 when you wake up, that can help too. Cats often run differently AM and PM, so whatever you can do to monitor both cycles is helpful.