New here & Pudge my diabetic kitty DX 12/17/11

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sophie

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Hi Everyone:

My name’s Sophie. My triplet cats now 10 yo (boy Pudge with blue eyes and long brown hair, his sisters Angel with blue eyes and fluffy gray hair and Spitfire green eyed with short black fur) and I live in Southern California. They were feral kittens rescued by my daughter in the wilds of Utah’s wintry mountains – no mama cat in sight.

Pudge, male, was diagnosed with diabetes on Dec. 17, 2011. Spent 3 days in the hospital (Dec. 14 – 17th) to confirm diagnosis, rehydrate and establish proper dose of insulin. His symptoms were: dull and flaking fur, peeing lots though not frequently, losing weight and starting to hug his water dish. Pudge is a big cat but overweight at 17 pounds 15 oz – vet thinks he should lose 3 – 4 pounds or weigh 14 to 15 pounds. All 3 cats had been on dry food diet with food always available.

Lab results for Pudge, 10 yo male (I have copies of the lab results):
12/14/2011
Albumin 4.0 (HIGH) Ref. Range 2.5-3.9 g/dL
BUN 40 (HIGH) Ref. Range 14-36 mg/dL
Glucose 435 (HIGH) Re. Range 64-170 mg/dL
Urine analysis Gluecose strip 3+ (HIGH), no ketones, no bilirubin
Fructosamine 586 (HIGH) Ref. Range 142-450 umol/L
No other illness.

12/17/2011
Glucose 71 Ref. Range 64-170 mg/dL

Vet’s recommendations on 12/17/2011 (brought him home @ 1:30 pm):
ProZinc insulin 4 units on U-40 twice a day, 12 hours apart
Hill’s r/d with liver & chicken mixed with his regular dry food
Bring Pudge back in one week for blood test (Mon. Dec. 26).

We bought ProZinc and a tray of Hill’s r/d cans from the vet. I had to call later to find out what time the am insulin was administered (told 9:00 am), gave us 5 U-40 syringes which got us through Monday, Dec. 18 night. By Sunday, we knew Pudge hated Hill’s food.

Vet’s recommendations and verbal only lab results from 12/26/2011:
Blood glucose 260 while normal value at max is 170
Fructosamine 430 while normal upper range is 450
Keep him on 4 units of ProZinc insulin
Make appointment for 4 weeks – if his blood glucose isn’t down we’ll consider increasing insulin.

For over a year, off and on, I checked my mom’s glucose and administered Lantus – though she didn’t have diabetes her levels had to be checked due to other conditions and meds. My daughter checked the internet and found info that cats’ glucose can be checked. Moreover, I got very concerned when I finally (!!) noticed that glucose of 71 from Dec 17 (reported by the lab to the vet's office at 4:00 AM) and Pudge on 4 units ProZinc! Switched to all canned Fancy Feast classic pate turkey or chicken, and treats to freeze dried rabbit since Pudge got sick on beef and liver.

We bought: ReliOn Micro with 30 & 33G lancets, triple antibiotic with pain relief ointment, BD insulin syringes 30G ½ inch (we know how to convert dosages of U-40 to U-100) and Keto-Diastix.

Have a problem with checking blood glucose: Pudge’s ears either bleed profusely –I hit a vein- or no blood. Pudge’s beginning to hate ear pokes. He’s a very strong cat who’s very loving but believes in immediate retaliation if you cause him accidental pain, though 2 seconds later all’s forgiven. Where else could I check for blood glucose? I don’t want to go the pads route due to litter box waste or other unsanitary surfaces. Any suggestions?

All 3 cats are now on all canned Fancy Feast pate (chicken or turkey since they hate liver and Pudge threw up beef pate) – I told the vet of this food switch

I lowered Pudge’s ProZinc insulin to 3.0 u on U-100 (or only 1.2 units of the vet’s recommended 4 units on U-40) which is what I use with ProZinc. I was scared of that BG of 71 on 12/17/11 on the 4:00 AM lab report while Pudge was alone in the hospital on a dosage of 4 units on U-40 which I later found out they administered at 9:00 am that same morning. I thought that was crazy though I don’t know what food they were giving him. They said he only ate at night when no one was around.

12/30/11 PM blood glucose 206
12/31/11 AM blood glucose 241 +6 =133 PM=415
1/1/2012 AM blood glucose=415 but this BG was taken 15 minutes after Pudge had 3oz of Fancy Feast classic
1/2/2012 AM blood glucose=389 so I got concerned and increased AM ProZinc to 5 units on U-100 (or 2 units on U-40 meaning half of the vet recommended amount). Pudge has a good appetite. Is this too much jumping around with the dosage? What would you suggest?

My questions:
1. Can blood glucose be tested other places than ears and between pads? Pudge even growls at the injections and, yes, he growls and does not hiss! He’s an immensely strong cat.
2.I would like to support his pancreas with smaller meals. How does such schedule work with the necessary blood glucose tests? I hate to inject blindly!! Pudge eats well, started to wash again, play some, skin’s less flaky and har shinier, pees less, poops OK.
3.Would he benefit by switching to Lantus? Why?
4.At what point should ProZinc dosage be increased / decreased and why?

Any comments and suggestions would be much appreciated. Many thanks for your time and I’m very glad we have found your forum.

Happy 2012!!!

Sophie and the triplets (older and not very computer literate).
 
Poopy and I welcome you to the best place you could have found for you and Pudge! cat_pet_icon

And, WOW! Your knowledge amazes me...Poopy was diagnosed the same day and I'm still trying to wrap my head around all this.

There's lots of folks here who can much better address your questions than I can, and I'm sure they will be responding soon.

Just wanted to say hi and welcome aboard!
 
Welcome Sopie and Pudge! Great job so far - you are way ahead on the learning curve.

4-5 units of Prozinc is a lot of insulin. We have had 2 cats who were on those sized doses from the vet come on with hypos in the last 2 days. Our method is to start low and go slow with dosing. Here is one of the threads: http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=59800

We start all cats at 1 unit twice daily and increase in small increments as the home testing indicates. I know it is going against your vet's advice, but I would start over at one unit. Test before each test and mid cycle to see how the insulin is working. If you get high numbers, you can always slowly increase. If you give too much, you can't get the insulin out of the cat after it is shot. Too much insulin can be a dangerous situation. Go over to our PZI forum. We have dozens of cats on PZI and none are on 4-5 units. Check out some of the threads and spreadsheets to see how they are doing: http://www.felinediabetes.com/FDMB/viewtopic.php?f=24&t=32799

Hometesting. Most cats will get used to the process. The secret is treats. Everytime you poke, the cat gets a treat. Lo carb treats If he is testy at first, you might try the burrito. We put a towel down on our couch next to the arm. Oliver got put on the towel and wrapped up until only his head was showing. A quick poke and treat and we were done. After a few days, he knew the treat was coming and we didn't need the burrito any more. As far as getting enough blood - are you warming the ear? That was magic for us. You can fill a prescription pill bottle with hot water and hold it on his ear for a minute or two. Another thing is to be sure the lancets are large enough. Most humans use 31 guage. New diabetics often need 25-27 gauge.

Yes, it is a good idea to feed small frequent meals. Just pull the food about 2 hours before testing. Food raises bg levels.

Lantus is a good insulin. So is ProZinc. i think you need to give ProZinc a chance before you switch. Here is a huge document that has lots of info on ProZinc and may be helpful: http://www.felinediabetes.com/FDMB/viewtopic.php?f=24&t=32799

I know it is hard to get advice that conflicts with your vet. All I can say is that we see hundreds of diabetic cats a week and they are all doing well, safely getting insulin. We would love to help you help Pudge.
 
Hi and welcome. I'm glad you didn't stick w/ 4 units!

Most people do test on the ear, but it helps to warm it first. Some people use the pad for the dewclaw, rather than the foot (for the reason you mentioned). Another option is to shave a small patch of fur somewhere to expose skin. We recommend you always test before giving insulin and if possible about 6 hours later to see how low he goes.

Good job on the food. Sometimes switching off dry is enough to reduce blood sugar without insulin, so keep a close eye. I suspect the 4u was balancing all the carbs. You can leave out food all day if you wish but we advise removing it 2-3 hours before the shot so you don't get a food-induced high reading (like a fasting test). Some use auto feeders, some freeze a portion & let it thaw, some just add extra water.

A "normal" blood sugar is generally 50-120. A regulated cat.has preshots around 250 with drops into double digits. If your +6 stays over 200 you may think about an increase. Try to keep a consistent dose 3-5 days (unles he gets too low) and then only go up by .2 or .25. (if you're using the conversion chart report the u40 dose).

Please come visit the pzi forum-we all use your insulin.
 
Welcome to you all!

This forum is probably the easiest to learn. The ppl here are all like family. Advice offered along with lots of furry paw hugs....

So glad you are testing...it will get easier once the routine is established. And many do very very well with the routine when lo carb treats are involved.

I believe you are very wise to switch to low carb foods after learning to home test as that can bring down those furry numbers up to or over 100. And so can home testing vs. vet stress testing.

Also wise to question the dosage?? That sure seems like alot of insulin! Bean was dx with 1 unit and he vet raised it to 2 units - 2 times a day... I found this forum and I did not raise it. Our first successful test, Bean was only 27. This was 2 hours after the shot! :o ....I had 2-4 more hours to go thru for her lows of low before she should start back on the increase. The folks here helped me save her life that dreadful night.... Now, she is in remission and diet controlled!

Keep up the good work, Pudge will thank you!
 
Hi Sophie,

Very happy you found us! Your instincts on dose have been very good. A starting dose of 4u, without any other conditions found at diagnosis, is just plain insane. My cat, Bob, was just as big as Pudge (weight-wise), and his starting dose was 1u (u40) twice a day. And his BG numbers at diagnosis were at least 100 points higher than Pudge's were. He eventually went as high as 4u twice a day, but that was after a month of treatment, and incremental increases. His numbers indicated more insulin was needed at the time. Pudge's number don't indicate that, and you have made good decisions in shooting less than you were advised to by the vet.

Your vet was sort of on the right track when he told you to transition off the dry gradually by mixing it with the cans. Unfortunately, the canned he prescribed was not a good choice, and again you did the right thing lowering the dose and picking a better lo carb food. If you still have some of that canned food left, you can return it to the vet and just tell him that Pudge won't eat it. They'll give you your money back.

So, going forward. You can go back to dosing one unit twice a day, twelve hours apart. You should test his BG before every shot (always) and also trying to test around 6 hours after the shot to see how low he goes on a given dose. Or you can cut back from his current dose of 2u to 1.5? That's up to you. Whatever number you pick, try to stick with it for 3 days or so, and collect data as much as you can. With several days of data, we can all put our thinking caps on together and figure out how it's working and how to proceed.

Great to have you here,
Carl
 
Hi!
Thank you for my warm welcome and all your comments which I found both helpful and reassuring. I'm very grateful, but couldn't get online until now as my WI FI was having fits. Pudge's Jan. 2, 2012, PM GB was 129 so I chose not to inject ProZinc. I understand that shooting when GB is under 200 is not an acceptable practice. Right? Today his AMGB was 415, so I injected 1 unit (ProZinc U-40 value) and will stick with it for 3 days, unless his numbers go sky high, then, I'll ask. I'm keeping my fingers crossed for a good +6 BG since he's drinking more water. My concern is that I saw a bead of insulin on the needle when I withdrew it this am - that hasn't happened to me before.

Wishing all the ill kitties well,

Sophie
 
just stopping by to say hi from another southern californian :-) i haven't been around much as of late due to a sick kitty of my own so not up to date on who's new here this last couple weeks but i saw the southern california reference and at least wanted to say hi :-)
 
It sounds like you have a good plan in place.

When you get a number under 200 at shot time, wait 20 minutes without feeding and test again. If he rises above 200, shoot a reduced dose. The 415 seems high but it is 24 hours after the last insulin shot so is to be expected.

Great job testing and thinking through the doses.

Can we help you set up a spreadsheet? Great color coded tool for you, your vet and us. When you want dose advice, we can see your history at a glance.
 
Hi,
Just lost my long message so I'll try again after dinner, but heartfelt thanks go to all of you... Pudge's +6 was 286. Thanks for all the links and hints...my head is spinning but happily since I'm a bookworm, too! Southern Cal, I'm sending health hugs to your kitty and to all others in need. Sue, many thanks & would appreciate a spreadsheet.
With appreciation,
Sophie
 
Sue, many thanks, I'll do the spreadsheet tomorrow.

To recap, Pudge had no insulin yesterday evening because his PMBG was 129 (now I know to test again in 20 minutes).
Pudge's today's statistics on 1 unit ProZinc:
AMBG was 433
+6 was 286
PMBG was 322 - didn't go up as high as I thought it might but it's high.

I'm itching to give him more insulin but staying with 1 unit. Will see what am brings.

Thanks everyone for your kind support,

Sophie
 
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