New Member - Glucose Curve Nadir - ProZinc

[varlene]

Hi, everyone. Smoky is 13 years old and has been been on ProZinc since he was 10; now at 8.25 units. His BG is high so I did a curve yesterday because I was home all day: 9a=457, 11a=454, 12:45=465, 3:03=478, 4:30p=473, 7p=470 7p=443, 8:30p=394, 10:15p=449, 12:28a=445, 7a=428 (ate), 9:15a=530; I did not give him any ProZinc last night at 9p because I wanted to see what would happen without any and BG went down at first but then when I saw 530 this morning after he ate, I gave him his 8.25 units but am now doubting myself when I saw him run to the water bowl and drink lots of water. He hits his nadir after about 10+ hours. Not a perfect smile curve. In August he was on 7 units and still it ran from 523 down to 370 at +10.25 hours then up to 429 at +12. Do I up the dose or start over at 2 units? If BG is too low or he is not eating, I skip the dose. I've kept records for the past year. His lowest BG in a year has been 43; his high 640. He has never eaten dry food, only wet, 16-17% carb count or less.

 

[SashaV]

16-17% carbs is way too much.
Are you checking for ketones?
Have you ever considered switching insulin? Had him checked for acromegaly?
And why would you start over on 2U?

The first step would be to get some food below 10% carbs, and keep a close eye on him, and watch his BG closely while you switch food.

It would be wonderful if you could set up a spreadsheet and signature so we can see what's going on.
@JanetNJ and @Deb & Wink might want to take a look..

 

[Panic]

I am not an expert on acromegaly (that would be Janet's position) but I don't advise dropping the dose right now, often you just end up losing a lot of time that way. I would get him tested for acromegaly and IAA.

If you need help setting up a spreadsheet we can have a mod do it for you, that is the most vital piece we'll need to see what your next step should be.

 

[varlene]

I have an excel spreadsheet of my own design that I have been using, not as extensive your version used for Panic and Mauer's. Mine is also a google sheet so will see if I can post a link in my signature if you want to see it until I start using the 12/12 version you provide for AlphaTRAK. Should I begin the new sheet as of yesterday or try to add historical data from my current sheet, how far back? Also, I see that you all do multiple tests daily whereas I was just testing at 12 hour intervals to see if okay to give the ProZinc, my goal was to have BG at about 300 at the time of injection. Do you all recommend multiple daily testing or only until things are stabilized?
Smoky is due for a vet appointment so will set that up.
Is it because his BG levels are so high that you brought up acromegaly? He did/does have feline tooth resorption FORL and had several teeth extracted.
Smoky is currently eating Fancy Feast Delights OWF/cheddar and Delights Chicken/cheddar. He also likes Gravy Lover's. Does not like pate. He's very picky so any ideas on a lower carb food?
For 12 years Smoky had been a bedroom cat only as he did not get along with any of our other cats, but we are now down to just four, two males and two females, all 13 years old. The bedroom door has been opened for many months now, and Smoky has been exploring the house and feeling very proud of himself. Unfortunately our other very friendly male Tracy has lymphoma and is probably not long for this world, which is no doubt causing stress.
Thank you for responding so very quickly.

***UPDATED SHARED LINK***This is a spreadsheet I created before learning about the FDMB version noted in my signature. I will continue to update my version from time to time; added charts, trend line.
Copy of Smoky's Spreadsheet (Do a Ctrl-F search for xx to get to the bottom):
https://docs.google.com/spreadsheets/d/1_7Bgkvmt1R26oAs7RuBZKsf_c-O4_465BRbjZfDFsKI/edit?usp=sharing

 

[Sienne and Gabby (GA)]

There is an excellent website on feline nutrition that was developed by a vet, Lisa Pierson, DVM. This is a link to the food chart on her site. We consider low carb to be less than 10% carb, medium carb is 10 - 15%, and high carb is over 15%.

You will need to set the permissions on your spreadsheet so that anyone with the link can view it. It truly is easier if for us if you can transfer several weeks of your data to our spreadsheet.

I'm tagging @Bandit's Mom (Bhooma) who can give you a hand if. you need it in getting your spreadsheet set up.

 

[JanetNJ]

I have an excel spreadsheet of my own design that I have been using, not as extensive your version used for Panic and Mauer's. Mine is also a google sheet so will see if I can post a link in my signature IF you want to see it until I start using the 12/12 version you provide for AlphaTRAK. Should I begin the new sheet as of yesterday or try to add historical data from my current sheet, how far back? Also, I see that you all do multiple tests daily whereas I was just testing at 12 hour intervals to see if okay to give the ProZinc, my goal was to have BG at about 300 at the time of injection. Do you all recommend multiple daily testing or only until things are stabilized?
Smoky is due for a vet appointment so will set that up.
Is it because his BG levels are so high that you brought up acromegaly? He did/does have feline tooth resorption FORL and had several teeth extracted.
Smoky is currently eating Fancy Feast Delights OWF/cheddar and Delights Chicken/cheddar. He also like Gravy Lover's. Does not like pate. He's very picky so any ideas on a lower carb food?
For 12 years Smoky had been a bedroom cat only as he did not get along with any of our other cats, but we are now down to just four, two males and two females, all 13 years old. The bedroom door has been opened for many months now, and Smoky has been exploring the house and feeling very proud of himself. Unfortunately our other very friendly male Tracy has lymphoma and is probably not long for this world, which is no doubt causing stress.
Thank you for responding so very quickly.
Copy of Smoky's Spreadsheet (Do a Ctrl-F search for xx to get to the bottom): https://docs.google.com/spreadsheets/d/1yBKkJbVUpAL8cd9dbP85r_-s76ys2phhUCg_WoJwBi0/edit#gid=0

can you open access to anyone with a link so we can see the spreadsheet? Have you had him tested for acromegaly?

 

[Panic]

Is it because his BG levels are so high that you brought up acromegaly? He did/does have feline tooth resorption FORL and had several teeth extracted.

Acromegaly and IAA are something we recommend if the dosage is getting on the high side - more times than not a cat won't need more than 3 units, and by the time they hit 5 or 6 we suggest testing to at least rule them out. You have a lot of things contributing to the higher dose though, the higher carb food will require a higher insulin dosage (so if you switch food, do monitor BG closely as he'll probably need a lower dose). If he has dental issues that will also raise BG considerably.

He also like Gravy Lover's. Does not like pate. He's very picky so any ideas on a lower carb food?

As Sienne listed, there's a lot of food options for under 10% carbs. I would keep the Gravy Lover's only for hypo events. Most low-carb food is going to be pate, however I believe Fancy Feast Roasted/Flaked/Chunky is a good idea as it is low carb and not a pate.

Be happy to peek at your spreadsheet once permissions allow us to view.

 

[varlene]

can you open access to anyone with a link so we can see the spreadsheet? Have you had him tested for acromegaly?

Done. I see that my spreadsheet was not set up to do 24-hour curves so will need to be updated so that the time column also includes the date. And at some point soon will move transfer date to your-style spreadsheet.

 

[varlene]

can you open access to anyone with a link so we can see the spreadsheet? Have you had him tested for acromegaly?

Last visit to the vet, Smoky was not eating and BG was normal without PZ, but that did not last long and then the pandemic happened. Will get testing for acromegaly IGF-1, Cushings, IAA, etc. Thank you!!!

 

[Panic]

Thanks so much for giving permission - am I right in seeing that for the most part you've just done pre-shot testing, no midday tests? Pre-shots are usually the highest number so to see some 200-300s indicates the dose is not too high and I would not recommend lowering right now (without making a diet change anyway). I would not be surprised if he ended up have a "high-dose" condition, but some cats just need a higher dose without any underlying reasoning. If he does end up having acro/IAA, you might consider switching to Levemir insulin, those conditions respond very well to that type. Janet's cat CC had acro and she was on Prozinc though, so depends on the kitty!

Our spreadsheet is set up so it's easy to read at a glance - it is color-coded so we recognize "good" vs "bad" numbers immediately and the 24 hour list allows us to see how far along in the cycle a number came. For a cat with a low number 2 hours after insulin, it is much more concerning than a low number 7 hours after insulin, for example. It would be great if you could fill out the last couple weeks for us on the new spreadsheet.

Most of us don't do all-day curves either, we do spot checks throughout the day. On Prozinc it's a good idea to check two hours (+2) after insulin to see where the cycle is headed, and another during the middle of the cycle (+5 or +6) to see how low the insulin dose is taking them. We base dosage on how low the BG goes, not how high it is at shot-time. Hope that helps explain how/why we like to do things! Do let us know when you get the results for Smoky!

 

[varlene]

I have entered month's worth of data, but can go back further if necessary. I see why I reached out to you all!! My poor Smoky.

 

[JanetNJ]

I would suggest changing the food so it's under 10 percent carb. Under 7 is even better.

 

[varlene]

I would suggest changing the food so it's under 10 percent carb. Under 7 is even better.

Smoky starting on Weruva this afternoon, all varieties under 4%. Hoping that he will like at least one or two of them.
We had to put our ailing Tracy to sleep this morning, so it is a very sad day. Tracy wandered into our backyard 13 years ago as a severely dehydrated kitten and grew into our most sociable and friendly cat who took an active interest in everything. He was handsome to the very end and a such a sweet guy who will be sorely missed.

 

[JanetNJ]

Smoky starting on Weruva this afternoon, all varieties under 4%. Hoping that he will like at least one or two of them.
We had to put our ailing Tracy to sleep this morning, so it is a very sad day. Tracy wandered into our backyard 13 years ago as a severely dehydrated kitten and grew into our most sociable and friendly cat who took an active interest in everything. He was handsome to the very end and a such a sweet guy who will be sorely missed.

Omg I'm so sorry for your loss.

 

[varlene]

Omg I'm so sorry for your loss.

Thank you, Janet.
I am hoping to get him tested later today for acro and hopefully test results will be back by Friday when the usual vet I see gets back to work

 

[varlene]

Smoky's BG dropped 350 points in 7 hours (449 to 107). He is now eating low carb food. I went into panic mode but now he's trending up 142 at 8 hours. I have a vet appointment in 1 hour for blood work and consult.

 

[Panic]

Sounds like the low carb is making a difference! That is a big drop so if he bounces (BG jumps back up due to the big drop) don't be surprised. How did the appointment go?

I am so sorry about Tracy. You take care of yourself.

 

[JanetNJ]

Smoky's BG dropped 350 points in 7 hours (449 to 107). He is now eating low carb food. Went into panic mode but now he's trending up 142 at 8 hours. I have a vet appointment in 1 hour for blood work and consult.

107 is a great number!

 

[varlene]

Sounds like the low carb is making a difference! That is a big drop so if he bounces (BG jumps back up due to the big drop) don't be surprised. How did the appointment go?

I am so sorry about Tracy. You take care of yourself.

Hi, Panic. Thank you for nice condolences about my sweet Tracy. He was a wonderful little guy!!
Yesterday Smoky produced a beautiful smile curve despite his stressful trip to the vet, who poopooed my request for an IGF-1 test because he hasn't seen it in his career (maybe because he never tests for it), but will do so. He wants to wait for blood test results to come back before any discussion on Cushings or IAA. Thought Smoky was doing well and asked me about my injection method, thinking I might be using U100 syringes. Today's numbers not as good as yesterday's probably because I chickened out and gave 8.25 last night instead of 8.5 because Smoky wasn't eating. I vow to be stronger going forward. Heading to the store in search of different low-carb food.

 

[varlene]

I am so sorry about Tracy. You take care of yourself.[/QUOTE]

Sounds like the low carb is making a difference! That is a big drop so if he bounces (BG jumps back up due to the big drop) don't be surprised. How did the appointment go?

Hi, Panic. Thank you for your condolences about my sweet Tracy. He was a wonderful little guy!!
I missed seeing your reply earlier so my apologies. Yesterday Smoky produced a beautiful smile curve despite his stressful trip to the vet who poopooed my request for an IGF-1 test because he hasn't seen it in his career (maybe because he never tests for it), but will test Smoky. He wants to wait for blood test results to come back before discussing Cushings or IAA. Vet thought Smoky was doing well and asked me about my injection method, thinking I might be using U100 syringes. Today's BG numbers are not as good as yesterday's, most likely because I chickened out and gave Smoky 8.25 last night instead of 8.5 because he wasn't eating. I vow to be stronger in the days/nights ahead.

 

[varlene]

I've called the vet's office three times for blood results but not everything was back until today. I need to stop by to pick up more ProZinc, so will ask for copies of the results when I am there, hopefully tomorrow.
P.S. How do I name Smoky's spreadsheet instead of showing the docs.google.com url?

 

[JanetNJ]

I've called the vet's office three times for blood results but not everything was back until today. I need to stop by to pick up more ProZinc, so will ask for copies of the results when I am there, hopefully tomorrow.
P.S. How do I name Smoky's spreadsheet instead of showing the docs.google.com url?

How much is your vet charging for the insulin?

to change the name, type the name you want, highlight it, then add the link.

 

[varlene]

Hi, Janet. I have been paying $106.79 which was the 1800PetMeds price back in 2018 that the vet matched. At 8.5 units per shot, it's going a lot faster now than it used to.
Thanks for the assistance with the spreadsheet link!!!

 

[JanetNJ]

Hi, Janet. I have been paying $106.79 which was the 1800PetMeds price back in 2018 that the vet matched. At 8.5 units per shot, it's going a lot faster now than it used to.
Thanks for the assistance with the spreadsheet link!!!

Ok that not a bad price. It’s 103.54 with authorship on chewy. Some vets charge a lot.

I hear ya. My kitty was high dose for a long time getting over 10 u. It went fast.

 

[varlene]

Ok that not a bad price. It’s 103.54 with authorship on chewy. Some vets charge a lot.
I hear ya. My kitty was high dose for a long time getting over 10 u. It went fast.

I love Chewy. When I called to get a RMA so I could return an unopened case of Hill's Urgent Care food that I no longer needed because Tracy had died, they gave me full credit and told me to donate the food. I thought that was wonderful, and then flowers showed up from them. So nice!! I couldn't believe it. Do they do a good job of keeping the ProZinc cold in transit?
The vet received results for the comprehensive blood test and fructosamine but is still waiting for the IGF-1 results, which explains why I haven't been called yet.

 

[JanetNJ]

I love Chewy. When I called to get a RMA so I could return an unopened case of Hill's Urgent Care food that I no longer needed because Tracy had died, they gave me full credit and told me to donate the food. I thought that was wonderful, and then flowers showed up from them. So nice!! I couldn't believe it. Do they do a good job of keeping the ProZinc cold in transit?
The vet received results for the comprehensive blood test and fructosamine but is still waiting for the IGF-1 results, which explains why I haven't been called yet.

Yes they send it in a cooler with plenty of ice packs.

 

[varlene]

Tests results finally in. The IGF-1 test was sent to Michigan State so took extra time. I have added Smoky's recent labs along with those from last year into the spreadsheet. IGF-1 range is (12-92) and Smoky is a 234 so more than double the max. The veterinary practice has no experience so suggests we contact specialists for scans and to evaluate next steps, possible radiation or surgery. I think we would rather just work on trying to keep his BG in check day to day as our past experience with specialists has not inspired much confidence. What is the consensus here on dealing with cats with likely feline acromegaly? I say "likely" because I don't know if the out-of-range IGF-1 is enough to confirm acromegaly or if we need to confirm a pituitary tumor. He is up to 8.5 units of ProZinc which tends to work some days but not others.

 

[Larry and Kitties]

What is the consensus here on dealing with cats with likely feline acromegaly? I say "likely" because I don't know if the out-of-range IGF-1 is enough to confirm acromegaly or if we need to confirm a pituitary tumor. He is up to 8.5 units of ProZinc which tends to work some days but not others.

I would post in the Acromegaly/IAA forum
https://www.felinediabetes.com/FDMB/forums/acromegaly-iaa-cushings-cats.12/
The cost of the cures, are about $8,000 or so and depends upon how far you have to travel,. There are threads in this forum that get inot other caretakers making the decision of what they did/not do. First I wouod change to Levemir insulin.

 

[JanetNJ]

Tests results finally in. The IGF-1 test was sent to Michigan State so took extra time. I have added Smoky's recent labs along with those from last year into the spreadsheet. IGF-1 range is (12-92) and Smoky is a 234 so more than double the max. The veterinary practice has no experience so suggests we contact specialists for scans and to evaluate next steps, possible radiation or surgery. I think we would rather just work on trying to keep his BG in check day to day as our past experience with specialists has not inspired much confidence. What is the consensus here on dealing with cats with likely feline acromegaly? I say "likely" because I don't know if the out-of-range IGF-1 is enough to confirm acromegaly or if we need to confirm a pituitary tumor. He is up to 8.5 units of ProZinc which tends to work some days but not others.

My cat was acro and we just treated with insulin. at her most she was up to about 13 units... but it would definitely fluctuate. She did rather well and in the end it was cancer that got her, not the acro at all.

 

[varlene]

I would post in the Acromegaly/IAA forum
https://www.felinediabetes.com/FDMB/forums/acromegaly-iaa-cushings-cats.12/
The cost of the cures, are about $8,000 or so and depends upon how far you have to travel,. There are threads in this forum that get inot other caretakers making the decision of what they did/not do. First I would change to Levemir insulin.

Thanks Larry and Kitties: I found helpful information on hard-to-control DM when I googled Levemir and I will definitely consider it. Because I just bought more ProZinc, a switch to Levemir won't happen anytime soon. Will keep you posted.

 

[JanetNJ]

Thanks Larry and Kitties: I found helpful information on hard-to-control DM when I googled Levemir and I will definitely consider it. Because I just bought more ProZinc, a switch to Levemir won't happen anytime soon. Will keep you posted.

I used ProZinc with my acro cat and had success with it.

 

[varlene]

My cat was acro and we just treated with insulin. at her most she was up to about 13 units... but it would definitely fluctuate. She did rather well and in the end it was cancer that got her, not the acro at all.

Hi, JanetNJ: I am so very sorry that you lost your C.C. It is very sad. Smoky has come a long way since he was first diagnosed with DM. He had been walking on his hocks instead of his feet but recovered thanks to ProZinc & Zobaline. Now we just need to get the BG numbers back down into the normal range with the right insulin and dosage.

 

[JanetNJ]

Hi, JanetNJ: I am so very sorry that you lost your C.C. It is very sad. Smoky has come a long way since he was first diagnosed with DM. He had been walking on his hocks instead of his feet but recovered thanks to ProZinc & Zobaline. Now we just need to get the BG numbers back down into the normal range with the right insulin and dosage.

thank you. She was very special.
Post in the acro forum. Looks like he's ready for an increase. Don't hold the dose too long.

 

[varlene]

thank you. She was very special.
Post in the acro forum. Looks like he's ready for an increase. Don't hold the dose too long.

Hi, JanetNJ: I upped this morning by .25 unit before reading this and wonder if I should I have upped by .5. I know I saw somewhere a guideline on how much to go up or down depending on highs & lows. How long is too long to wait? Moving to acro forum. Thank you.

 

[JanetNJ]

Hi, JanetNJ: I upped this morning by .25 unit before reading this and wonder if I should I have upped by .5. I know I saw somewhere a guideline on how much to go up or down depending on highs & lows. How long is too long to wait? Moving to acro forum. Thank you.

When you are in high doses you tend to raise in half units (or even hole units when really high doses). I used to raise every few days to get ahead of insulin resistance.

 

[varlene]

When you are in high doses you tend to raise in half units (or even hole units when really high doses). I used to raise every few days to get ahead of insulin resistance.

Hi, Janet: The instructions at https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/ look to be geared to U-100 insulins like Lantus and Levemir so I thought even a .25 unit of U-40 ProZinc (= .6 of U-100) might be overdoing it. But you used ProZinc, so you are saying upping by .5 is the way to go? Is this the process for the rest of Smoky's life where I will be raising it every few days, first to get it to a normal range and then to keep it there? Is there ever a point where a certain dosage will settle in for a while even though he is an acro cat?

 

[JanetNJ]

Hi, Janet: The instructions at https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/ look to be geared to U-100 insulins like Lantus and Levemir so I thought even a .25 unit of U-40 ProZinc (= .6 of U-100) might be overdoing it. But you used ProZinc, so you are saying upping by .5 is the way to go? Is this the process for the rest of Smoky's life where I will be raising it every few days, first to get it to a normal range and then to keep it there? Is there ever a point where a certain dosage will settle in for a while even though he is an acro cat?

Think of it this way. Going from 1 u to 1.25 is a 25% increase. Big increase. Going from 8 to 8.25 is just a 3% increase. Not such a big increase. Going from 8 to 8.5 is a 6.25% increase. Now if you're just tweeking it a little To lower just a bit a 0.25 increase is fine. Ultimately you hold the syringes. If you are uncomfortable with a 0.5 u increase, than go ahead and do a 0.25 increase.

No you will not be raising forever. My cat was up to 12.5 units at her most... then down to 8, back up to 11, then down to 7, back up to 10... Eventually down to about 4-4.5.... Insulin needs fluctuate.

 

[varlene]

Think of it this way. Going from 1 u to 1.25 is a 25% increase. Big increase. Going from 8 to 8.25 is just a 3% increase. Not such a big increase. Going from 8 to 8.5 is a 6.25% increase. Now if you're just tweaking it a little To lower just a bit a 0.25 increase is fine. Ultimately you hold the syringes. If you are uncomfortable with a 0.5 u increase, than go ahead and do a 0.25 increase.
No you will not be raising forever. My cat was up to 12.5 units at her most... then down to 8, back up to 11, then down to 7, back up to 10... Eventually down to about 4-4.5.... Insulin needs fluctuate.

Excellent explanation and fantastic news. Thinking in percentages makes perfect sense. Thank you!!!