? New member need help

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Max & Lori, Jul 20, 2021 at 12:27 PM.

  1. Max & Lori

    Max & Lori Member

    Joined:
    Tuesday
    My cat Max is 11 years old with IBD and diabetes. He weighs 17 pounds. He was diagnosed on 6/24/21 with diabetes and we’ve been unable to get his glucose regulated. He was started on Prozinc 3 units twice a day and the vet had increased him weekly until we got to 6 units twice a day without much improvement. He runs mostly in the 400s, but has been over 600. He has IBD which complicates things with his diet due to his diarrhea. He eats Fancy feast or Purina pro plan Metabolic canned chicken mostly. No dry. He was in the hospital last week due to his sugar being over 600 and he stopped eating, plus had diarrhea. Dehydrated/questionable DKA. The vet changed him to Vetsulin 5 units twice a day. I know this insulin does not last more than 8 hrs in a cat although it has brought him down into the 250-300’s range for the most part. It just shoots back up to the 400-600 range when the insulin wears off. I give it at 6 am and 6 pm. I feed him one can of Purina pro plan or one can Fancy Feast in the morning and the evening. He stays hungry all the time but since he’s so hard to regulate I don’t know if he should be eating more, but if he does I can’t get his glucose level down. I free really wish this insulin would last longer or we could find something to regulate him more. I do have a spreadsheet on him of that would be helpful. Any recommendations about getting Max’s glucose under control?
     
  2. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    Hi Lori! Glad to see you over here from the Feline Diabetes group!

    If you have the time, it will be helpful for you to go ahead and add your "Signature". Just click on your name and then "Signature" and a new little box will come up for you to add information in like:

    Your name/Cat's name, age, sex, date of diagnosis, type of insulin, type of meter, type of food, any other health issues or meds? and at the end put the link to your spreadsheet.

    By doing that, all your posts will have the Signature automatically attached so people won't have to keep asking the same questions multiple times.

    Your vet actually started you at a high dose. Most cats should start at .5 to 1U so it's possible your dose is actually too high. No cat should be on 6 units of any insulin after less than a month!

    ProZinc is usually a much better insulin for cats than Vetsulin which is more geared towards dogs. When we can see your spreadsheet, we'll probably have more suggestions for you.

    This "Help us to help you" post can be helpful for new members too!
     
  3. Max & Lori

    Max & Lori Member

    Joined:
    Tuesday
    Thank you! My spreadsheet is actually from another FB Diabetes site and I’m not sure how that works here. I’m still trying to get acclimated to this site.
     
  4. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    If it's the other Facebook group, they pirated theirs from us in the first place, but somehow they did something that causes it to crash on a lot of people's phones/tablets so you'd need to switch to our original version but you can copy/paste the information from one to the other so you wouldn't have to totally start over. Here's the Instructions on getting the FDMB spreadsheet (which you'll notice looks very familiar)
     
  5. Max & Lori

    Max & Lori Member

    Joined:
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    I added my spreadsheet to my Signature. Could you take a look at that? If he did start with a dose too high, can that be fixed without harm to the cat?
     
    Last edited: Jul 20, 2021 at 4:38 PM
    Reason for edit: Asking a question
  6. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    I will tag
    @Chris & China (GA)

    @JanetNJ

    for you Lori switched from Prozinc to Vetsulin on 7-16
    Can you please take a look at her SS

    Also on your spreadsheet could you please put a line above when you switched to
    Vetsulin , I don't anyone might see it in your remarks section
    The SS in your signature works, you might want to get rid of the other one at the end of your post in #4
     
  7. Max & Lori

    Max & Lori Member

    Joined:
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    Im not sure how to put a line on the spreadsheet where I started Vetsulin without messing up my spreadsheet. Could you fix it for me? If not, just let me know how.
     
  8. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Hi Lori I only know how to do it on my tablet,
    I will ask @Chris & China (GA)
    Or
    @Bandit's Mom
    to fix it for you Bhooma will be on tonight she lives in India
    Hi Bhooma could you please add a line above Lori's SS on 7-16 She switched to Vetsulin
    I'm hoping others will give you some advice about insulin :cat:
    @Sienne and Gabby (GA)

    @Wendy&Neko
    Her kitty was on Prozinc then switched to Vetsulin on 7-16
    Giving very high units of insulin
     
    Last edited: Jul 20, 2021 at 5:22 PM
  9. Max & Lori

    Max & Lori Member

    Joined:
    Tuesday
    Thank you. I hope someone has some good advice!
     
  10. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    May 10, 2013
    Absolutely yes! Sending you a PM on Facebook about your spreadsheet
     
  11. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    I believe Wendy used Caninsulin and then Lantus and finally Levemir. I’m pretty sure she never used PZ.
     
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  12. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    I think Diane was tagging Wendy for advice on insulin and then added the extra information that Lori had switched from ProZinc to Vetsulin....not that Wendy went from ProZinc to Vetsulin
     
  13. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    I think you are right!! Sorry @Diane Tyler's Mom

    Lori and I were discussing her SS in a PM and I noted her switch from PZ to Vetsulin. She mentioned this was her vet’s decision. This is what I told her which I am putting publicly for peer review.

    “The fact that he has seen some numbers in the 100s on a lower dose makes me wonder if he is overdosed.

    I don’t know where you are located but you might want to start a post on Main Health asking for vet recommendations in your city. If you can afford it, Lantus or Levemir would be much better options and we can help you with a dose. If you can’t afford it, going back to PZ would be fine. Do you have any PZ left? If so, maybe we should help you get him back on that on a lower dose.”

    Lori…one thing they can really help us see if 6u is too much is for you to get a test or two every single night after PMPS. If you could do a +2 and a “before bed”, we can see where he’s headed. It’s quite common for cats to drop low at night and then pop way back up after. This is called a bounce and it can last up to six cycles after the low number. You can see an example of him dropping down into the 100s on 7/7 and 7/8 and then popping way back up.

    We don’t want to just drop the dose way back without doing this kind of investigation because it’s always possible he might need close to this amount of insulin. We don’t want to put him at risk for DKA by cutting the dose too much. So, first, we figure out how low this dose is taking him and then we can safely adjust.

    What do you think?
     
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  14. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    Line added for switch to Vetsulin....Hopefully we'll get to add one when she switches back to ProZinc or tries Lantus or Levemir!
     
  15. Max & Lori

    Max & Lori Member

    Joined:
    Tuesday
     
  16. Max & Lori

    Max & Lori Member

    Joined:
    Tuesday
    I will start doing this. Thanks!
     
  17. Max & Lori

    Max & Lori Member

    Joined:
    Tuesday
    Please help. I'm not sure if I'm supposed to continue commenting here on this post or not but Max's regular vet just called me about Max and said that I could go back to the Prozinc but he wanted me to give 7 units twice a day. I've already discussed with some of you the possibility that Max started on a dose of Prozinc that was to high (3 units), then he went up to 6 units. He then was hospitalized for possible DKA and the vet changed him to Vetsulin 5 units per day, then Vetsulin 6 units per day. I do not like using the Vetsulin because it is so short acting in Max. I questioned the vet about this some time ago and he wanted me to keep with the current plan. Being unhappy about this, I called around to get an appointment with another vet. I hated to do that since Max has been with this vet for 11 years and he knows his history of asthma, IBD, heart murmur due to a mildly enlarged heart. I did get an appointment with a new vet for tomorrow. I know nothing about the new vet, but I was hoping he would give me Lantus. That is not a sure thing though. I guess the new vet requested records from the old vet because the old vet just called me about Max and wanted him to go back to the Prozinc 7 units twice daily. My question is what should I do? Should I give the Prozinc another try? If the dose is too high, what dose should I give him? Or should I keep the appointment with the new vet and take a chance on what he will do? I don't want him to get DKA again. He was just in the hospital last week. PLEASE HELP! I am so confused and frustrated. @Marje and Gracie @Chris & China (GA)
     
  18. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Tagging @JanetNJ also
    @Panic
    Janet and Elizabeth can you please read post #1 and. #16 Thank you
    Lori is having a tough time
    Thank you
     
  19. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    Sep 21, 2018
    Thank you Chris
    @Chris & China (GA)
     
  20. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    Sep 21, 2018
    Lori was he DKA or not, can you add that to your signature also so members know about this I see you said he was in the hospital last week
    @Max & Lori
     
  21. Max & Lori

    Max & Lori Member

    Joined:
    Tuesday
    Hey can you tell me how to add my signature? I’m still trying to figure out this site. Also the vet told me that he thought he was on DKA, but of all things he didn’t check that. He checked a CBC, gave IV fluids and treated him for an infection because he had a fever. Max had quit eating and was symptomatic of DKA so he treated him.
     
  22. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Your signature is already there :cat:
    What do you mean
     
  23. Max & Lori

    Max & Lori Member

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    It won’t let me add it there. I don’t see how to edit it.
     
  24. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Tap on your pic of Max then hit profile and then go up top and tap on Max & Lori
    A drop down will appear, tap on signature ,add to it then hit save changes
    Let me know if it worked
    @Lori & Max
     
  25. Max & Lori

    Max & Lori Member

    Joined:
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    Okay it finally worked. I added it.
     
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  26. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    Sep 21, 2018
    Great, waiting for someone to answer the tags
     
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  27. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    Wow going to 7 units is a lot. I wouldn't raise in whole units. I'm glad you're doing back to ProZinc. Makes me wonder if something else is going on, like acromegaly. Might be something to test for. How are your cats teeth? Any infection?
     
  28. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    First, if he had DKA, he would have been really sick and in the hospital for a few days, at least. Perhaps he was just showing ketones which is not the same thing. Are you testing urine ketones at home?

    Did you talk to your vet about whether he’d give you Lantus? If that’s your goal and he won’t give it to you, I’d see the new vet and hope he will. Under. I circumstance would I raise his dose u til you have a few nights of data and are testing ketones. It’s really important until l we figure out how many units he really needs to test his ketone every single day and tell us if he stops eating/drinking, is lethargic, doesn’t feel well.

    And even though his BG is high tonight, please get a before bed test so we can see if it’s coming down any.

    If you decide to switch to PZ instead of Lantus, go ahead and give it in the morning at current dose u til we can figure out what he’s doing.

    how does that sound?
     
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  29. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    For now, I'd just stay at the 6U dose of Vetsulin you're on since you're going to see the new vet tomorrow. Making a change tonight or in the morning doesn't make much sense since we don't know what the new vet might say or if they will give you a script for Lantus or Levemir (if you can, get Levemir...it's usually a better choice for higher doses)
     
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  30. Max & Lori

    Max & Lori Member

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    I have not been checking for ketones. Should I check his urine with the urine strips?
     
  31. Max & Lori

    Max & Lori Member

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    I did ask for Lantus but he disagreed with me on that.
     
  32. Max & Lori

    Max & Lori Member

    Joined:
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    I will go to the new vet and see what he says. I will also check more BG levels at night. If I still can’t get Levemir or Lantus, I will let you know. Thanks so much. I know I’m a disaster right now but I really appreciate you all.
     
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  33. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    Yes, if you have them. It's important to keep a close eye on them with a history of ketones recently
     
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  34. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Yes. Urine ketone, not urine glucose strips.

    Time for a new vet. You are Max’s advocate and you are learning. Your vet should investigate and see how widely Lantus is used. If he’s not willing, I’d move on. Whether it’s FD or not, no vet should dismiss you and your ideas unless he can prove it’s completely unsafe.

    Did you ask when you made the appt if he uses Lantus in cats? Thanks for checking BGs tonight.
     
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  35. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Good luck tomorrow seeing the new vet, please keep us posted
    Max is one handsome boy Lori :cat:
     
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  36. Max & Lori

    Max & Lori Member

    Joined:
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    I did not ask if he used Lantus. I spoke with the receptionist and I just assumed she wouldn’t know that info. I did have some ketone strips that I got a couple of wks ago. I’ve just been unable to catch him in the litter box but I did see a little urine on the wall of the litter box after he went this morning so I checked that. No ketones. I will try to catch him in there again.
     
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  37. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    If he's hard to catch in the box, there are ketone blood meters as well that work just like reg bg meters.
     
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  38. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    If he got into any low numbers, we should know by tonight. Since bounces usually break within six cycles, he could have gone low 7/19 which means tonight is his sixth cycle after that.

    However, it’s possible he’s going to be a high dose cat so don’t rule that out in your mind. There are many possibilities for that. One is he just was diabetic longer than you know and he has a lot of glucose toxicity built up so it might take a higher dose to break through it, he might have a condition where antibodies attack the insulin and make it partially unusable to him (there are ways to combat this & it’s self-limiting within about a year), or he could potentially have acromegaly. But…baby steps. Let’s see what the next two cycles bring.

    Good luck today!
     
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  39. Max & Lori

    Max & Lori Member

    Joined:
    Tuesday
    Just checked BG at 10:00 and it’s higher than the AMPS and he’s had 6 u of Vetsulin. He ate 1 can of Fancy feast chicken pate and I gave the insulin 25 minutes after that. It makes no sense to me.
     
  40. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Each meter can have a variance of 20% between tests which means he’s just flat today, he’s not higher.
     
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  41. Max & Lori

    Max & Lori Member

    Joined:
    Tuesday
    Good news! Max and I went to see a new vet today and we had a great visit. We have a prescription for Lantus. The vet actually wanted him to be on that. We got the pens instead of the vial so it will last longer. He is supposed to start off on 2 units twice a day since he was already on such a large amount of Vetsulin. We will do a glucose curve here at home after he has been on the Lantus 10-14 days and email to vet. We will start Lantus tomorrow morning. I’ve got to do some reading on that tonight. Hopefully I can order from Canada next time to save some money if anyone knows of a good pharmacy. Max is also being tested for acromegaly and pancreatitis. He also will be scheduled for an echocardiogram to see what’s going on regarding the heart murmur. The vet was awesome and spent about an hour with us. Very knowledgeable about feline diabetes. He was very impressed with the spreadsheet I’ve been keeping here. I am so relieved now that we are at least on the right path. Any advice you want to give me about Lantus would be great. I hope and pray we will start seeing some improvement in things soon.Thank you so much @Chris & China (GA) @Marje and Gracie @Diane Tyler's Mom
     
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  42. Chris & China (GA)

    Chris & China (GA) Well-Known Member

    Joined:
    May 10, 2013
    So happy to hear you are so thrilled with the new vet! I know it's hard to leave one that you've used for years but it sounds like it was a very positive experience!

    You might want to call them and ask if they can add the IAA test along with the Acro test. It's another condition that it helps to know if it's in the picture and both are done at the same place.
     
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  43. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Lori that is such Great News, sounds like you have found a really great vet
    I'm so happy !!!
    I'm glad you got the pen, now did you get the U-100 syringes for Lantus with the half unit markings. With the needle or whatever you call it that comes with the pen you can only adjust by whole units, so we the pen like a vial and use U-100 syringes to stick inside the gray rubber stopper on the pen and draw our insulin
    If not get them next time , we adjust doses by 0.25 units
    What did the pharmacy charge you for the Lantus pen?
    I will give you the link for Lantus and you can read about it, if you need to ask a question go ahead
    There are 2 dosings methods when using Lantus TR Tight Regulation and SLGS
    You can read about them also

    Oh I'm glad he is checking for acromegaly and pancreatitis
    @Max & Lori
     
    Last edited: Jul 22, 2021 at 6:04 PM
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  44. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    Sep 21, 2018
    Lol Chris I was going to say that but couldn't remember what it was called
    You are good Chris :cat:
    @Chris & China (GA)
     
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  45. Max & Lori

    Max & Lori Member

    Joined:
    Tuesday
    I believe he did do that as well.
     
  46. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Max could you add to your signature you are using the Alpha Trak



    Here is the link for Marks Marine Pharmacy in Canada
    I suggest buying the 5 pens they will last a year depending on the dose you give
    Just go to the site and type in Lantus
    https://rxcanada4less.com
    Also once your vet sends a script over , you will never need another one to reorder
    They are very nice people, when you want to order just call them and they will explain everything
    @Max & Lori
     
    Last edited: Jul 22, 2021 at 6:57 PM
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  47. Max & Lori

    Max & Lori Member

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    I am so happy too! I’m kicking myself that I didn’t change vets sooner. It was a set of five pens for a little over $400. I got syringes from the vet and they do have the half markings. Yes send me the link on Lantus please! I’m so thankful for y’all!
     
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  48. Max & Lori

    Max & Lori Member

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    Tuesday
    Awesome thanks for the link for the Canadian pharmacy!
     
  49. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    May 10, 2013
    I'm not sure I'd drop back that much. Lantus isn't "stronger" than Vetsulin the way you're thinking and dropping back that much will probably just result in a lot of wasted time while you work your way back up. Also, be prepared to test your patience. Whatever "starting dose" you begin with, it usually takes 5-7 days before you're going to see how he's really responding to that dose (although some cats can react much sooner)

    I'd probably suggest that if you do drop the dose, you start at 5U....yes, I said 5 units. Let's get some other opinions though. We have until tomorrow to make a decision.

    @Marje and Gracie

    ETA...I'll also put a new line in for you on your spreadsheet for the change to Lantus
     
    Last edited: Jul 22, 2021 at 6:29 PM
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  50. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Holy crap over 400 bucks ,yes it's extremely expensive in the US
    Sometimes the pharmacy you get it at has a coupon to apply for you
    Like CVS, Walmart, Costco . It's about 198.00 from Marks
     
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  51. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    Sep 21, 2018
    Chris you are so thoughtful :cat:
     
  52. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
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  53. Max & Lori

    Max & Lori Member

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    Yes CVS was the cheapest and they used a coupon! No telling what it was without the coupon.
     
  54. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    @Max & Lori @Chris & China (GA)

    I just have a moment but since you are three hours later than me, I want to be sure you see this, Lori.

    I had already been thinking of dose for Lantus and I agree with Chris; 5u bid was what I was thinking because that’s the dose where he saw some BGs in blue. He’s had almost six cycles since he could have possible gone low and he’s not seen any lower numbers than 200s. If you start him at 2u bid, I’m afraid we will have to fast track him up and he will build more glucose toxicity.

    I know we are asking you to go against what this new vet that you like said. But when we switch from one insulin to another, we don’t go by the same conversion we would if he was starting from scratch because we already know what insulin can or can’t do for him.

    It’s your decision and if you go with 2u, we will back you up and work to fast track him but we’ve dealt with this many, many, many times and I just think 2u is too low.

    Caveat: if you see any BGs below 100 tonight, I’d start at 4u.
     
    Last edited: Jul 22, 2021 at 8:14 PM
  55. Max & Lori

    Max & Lori Member

    Joined:
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    Okay. I guess I'm a little nervous because I'm not sure what to expect. I hope he tolerates the time it takes to respond without getting sick. I wondered why the vet dropped it back so much. I suppose I was thinking it was stronger. I am getting ready to do some reading. I will check back later on the dose. Thanks for fixing my spreadsheet Chris.
     
  56. Max & Lori

    Max & Lori Member

    Joined:
    Tuesday
    Wow I am super nervous. I guess I was just thinking Lantus would be a lot less amount of insulin. I know you guys are way way more experienced than me. If I do go with the 5 units bid, am I supposed to tell the vet that? I'm supposed to do the glucose curve for him in a couple of weeks.
     
  57. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Well I would be honest with him. No…when we are switching insulins, except between Lantus and Levemir, we start at the dose where we saw some decent numbers.
     
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  58. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    @Lori & Max The other reason we don’t want to take the dose back too much because we know he at least had ketones if not DKA.
     
  59. smorgasbord

    smorgasbord Member

    Joined:
    Apr 19, 2021
    For what it's worth, we were on Vetsulin, 5.5 units, before switching to Lantus. Lantus dose of 2.5 was still getting readings of "Hi" (650+) on our AlphaTrak meter. It wasn't until we upped the Lantus to over 4 units that we saw any readings that weren't bonkers high.
    Glad you found a vet that agreed with giving Lantus, and don't be afraid to speak your own opinion with them!

    One more thing, I didn't see needles mentioned, forgive me if I missed it. Make SURE you are using needles that say U-100. Lantus is a U-100 insulin, and Vetsulin is a U-40 insulin.

    ETA: I see Diane already asked regarding the needles, great!
     
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  60. Max & Lori

    Max & Lori Member

    Joined:
    Tuesday
    @Chris & China (GA) @Marje and Gracie should I continue to post under feline health since I’m starting Lantus or move over to that forum? I know I’m going to need you guys a lot because I still feel clueless about what I’m doing. I read the Lantus files but I’m one of these “learn by doing” type of people. Thanks for your input @smorgasbord
     
  61. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Since you have learned the basics, you can move to the Lantus forum. If you haven’t read the stickys there, you’ll want to read them.

    Here are the Posting Guidelines to read first so you post correctly as it’s different there. Also, please link this thread. Be glad to see you there!
     
  62. Max & Lori

    Max & Lori Member

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    How do you link this thread?
     
  63. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    You will start each post over there by copying the browser address of the previous thread and pasting it in the new one following the above. Most people just entitle it “Previous” or “Yesterday” but some get creative. It’s very important to link the previous thread every day over there.
    Let me know if you have questions.
     

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