New Member - Rose

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rk34

rk34

Member Since 2022
Hi all. I'm joining here hoping to get a better handle on treating our cat Rose's diabetes. She is about six years old and recently diagnosed on September 8th, we started her same day on 1 unit Prozinc twice/day. With the Alphatrak II meter we had a couple BG curves back in September with the days starting/ending in 300-400s but still hitting mid-day lows around 50 our vet mentioned she wished she could raise the dose due to the highs but couldn't justify that due to the lows. We have been on 1 unit ever since and in between I had done several spot checks but not with any regular schedule. We tried to use a Freestyle Libre 2 last week and it fell off within an hour.

Rose used to be almost 11 lbs, I'm sure her old diet of unlimited dry food ended up causing her diabetes. I didn't know any better. Since her diagnosis we have switched to twice/day feeding of Tiki Cat After Dark wet food. At diagnosis she was down to 7.3 lbs,very bony and weak. Within a month on Prozinc she was back to around 9 lbs and looking/feeling much better so we've just assumed everything is fine.

Skip to Monday Nov 7th when I had planned to do a new BG curve to see how things are going and ended up with our first big scare. She started the day at 197 around 7:09am and ate, shot 1 unit at 7:55am. By 10:10am she was 79, I checked again at 11:12am and she was down to 23. I immediately fed her additional food, plus treats, as well as 2.5ml of Karo syrup. About 5 min later I tested again and got Lo readout (<20) and called the vet but they weren't available to talk. Rose was conscious and able to walk so I didn't panic too much. The vet called back shortly after the next test at 11:58am which she was back up to 131. Discussed the possibility that she may be going into remission a bit and to skip her evening dose and do another curve the next day. Rose seemed to be feeling bad the rest of the day but her BG bounced around between 80-120 for the next six hours. BG was up to 244 by the time I went to bed at 11:20pm.

Nov 8th she started the day at 313 BG and we dosed half a unit. She hit a low of 85 about 4.5 hrs in and steadily went back up to 193 in the evening when we gave her a half unit again. Today Nov 9th she started at 163 so we skipped her shot, but she went up around 250+ mid day and in the evening she was at 146 so we skipped again. Her last reading about ten minutes ago was 193 and I'm about to go to bed after writing this.

I feel terrible that she's probably been going low like this for a while, but she's been seemingly well. I've tracked all her data in excel but I see you all use a spreadsheet with specific format of +hrs after shot. I would like to convert it all into that for review and advice, but I was wondering if my test times are not at even hour intervals are you just rounding up or down?

I appreciate any help you can offer, and please let me know if you need any additional info.
 
Welcome. It is good that you are home testing and you took the correct actions at low BGs.
In order really help you we need BG value incudin g the curves you measure. Most of use here put the BGs in a spreadsheet which can be viewed by other with a link in your signature. Here is how to create and use the spreadsheet:
HOW TO CREATE A SPREADSHEET
HOW TO USE THE SPREADSHEET
If you have difficulties creating the spreadsheet other here can creat one for you.
 
Welcome Dan and Rose
The sooner you can get your SS done the better

We feed our cat's more than just twice a day.
We feed smaller meals maybe @+2 and @+4 like a tablespoon or so , bigger meal at AMPS and the PMPS
Thank God you were home testing ,I'm going to tag a Prozinc user for you ,and a few other members that aren't in case Melissa isn't around
You have come to the right place
If it wasn't for the experienced members here giving me advice Tyler wouldn't be in remission today
You asked about if the testing is not done at even intervals ,for instance say you do a test at 4 and a half hours after giving insulin you would put it in the 4 cell like this @4.5
.25 would be for 15 minutes
.5 would be for 30 minutes
.75. Would be for 45 minutes
Or let's say you test 2 hours after giving insulin and the BG is 40 ,then you test 20 minutes later and the BG is 45 you would put 40 in the 2 cell then right under that you would put 45 +20 min
When they are not done hourly you would need to color code them manually , the color codes are at the top of the spreadsheet

You want to mix up the times you test maybe one day test @+2, @+4 and @+6 both cycles
Next time test @+3, @+5, @+7 both cycles
The more the better



About the spreadsheet we use it to track our cats BG so we know how the insulin is working and how low they are dropping so we know when to either increase or decrease the dose
We adjust the dose by 0.25 units at a time . We don't adjust the dose by going by the Pre Shots

About the spreadsheet
AMPS - means AM Pre Shot the first test you take in the AM ,you need to withhold food 2 hours before testing so it's not food influenced

Units is where you would put how much insulin you gave
+1 is one hour after giving insulin if you were to test then that's where you enter his _BG number
+2 two hours after giving insulin. ditto
+3 and so on until you get to PMPS - PM pre shot withhold food 2 hours before testing

+1 same as you do for AM cycle

We don't give times because we are all in different time zones that's why we use the + numbers
I'll give you the link to set it up , if you have trouble just ask and we have a member who will gladly do it for you


You can look at any members spreadsheet to see what it looks like, it's at the end of everyone's signature just tap on itit

Do you have the U-40 syringes with the half unit markings
Please read about Prozinc here especially the dosing methods ,you would follow one of them ,
I would suggest SLGS for now
Read all the yellow stickys

https://felinediabetes.com/FDMB/forums/prozinc-pzi.24/

Here is something from the SLGS method to read but please read all the yellow stickys

Hold the dose for at least a week:
  • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.
After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours. Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet. The goal is to learn how low the current dose is dropping kitty prior to making dose adjustments.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit

We use 68 as the take action meter when using the alphatrak meter.
Start feeding Rose ,we don't like to see any number below 68 on a pet meter

Normal on a pet meter is 68-120ish.
 
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The Tiki Cat After Dark Pates are high in carbs ,if you are feeding the pates I wouldn't change anything since Rose dropped so low. Stay with what you are feeding her
We like to feed 10% carbs and under ,most feed 6% and under
I'll give you the food chart below

Sharing it here for easy reference (only including the "dry matter" chart since it's the one to follow):

upload_2022-10-14_12-56-9-png.65502
upload_2022-10-14_12-56-26-png.65503
 
Do you have any med and high carb wet food and some honey?
Such as

Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy 20% High Carbs

Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Turkey Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Chicken and Beef in Gravy 15% Med Carbs

Good idea to mark the cans with magic marker how many carbs

Or any on the food chart. Doesn't have to be Fancy Feast just an example about the med and high carb foods
And some honey in the house

https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-

Between 11% and 17% is medium carbs.

18% and over is high carb.
 
rk34 said:
Hi all. I'm joining here hoping to get a better handle on treating our cat Rose's diabetes. She is about six years old and recently diagnosed on September 8th, we started her same day on 1 unit Prozinc twice/day. With the Alphatrak II meter we had a couple BG curves back in September with the days starting/ending in 300-400s but still hitting mid-day lows around 50 our vet mentioned she wished she could raise the dose due to the highs but couldn't justify that due to the lows. We have been on 1 unit ever since and in between I had done several spot checks but not with any regular schedule. We tried to use a Freestyle Libre 2 last week and it fell off within an hour.

Rose used to be almost 11 lbs, I'm sure her old diet of unlimited dry food ended up causing her diabetes. I didn't know any better. Since her diagnosis we have switched to twice/day feeding of Tiki Cat After Dark wet food. At diagnosis she was down to 7.3 lbs,very bony and weak. Within a month on Prozinc she was back to around 9 lbs and looking/feeling much better so we've just assumed everything is fine.

Skip to Monday Nov 7th when I had planned to do a new BG curve to see how things are going and ended up with our first big scare. She started the day at 197 around 7:09am and ate, shot 1 unit at 7:55am. By 10:10am she was 79, I checked again at 11:12am and she was down to 23. I immediately fed her additional food, plus treats, as well as 2.5ml of Karo syrup. About 5 min later I tested again and got Lo readout (<20) and called the vet but they weren't available to talk. Rose was conscious and able to walk so I didn't panic too much. The vet called back shortly after the next test at 11:58am which she was back up to 131. Discussed the possibility that she may be going into remission a bit and to skip her evening dose and do another curve the next day. Rose seemed to be feeling bad the rest of the day but her BG bounced around between 80-120 for the next six hours. BG was up to 244 by the time I went to bed at 11:20pm.

Nov 8th she started the day at 313 BG and we dosed half a unit. She hit a low of 85 about 4.5 hrs in and steadily went back up to 193 in the evening when we gave her a half unit again. Today Nov 9th she started at 163 so we skipped her shot, but she went up around 250+ mid day and in the evening she was at 146 so we skipped again. Her last reading about ten minutes ago was 193 and I'm about to go to bed after writing this.

I feel terrible that she's probably been going low like this for a while, but she's been seemingly well. I've tracked all her data in excel but I see you all use a spreadsheet with specific format of +hrs after shot. I would like to convert it all into that for review and advice, but I was wondering if my test times are not at even hour intervals are you just rounding up or down?

I appreciate any help you can offer, and please let me know if you need any additional info.
Click to expand...
Hi Melissa
@FrostD

Tagging a few other members who are not Prozinc users in case Melissa is not around , she is pregnant and due soon

@tiffmaxee

@Suzanne & Darcy
 
Hi there. The whole situation sounds very scary to me. I hope you can get a spreadsheet up and running. Make sure you are feeding a low carb wet cat food and are splitting it up into smaller meals throughout the day, as has been suggested. If you want her to gain weight anyway (and sound like maybe she needs to?) then I would not worry too much about feeding extra at these snack times. If she is currently eating a high/medium carb cat food, I would transition to all low carb and monitor her BG levels as much as possible during the cycle (with spot checks at different times in the cycle) and I, personally, would not give insulin at this time until my full diet transition to low carb was complete. Only after Rose is eating all low carb wet food will you really know what is going on with her BG (without insulin). I am saying this because the low readings that you mentioned getting on your Alpha Trak, if correct, are extremely dangerous. After the transition, insulin could be restarted, if necessary, at an appropriate starting dose (based on the numbers you would collect after the diet transition is complete.) We would need to see a spreadsheet with this data that you will collect in order to be able to advise on whether insulin is needed or to advise on an appropriate starting dose. Lots of love to Rose!
 
Ale & Minnie (GA) said:
I think we all agree on more meals. Curious to see what Melissa thinks, but i feel you should go down to 1/2 a unit. 1 unit seems to be too much and getting her too low.
Click to expand...
Hi Ale she is on 1/2 unit
Here is where Dan mentions it
Nov 8th she started the day at 313 BG and we dosed half a unit. She hit a low of 85 about 4.5 hrs in and steadily went back up to 193 in the evening when we gave her a half unit again. Today Nov 9th she started at 163 so we skipped her shot, but she went up around 250+ mid day and in the evening she was at 146 so we skipped again. Her last reading about ten minutes ago was 193 and I'm about to go to bed after writing this.
@Ale & Minnie (GA) :cat:
 
Hi and welcome to the group! You are getting great advice in here, I have nothing to add just wanted to extend a warm welcome and say --- this place is amazing. If you trust the experts on here and follow their advice, wonderful things can happen.

My boy Hendrick was diagnosed in January of this year. With the help of the incredible people here like Diane, he is now a diet-controlled diabetic feline! He went into diabetic remission in June after following the Tight Regulation dosing method and heeding the advice and guidance of the FDMB gurus.
 
Ale & Minnie (GA) said:
I think we all agree on more meals. Curious to see what Melissa thinks, but i feel you should go down to 1/2 a unit. 1 unit seems to be too much and getting her too low.
Click to expand...
Agreed and that’s why they cut it to 1/2 unit. But I am still concerned with the nadir she had on the 1/2 unit dose and with doing a transition to low carb food that even 1/2 unit could be too much. We really need to see a spreadsheet to help!
 
Welcome!

I suspect yesterday's drop was a two-pronged issue - she cleared the bounce from the hypo very quickly, but also they tend to be more sensitive to insulin after hypos like that. She's leveled out fairly nicely without insulin but does need to be a smidge lower.

I do suspect she's been overdosed for awhile and is causing swings. Any history of ketones? Did she have any other issues at diagnosis? Infection, dental problems, etc?

If she doesn't have a history of ketones, I'd actually suggest starting at 0.1U only when she's above 175 and you can monitor. Of course, the spreadsheet you mentioned would give me a much better idea but for now 0.1U seems safest. It's a little difficult to measure at first. This is a U100 syringe but concept still applies:
upload_2022-11-10_21-22-45.png



If she has a history of ketones or DKA I'll have to see spreadsheet for sure and think on it.
 

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Thank you all for your kind words. A lot of questions between everyone's posts so I will answer all below:

1. I do have the half unit mark U-40 needles, smallest I could find so Rose wouldn't have too much pain (31ga 5/16")
2. We have begun feeding her in partial amounts bit throughout the first half of the cycles starting today. I understand now why that is a good idea and hope should help smooth out her curves.
3. We will make sure to pay extra attention/feed when she tests below 68.
4. Since late September we have fed her strictly the After Dark Chicken (not the pate) early on we were giving her lots of treats in addition to it since she is a picky eater and it also made the injections easier. The Tiki Cat has practically zero per the list posted above so I'm surprised that Rose is still ending up with highs. Our vet instructed us that the lowest carb diet possible plus insulin was the best course of action but I see now how both combined are causing her to have bad low levels.
5. We will purchase some higher carb wet food for use in low BG situations. She is a picky eater so we'll try some of these out and figure out what she likes.
6. We actually don't want her to gain much more weight, she is a small framed cat and at 11+lbs she looked pretty overweight if not obese. She used to have unlimited Iams Proactive Health food. We have been tracking her weight every other day since diagnosis and she is around 9.25lbs now and appears healthy
7. Other health issues: she had an emergency vet visit one week prior to her diagnosis due to a bloody puke. The ER vet did urinalysis and found 1000mg/dL glucose and 15mg/dL ketones, blood panel was all pretty normal except 320 bg. They said it was probably not diabetes but to have a follow up appointment. We had her normal vet visit scheduled a week out anyways because of her abrupt weight loss and lethargy. On Sep 8 (diagnosis date) our regular vet made the comment that the ER vet must have been stupid or something for not diagnosing at the time. Urinalysis on Sep 8 showed low single digit ketones (i don't remember the exact number and can't find the paperwork right now) Health problems otherwise are kind of long but nothing serious, we always joke that she has bad inbred genetics but we really love her a lot. We rescued her from the woods near our old house as a stray along with her mother and she was definitely malnourished as a kitten. Her mother sadly died abruptly after a year or so, after consulting with a vet the best guess was Feline Aortic Thromboembolism. As a kitten Rose got feline herpes virus and still has occasional flareups (over the last week she has lost some fur around one eye.) She used to have frequent bad gas and soft stool but that has improved significantly since wet food transition. Over the last 6 months she has starting compulsively licking her belly and thighs and has licked off most of the fur there and has some dandruff on her back. She lost several of her tiny front teeth within the first few years of her life and has one fang that sticks out a bit, more than one vet has said it is in OK condition and does not need to be pulled (yet.)

Hope I'm not writing too much...here is the spreadsheet with my data translated over. I really didn't know too much about when/how often to test before coming here so I understand a lot of the spot checks probably aren't useful. We will do a better job going forward.

https://docs.google.com/spreadsheets/d/15Ne49AbvqgdXMxpgJNFt34wY4o4VzxrMkkMITkSCtus/edit?usp=sharing
 
Beautiful spreadsheet! Way to go! She looks like she was doing okay. I agree that she was probably overdosed for quite a while. So glad you caught that lime green hypo! You're on the right track now. Some of the health issues you mentioned (such as fur coat) will quite possibly improve when she gets regulated. I used to feed those Tiki Cat foods (the low carb ones) also. My cat loved the one with the little quail egg halves on top. For treats when you are testing... what are you giving her? What does she like. A lot of us use the Pure Bites freeze dried treats (chicken, shrimp, etc.) as many cats like them and they are no carbs. But there are other options as well (even a small amount of any low carb food she likes) - I sometimes gave a few pieces of low carb Dr. Elsey's Clean Protein kibble to my guy... but since your kitty was recently transitioned, you may not want to give any kibble. Bonita Flakes are a real hit at my house. I buy the human grade ones from the (fancy) grocery store, but I have also used others in the past.
 
I do have a question when you get a chance to get your papers together... what was her Fructosamine level in the blood. You mentioned glucose numbers but I don't know if it's fructosamine, which gives more of an "average" of blood glucose over a period of time (about 2 weeks or so). That's really the test you want for diagnosing diabetes (although it's clear now that Rose is diabetic). Just straight glucose numbers are often elevated at the vet due to stress and (often) illness. I was just wondering if that ER vet just did a straight BG or ran a Fructosamine test (doesn't give me much confidence in them if they did not run it.) By the way, now that you are home testing, you will not need to run any more Fructosamine tests because you have all this data and can see how she's doing. My meter (ReliOn Premier, can give a 7, 14, and 30 day average of all BG readings.)
 
Ok I would try 0.25U any time she's over 200, and whenever you can do a spot check around +4 at least. If she drops below 90 that's a reduction down to 0.1U most likely

That was quite a high level of ketones, very lucky no DKA! We do recommend testing ketones at home about 2-3x a week, you can use human urine strips like Ketostix. They also make blood meters but those are a little more expensive. In her numbers I don't expect ketones, but given her history of ketones and other issues it's a good warning system.
 
Hi all, I updated the SS with the couple checks I did today. She was a bit high this morning (259) after getting .25U last night but we stuck with .25U again this morning and she was 207 at her +4 check. I figured I would try .5U tonight and do a +4 check before bed to be safe, hoping this will get us a better number tomorrow morning. Since I'll be testing her more frequently now is it OK to keep using her rear paw pads, she doesn't seem to mind at all? She has thin ears and the black fur makes it very hard to see veins, never had any success with that in the first couple weeks so switched to paws.

As far as testing goes I no longer give her treats, but she really likes the Temptations Chicken flavor. We've tried Blue Buffalo Wilderness chicken treats, some freeze dried chicken hearts, Inaba Churu purees and she doesn't seem to like any of them. She's always been picky, prior to getting diabetes she literally only ever wanted her Iams dry food, wouldn't eat any treats or any other type of dry or wet cat food, never liked milk/cream/butter/seafood/chicken or any other human food cats typically like. Her sudden weight loss and ravenous desire for new foods was what queued us to schedule her normal vet visit.

Fructosamine at ER visit (Aug 31) was 299µmol/L, within normal parameters.

For Ketostix is there any chance that pee soaked litter would be enough to get a result? I kind of doubt I'll be able to catch her in the act very often.
 
Can you put the spreadsheet into your signature please so it is early to see.?
No … sticking the strip into the pee soaked litter does not work.
I would definitely be testing the urine for ketones with the level that the vet tested.
CATCHING AND TESTING URINE

Are you testing the BG before you give the doses of insulin.? I can’t see many preshot tests at all.
 
Bron and Sheba (GA) said:
Can you put the spreadsheet into your signature please so it is early to see.?
No … sticking the strip into the pee soaked litter does not work.
I would definitely be testing the urine for ketones with the level that the vet tested.
CATCHING AND TESTING URINE

Are you testing the BG before you give the doses of insulin.? I can’t see many preshot tests at all.
Click to expand...


Just added it to sig. Prior to this week we didn't have much guidance on when we should be testing, so no. Going forward we are. An issue I realized though in the last couple days is the PMPS and the +11 are effectively the time same since we are testing at 7am/pm, letting her eat for 20-30min (she is a slow eater) then injecting right before 8am/pm. Should I try to adjust our timing on this process?

I'll pick up some Ketostix tomorrow and give it a try.
 
rk34 said:
Just added it to sig. Prior to this week we didn't have much guidance on when we should be testing, so no. Going forward we are. An issue I realized though in the last couple days is the PMPS and the +11 are effectively the time same since we are testing at 7am/pm, letting her eat for 20-30min (she is a slow eater) then injecting right before 8am/pm. Should I try to adjust our timing on this process?

I'll pick up some Ketostix tomorrow and give it a try.
Click to expand...
I would pick the time you want to shot and work back from there. I would still put the time you test as the PMPS.
As you are using Prozinc you don’t have to wait until she has eaten all the food before shooting as the onset of Prozinc is around +2. As long as she is eating and you know she will eat, you can shoot before she is finished.
 
rk34 said:
Yes, 249 which seemed pretty high, but now her AMPS today is 101...not sure if I should skip or just give a tiny amount like .1?
Click to expand...
Just tested again after 1 hr & food and she is only 109, I'll be skipping this shot. Seems like .5 at night is too much and .25 too little, or maybe after reading into SLGS I'm trying to adjust too much. Should I just stick with .25 for a week or so and see where her BG levels end up?
 
I would stick to the 0.25U for a few days to see how she settles down, you did the right thing skipping such a low preshot. Hopefully the 0.25U will let.you shoot twice a day, otherwise 0.1U might be better.

I think yesterday she was bouncing a bit, and then last night she had a later nadir - thats common when they break a bounce.

Either way these numbers at such a low dose are encouraging!
 
rk34 said:
I'll be testing her more frequently now is it OK to keep using her rear paw pads, she doesn't seem to mind at all?
Click to expand...
It's fine to continue testing with her paw pads if she's tolerating it. A lot of people use those head mounted bright lights to shine a bright light on their cat's ear to see the vein. But seriously, why mess with success if she's letting you do it? :-) Have you tried getting a small bag (2lb.) of Dr. Elsey's clean protein kibble food. She may like it for a testing treat since you said she used to eat kibble. My cats like all the flavors. Currently they get treats of the duck, rabbit (out of stock now) and sometimes chicken (which for some reason has become messy with a lot of broken pieces.) Chicken is the lowest in carbs though, but none of them are very high in carbs and we are only talking a few pieces as a treat.
 
Updated my SS and tested negative for Ketones on Saturday. I notice her BG is creeping up with the .25 dose but it's only been four cycles. If she is still high (300+) tonight do you think I should stick with the .25 or go a little more? If more what is the best way to measure .1 increments (ex .3, .4 etc)?
 
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