New Member - Struggling to Regulate

[Meghan Murphy]

Hi everyone,

I am new here and wanted to introduce my 14 year old kitty, Cami to the group. She was diagnosed with diabetes in late February this year, which was closely followed by a dramatic stay in the pet ER where they helped get her electrolytes back on track and determined that she also requires a potassium supplement in addition to insulin.

Cami is currently on prozinc and was taking 4 units twice a day until this past Saturday (June 22) following a vet visit. They advised that we increase her dose to 5.5 units twice a day which we started on the June 22 evening dose. I attached two files - the file called "Cami Curve" shows her readings prior to the vet visit and we brought it with us to discuss, the second file called "Cami Glucose Readings" shows what happened since then.

Previously, on the 4 unit dose, her glucose levels were dropping and for a time were pretty steady in the mid 300s (not regulated, but fairly consistent and we started to see a decrease in thirst and pee which was great!). Her levels started to increase just before our scheduled vet visit to the low 400s, with some sporadic readings above 500. We were not sure why the readings increased since no other variables have changed. The vet gave her an antibiotic injection thinking the higher readings might be due to a UTI, but didn't do any testing.

Since increasing the dose to 5.5, her blood glucose has seemed to increase dramatically. Readings today were in the 500s, including the high 500s just before her evening dose. We are alarmed that the increased insulin dose has seemed to have a reverse effect!

Cami eats purina pro plan DM wet food and has about 2 cans per day (one in the morning and one in the evening). She is constantly hungry and I know the food isn't being processed correctly, which is tough for us to watch.

Wondering if anyone has advice or words of wisdom. We are trying to be patient and are sad that our kitty seems to be so stressed.

(Note that this dose increase was more than our typical increase. We previously only increased 1 unit at a time.)

 

[Bron and Sheba (GA)]

Hi and welcome Megan and Cami to the forum.
Thanks for the glucose readings.
When she was in the ER to have her electrolytes checked, did they say she had ketones or DKA?

First of all, increasing the dose from 4 units to 5.5 units is not something we would ever recommend. I don’t think that is a safe thing to advise.
We recommend increases of 0.25 units at a time. And only increase if the blood glucose indicates an increase. Looking at the curve you sent (the second one which multiple dates on it) I can see that the 3 units and the 4 units dropped her to the low 100s which means the insulin was working. Then she bounced back up high after that which is completely normal for newly diagnosed cats.
Here is an explanation on bouncing

• Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).

The high BGs you see after the lower ones are from bouncing….that doesn’t mean the dose needs to be increased. Dosing is based on how low a dose takes a cat, not how high it goes. Does that make sense?

How is the blood glucose being measured?
Are you testing it at home yourself?
If so what type of meter are you using?

For now until you can see what is happening with the blood glucose, by home testing, I would reduce the dose back to 4 units.
If you are not home testing I would recommend you think strongly about doing so. It is really the only way you can know what is happening and when to increase the dose and to keep Cami safe... We can help you with that. And if you can set up a spreadsheet of ours, we can help you with dosing.

Here is a link HELP US HELP YOU

Also a link to HOMETESTING

In regards to food, there is no need to be feeding a prescription food. Apart from the expense, there is nothing special about it. I will give you a list of foods which you can look at and which are available at pet stores and supermarkets. Just look for canned foods that are 10% or under carbs. FOOD CHART
Also please give some snacks during the day and evening as well as the two main meals before the doses of insulin. A snack is a teaspoon or two of normal low carb food. With the newer insulins it is better for cats if they get several snacks as well a the main meals. And you will find Cami will be much more content.
Also make sure you have a hypo kit set up in case it is needed. Info for that in the above link ‘help us help you’
I hope I have answered everything. If not, let me know.
Keep posting and asking questions. I am sure we can help you get sorted out with Cami.
Bron

 

[Meghan Murphy]

Thanks so much for your response!

She was tested for ketones before, during, after, and awhile after her ER stay, including in April when she was acting strange and I thought things were headed downhill. She has consistently NOT had any ketones, which is great. This is something we are aware of and was a major concern/reason we took her to the ER. So far so good. Fingers crossed. Is this something we can test at home? Would love to have a quick way to tell if something life threatening is happening.

We have increased insulin dose based on vet guidance - certainly not our own opinions since we have such little experience with feline diabetes. They based this increase on her fructosamine levels, which we previously used as a guide to increase insulin doses. Is this something you have heard of before? Her fructosamine levels have been consistently very high above "normal." Her most recent result was 524 (I think ~400 is the ideal max for diabetic cats). We have previously thought that using a 12 hour curve was the only way to determine a dose change, but the vet suggested fructosamine testing a couple months ago. Please let us know if you are familiar with the fructosamine approach.

The bouncing concept makes sense. That is the clearest explanation I have seen to date. Thank you for that!

We are testing her blood glucose at home using an AlphaTrak 3. We have also gotten some blood glucose tests from the vet at different times to corroborate "HI" home readings (basically confirming that it really was "off the chart" high). While alarming, it helped validate the results we saw at home. We are pretty comfortable with the ear prick testing and Cami has been so incredibly patient with us. Hopefully she knows we are trying to help her! We foolishly tried the Libre twice and it died both times shortly after. Since her BG was so high during this time, we got almost no actual readings, they were all just "HI." I doubt we would try this approach again.

Yesterday, her blood glucose readings at home were steady in the low-mid 400s. I'm going to fill out the template googlesheet I found in this forum so I can communicate numbers a bit better. Right now, we are obsessively tracking her readings in our own format. We measured periodically yesterday following our morning 5.5 units insulin dose. Before the dose, she was at 428, then at +1 she was 416, +3 was 417, +4 was 417, +5 was 426, +6 was 446, +9 was 433, and +10 was 448. So while we didn't see a big drop followed by bounce associated with this specific dose (or really any drop at all), I'm not sure if a drop may have happened a couple days ago and she is still recovering based on your feedback. I'm all ears if you have experience with this. These are the biggest questions we have... what, if anything, is "normal?"

Somewhat related, I'm wondering if behavior is sometimes a better indicator of a serious problem than BG reading. Sometimes she is acting totally normal with BG at 500. So while we might be concerned with the number, she is still playful, has an appetite, and seems to be doing okay. Times we have been concerned were usually due to change in behavior - mainly low energy and loss of appetite - which have usually coincided with VERY high BG. I guess my question is.... if her BG is steady at 400-450, if she is acting okay, should we be concerned? Or should we just stay the course? Obviously BG at 400 is not the end goal, but might be where we are right now as we refine dose amounts - is it possible this is normal?

Thank you so much for the food feedback. Cami was previously a bland, dry food eater only (science diet indoor). She ate this at the shelter and refused to eat anything else when we brought her home at 1 year old. She never previously ate wet food (because she didn't like it!) so the fact she was willing to eat the prescription wet food was a bit of a relief. We are certainly willing to try other varieties as long as she is too.

I'm also sure Cami would LOVE some snacks! This is great.

We appreciate you!

 

[Diane Tyler's Mom GA]

Thanks so much for your response!

She was tested for ketones before, during, after, and awhile after her ER stay, including in April when she was acting strange and I thought things were headed downhill. She has consistently NOT had any ketones, which is great. This is something we are aware of and was a major concern/reason we took her to the ER. So far so good. Fingers crossed. Is this something we can test at home? Would love to have a quick way to tell if something life threatening is happening.

We have increased insulin dose based on vet guidance - certainly not our own opinions since we have such little experience with feline diabetes. They based this increase on her fructosamine levels, which we previously used as a guide to increase insulin doses. Is this something you have heard of before? Her fructosamine levels have been consistently very high above "normal." Her most recent result was 524 (I think ~400 is the ideal max for diabetic cats). We have previously thought that using a 12 hour curve was the only way to determine a dose change, but the vet suggested fructosamine testing a couple months ago. Please let us know if you are familiar with the fructosamine approach.

The bouncing concept makes sense. That is the clearest explanation I have seen to date. Thank you for that!

We are testing her blood glucose at home using an AlphaTrak 3. We have also gotten some blood glucose tests from the vet at different times to corroborate "HI" home readings (basically confirming that it really was "off the chart" high). While alarming, it helped validate the results we saw at home. We are pretty comfortable with the ear prick testing and Cami has been so incredibly patient with us. Hopefully she knows we are trying to help her! We foolishly tried the Libre twice and it died both times shortly after. Since her BG was so high during this time, we got almost no actual readings, they were all just "HI." I doubt we would try this approach again.

Yesterday, her blood glucose readings at home were steady in the low-mid 400s. I'm going to fill out the template googlesheet I found in this forum so I can communicate numbers a bit better. Right now, we are obsessively tracking her readings in our own format. We measured periodically yesterday following our morning 5.5 units insulin dose. Before the dose, she was at 428, then at +1 she was 416, +3 was 417, +4 was 417, +5 was 426, +6 was 446, +9 was 433, and +10 was 448. So while we didn't see a big drop followed by bounce associated with this specific dose (or really any drop at all), I'm not sure if a drop may have happened a couple days ago and she is still recovering based on your feedback. I'm all ears if you have experience with this. These are the biggest questions we have... what, if anything, is "normal?"

Somewhat related, I'm wondering if behavior is sometimes a better indicator of a serious problem than BG reading. Sometimes she is acting totally normal with BG at 500. So while we might be concerned with the number, she is still playful, has an appetite, and seems to be doing okay. Times we have been concerned were usually due to change in behavior - mainly low energy and loss of appetite - which have usually coincided with VERY high BG. I guess my question is.... if her BG is steady at 400-450, if she is acting okay, should we be concerned? Or should we just stay the course? Obviously BG at 400 is not the end goal, but might be where we are right now as we refine dose amounts - is it possible this is normal?

Thank you so much for the food feedback. Cami was previously a bland, dry food eater only (science diet indoor). She ate this at the shelter and refused to eat anything else when we brought her home at 1 year old. She never previously ate wet food (because she didn't like it!) so the fact she was willing to eat the prescription wet food was a bit of a relief. We are certainly willing to try other varieties as long as she is too.

I'm also sure Cami would LOVE some snacks! This is great.

We appreciate you!

@Bron and Sheba (GA)

 

[Bron and Sheba (GA)]

Is this something we can test at home?

Yes you can text for ketones with a bottle of ketostix from Walmart or a pharmacy …it’s a urine test..OR you can buy a blood ketones meter and test similar to a blood test.

We have increased insulin dose based on vet guidance - certainly not our own opinions since we have such little experience with feline diabetes. They based this increase on her fructosamine levels, which we previously used as a guide to increase insulin doses. Is this something you have heard of before? Her

A fructosamine test is a good test to do at diagnosis as it can tell you what the average BG has been for the past couple of weeks, and eliminates cat stress which can heighten the BG at the vet. But after that, if you are hometesting, the fructosamine test is really redundant.
Many vets don’t really understand hometesting or don’t want to and still rely on the fructosamine test which only gives an average…not if the BG is high or low. So there is no need to spend money on those again if you are hometesting.
In saying all of that, even if the fructosamine test was high, I would only recommend going up by 0.25 unit increments. You can’t rush feline diabetes. You are right, using a 12 hour curve is a much better way of deciding the dose. Even just looking at the spreadsheet as a whole over the last week, if you have been doing several test a day, will tell you what needs to be done.

We are testing her blood glucose at home using an AlphaTrak 3. W

Keep using the alpha track meter. Can you set up a spreadsheet please and start adding data. If you can add the past few weeks that would be great. We can help you with dosing but we have to be able to see the BG data on the SS. Also if you could set up the signature …very easy…so we can find out all about your kitty. That will appear at the bottom of all your posts. People who help you with dosing will look at the SS and signature every time.

Before the dose, she was at 428, then at +1 she was 416, +3 was 417, +4 was 417, +5 was 426, +6 was 446, +9 was 433, and +10 was 448. So while we didn't see a big drop followed by bounce associated with this specific dose (or really any drop at all), I'm not sure if a drop may have happened a couple days ago and she is still recovering based on your feedback. I'm all ears if you have experience with this. These are the biggest questions we have... what, if anything, is "normal?"

Yes it is very possible she is still bouncing from a lower BG a day or 2 ago. Bounces can last for up to 6 cycles. Only looking at the data over several days will tell us. So keep testing and I’m looking forward to seeing the SS

Somewhat related, I'm wondering if behavior is sometimes a better indicator of a serious problem than BG reading. Sometimes she is acting totally normal with BG at 500. So while we might be concerned with the number, she is still playful, has an appetite, and seems to be doing okay. Times we have been concerned were usually due to change in behavior - mainly low energy and loss of appetite - which have usually coincided with VERY high BG. I guess my question is.... if her BG is steady at 400-450, if she is acting okay, should we be concerned? Or should we just stay the course? Obviously BG at 400 is not the end goal, but might be where we are right now as we refine dose amounts - is it possible this is normal?

Cats can get used to high BGs if they have been in them for a while. And their bodies think that is the new normal. If the BG goes up really high they can feel lousy OR if the BGs drop lower than they are used to ….say in the 200s ….they can also feel lousy, as their body is not used to these numbers. There is really nothing you can do about it except home testing, making sure there is plenty of water available, feeding lots of food and giving the doses of insulin and following a dosing method. Following a dosing method is what I would strongly recommend.
Here is a link to using prozinc insulin.
PROZINC BASICS

PROZINC DOSING METHODS

I'm also sure Cami would LOVE some snacks! This is great.

Yes please give lots of snacks. I remember when my Sheba was diagnosed I only fed her twice a day as per the vet and she was always crying for food. I felt awful. When I started to give her snacks she was so much happier and content.

I am going to tag @Suzanne & Darcy to help with dosing a she is a prozinc user.