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Mau's Mom

Mau's Mom

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Hello, PZI forum ;)

My cat Mau was diagnosed a few months ago with diabetes at a vet appointment and we have since made all the recommended dietary changes without sufficient success to keep him off insulin. He's mostly been in the high 200s/low 300s and had started to lose a bit of weight so the vet has prescribed insulin for him in the hopes of getting him regulated.

This weekend we were sent home with the ProZinc and instructions to start with 1 unit twice a day. For a variety of reasons, including a rude clinic employee who would not furnish us with the proper syringes and an unsympathetic pharmacist who would not sell any to us without a script, he did not get his first shot til last night (Sunday eve.) His first pre-shot BG was 302, we gave him his one unit, and then tested at +1 and +3 (in fairness I tried at +2 but was unsuccessful.) At +1 he was at 285, but at +3 he was at 323. Sigh. I did not expect that result, but by that time I figured he was at least not dropping like a stone/risking a hypo incident and we all went to bed. This morning I was not able to get a decent sample - Mau is now REALLY over the whole ear pricking thing, and I had to get to work - so he got his 1 unit shot and hopefully is surviving the day.

Can someone here tell me whether it is normal to get such a small/short response to this insulin and give me an idea what to expect going forward? Mau is a small (6 1/2 lb) young male that we guess is around a year and a half old. We adopted him earlier this year from a rescue so not sure of his exact age, but we do know his first few months were not healthy ones, poor guy. However, he is now healthy (other than the diabetes) with a nice shiny coat, playful demeanor, and loving personality.
 
Welcome Mau and ____?

When you say you made the recommended dietary changes, what are you feeding? We recommend low carb, canned or raw food with less than 10% calories from carbohydrates. Since that number isn't posted on the cans, one resource for that information is Cat Info, which has a printable file listing the % calories from carbohydrate, protein, and fat, plus the phosphorus concentration for those also fighting renal disease.

It can take some time to titrate the correct level of insulin. The most important number is the lowest level, the nadir, around 5-6 hours after a ProZinc shot. Very often, food may spike the glucose level around 2 hours after feeding.
 
You may find the following helpful.

Here are some glucose reference ranges used for decision making using a human glucometer:

< 40 mg/dL
- Treat as if HYPO
- At nadir (lowest point between shots) in a long term diabetic (more than a year), may earn a reduction.

< 50 mg/dL
- If before nadir, steer with food, ie, give modest amounts of medium carb food to keep from going below 50.
- At nadir, often indicates dose reduction is earned.

50 - 130 mg/dL
- On insulin - great control when following a tight regulation protocol.
- Off insulin - normal numbers. (May even go as low as the upper 30s; if not on insulin, this can be safe.

> 150 mg/dL
- At nadir, indicates a dose increase may be needed when following a tight regulation protocol.

180 - 280 mg/dL
- Any time - The renal threshold (depending on data source and cat's renal function) where glucose spills into the urine.
- Test for ketones, glucose is too high.

>= 280 mg/dL, if for most of the cycle between shots
- Uncontrolled diabetes and thus at risk for diabetic ketoacidosis and hepatic lipidosis
- Follow your insulin protocol for dose adjustments
- Test for ketones; if more than a trace level of ketones, go to vet ASAP.
 
BJM said:
Welcome Mau and ____?

When you say you made the recommended dietary changes, what are you feeding? We recommend low carb, canned or raw food with less than 10% calories from carbohydrates. Since that number isn't posted on the cans, one resource for that information is Cat Info, which has a printable file listing the % calories from carbohydrate, protein, and fat, plus the phosphorus concentration for those also fighting renal disease.

It can take some time to titrate the correct level of insulin. The most important number is the lowest level, the nadir, around 5-6 hours after a ProZinc shot. Very often, food may spike the glucose level around 2 hours after feeding.
Click to expand...

Thanks, BJM

He is on a low carb wet food diet (Fancy Feast, mostly.) I guess the uptick in the BG was probably food related, then, which is helpful to know. Unfortunately it will be next weekend before I can test him at +5 or +6 so I guess we will keep him on the 1 unit per shot for now and see how he does. I appreciate the links you posted above as well!
 
If possible, it will help folks give you feedback if you set up an online spreadsheet using our template and instructions here

Soem of the headings are:
AMPS = morning pre-shot test
PMPS - evening pre-shot test
+1
+2
etc = hours since insulin given
Notes/comments = self explanatory
 
Welcome Mau and Mau's Mom,

BJ has given you the basics. Can you tell us what trouble you are having getting blood? If you give us your technique, maybe we can give suggestions. Two questions right away - are you sure heating his ear before poking? What size lancets? (we suggest 25-27 gauge at first rather than the 30-31 gauge humans use.). Is he fighting you or is the ear not bleeding?

Would love to hear the story of how he got his name...
 
Sue and Oliver (GA) said:
Welcome Mau and Mau's Mom,

BJ has given you the basics. Can you tell us what trouble you are having getting blood? If you give us your technique, maybe we can give suggestions. Two questions right away - are you sure heating his ear before poking? What size lancets? (we suggest 25-27 gauge at first rather than the 30-31 gauge humans use.). Is he fighting you or is the ear not bleeding?

Would love to hear the story of how he got his name...
Click to expand...

Hi Sue,

I'm a Sue, too :)

I have been monitoring Mau's BG for months now, and usually I don't find it difficult but last night was the first time I had to do it so many times in succession (every hour or so following the insulin shot) and Mau just plain had had enough after the first few times.

He is a bit of a handful sometimes, and because he is a relatively new addition to the family, I am hesitant to make him fearful of me handling him. He had a *very* rough start in life and it has taken a while for him to trust me, and to let me pick him up and pet him and so forth. I was not willing to throw away all the months I've spent gaining his trust just to get one more BG reading last night. He'd been a really good trooper the whole day and the ear just wouldn't bleed the way I can normally get it to, plus he must have been sore from all the previous poking so I let it be once it appeared he was not in any danger of a hypo. We'll keep plugging away at it.

Mau got his name because, well... he's a Mau. It's an Egyptian breed, not something I knew anything about before we got him, but we've had fun learning about the breed since then. You can see what they look like here: http://www.cfa.org/Breeds/BreedsCJ/EgyptianMau.aspx .

They are very interesting creatures, with natural spots and a very cool underfur that can be a totally different color. Our little fellow is a smoke color and his underfur - invisible unless you ruffle the top hairs - is pure white. He looks like a little panther. He was too dark to be a good candidate for his show breeder, and was basically discarded as a result. grr_red

When the rescue found him, he was just a half grown kitten in really poor condition with mange, etc. Thanks to the rescue and their good care he recovered his health and we were thrilled to adopt him when he became available. He is a total sweetheart - not that I am biased or anything!!
 
Not biased at all ! ;-)

Check my signature link to Secondary Monitoring Tools for some additional ways to assess Mau, particularly urine ketone testing. Ketones form as a by-product of fat breakdown for calories. Too many may trigger diabetic ketoacidosis, a potentially fatal, expensive to treat complication of diabetes.
 
What a beautiful breed. Bless you for rescuing him.

Are you sure giving him a treat every time you test? That is usually the secret to this thing - they come to associate something they like with something they aren't so keen about. My kitty likes Pure bites - freeze dried low carb fish/meat treats.

If you have to ration testing until you both are comfortable, I'd suggest you always try for a test before each shot - to be sure the amount you are planning to shoot is safe - and whenever you can, a midcycle number.
 
Sue and Oliver (GA) said:
What a beautiful breed. Bless you for rescuing him.

Are you sure giving him a treat every time you test? That is usually the secret to this thing - they come to associate something they like with something they aren't so keen about. My kitty likes Pure bites - freeze dried low carb fish/meat treats.

If you have to ration testing until you both are comfortable, I'd suggest you always try for a test before each shot - to be sure the amount you are planning to shoot is safe - and whenever you can, a midcycle number.
Click to expand...

Aw, thank you. Of course we think he is just the handsome-est cat around! I put a pic of him in my avatar so you could see the real thing ;)

I do offer a treat every time we test but he is remarkably uninterested. I've never had a cat that cared so little for treats; he's really not food motivated at all. (As an aside, if your kitty likes Pure bites, I can send you several packages, as Mau turned his nose up at all of them...)

I have spoken to our vet, who is a very well respected feline specialist who has successfully managed quite a few diabetic cats in his practice, and he feels very comfortable with our current plan of just testing periodically. I know that it is not the approach recommended here and I understand it is not ideal not to test more frequently, but I have to balance that ideal with the reality of handling an animal who was essentially abused and whose trust in humans, even HIS humans, is a bit tenuous at this point. We'll just keep trying to manage as best we can. I thank you very much for your help!
 
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