Hi Sally I can tag a few members for youLooking for advice on Alec's spreadsheet. He is on vetsulin since last Monday, started with 2 and was told by vet this Monday increase to 3. His glucose reading increased since the unit change, please advise.
https://docs.google.com/spreadsheets/d/1X3LCIrFUqEMprgaxBXj7zCnZ90QNcCwciaRTSC9n21w/edit?usp=sharing
You're right I just noticed that on the SSIt looks like you already did increase to 3 units a few cycles ago.
Waiting for answers to others' questions but please go down to 2.25U. 3U is far too high and dangerous at this point in time. If the vet based the decision on an in office curve, the BG is often elevated from stress.
Additionally, with how hard and fast he was dropping, he was doing what we call "bouncing". This is when the drop lower and/or faster than their body is used to; the liver perceives it as a threat and dumps stored glycogen and counterregulatory hormones in order to spike BG back up. The effects of this can last up to 6 cycles, though on Vetsulin it's usually less. So if a curve was done on a cycle where he was high and flat, it could look like he needs more insulin....but when he clears the bounce it can easily be a hypo at 3 units.
You can feed him any time during the day except for the two hour period before the preshot tests (the tests you get before shooting insulin.). Do the test first before you feed him. Then go ahead and feed him and shoot the insulin 30 minutes later. The reason for not feeding for two hours prior to the preshot tests is so that you can have an accurate blood glucose number that is not inflated by the food. This way you will be able to make sure that it’s safe to shoot insulin (that he is not too low.).Thank you so much for your advice! I reduced the does back to 2.25 U tonight, and even think I may go back to 2 tomorrow. Even though Alec just started to receive the shot last Monday, he actually showed worse symptom compared before he took any insulin. I definitely noticed he was less energetic, more hungry and drank/urined more since we gave him 3U 2 days ago.
I will start to do more tests today. Any suggestions on how frequent I should go? another challenge is he's been hungry all times, but if I need to test frequently, how can I give him some low carb food throughout the day?
His symptoms probably were worse because his BG numbers were so high. When they’re in higher numbers they usually drink and therefore urinate a lot more. It sounds like he doesn’t feel well in the really high numbers.Thank you so much for your advice! I reduced the does back to 2.25 U tonight, and even think I may go back to 2 tomorrow. Even though Alec just started to receive the shot last Monday, he actually showed worse symptom compared before he took any insulin. I definitely noticed he was less energetic, more hungry and drank/urined more since we gave him 3U 2 days ago.
I will start to do more tests today. Any suggestions on how frequent I should go? another challenge is he's been hungry all times, but if I need to test frequently, how can I give him some low carb food throughout the day?
I am a bit stressed out by the fact that his BG became higher after starting to get the vetsulin. I am not sure if I should have Alec stay on Vetsulim for a while before the switch or should I switch to other insulin.His symptoms probably were worse because his BG numbers were so high. When they’re in higher numbers they usually drink and therefore urinate a lot more. It sounds like he doesn’t feel well in the really high numbers.
I did not skip any shots, missed several preshot testings, Alec and I are still a bit nervous with that, but I am improving.Oh I meant to ask about the skipped shots?
The vet did not tell me, and did not share the test reports. I remember seeing a number (~275, but I am not very certain) on his note when he talked to us.Do you know what his fructosamine test number was when he was diagnosed?
You know, I really appreciate that you have begun testing Alec. It’s so essential and it can be scary and discouraging in the beginning. I’m impressed that you started a spreadsheet to chart his numbers. You’re doing well for a start!I did not skip any shots, missed several preshot testings, Alec and I are still a bit nervous with that, but I am improving.
I'll tag Melissa for you and Suzanne about your question about the type of insulin to give and the doseThanks, had another test just now. 2hr 40 mins after the PM shot. 598 down to 480. will do another one at +4 tonight.
Another thing is my vet asked to bring Alec in for a 2 weeks follow up exam (since last Monday's diagnosis), will be a day drop test - was told they will check his blood 3 times during the day, and 1 urine test. Alec will stay there from 7am to 5pm.
I am a bit hesitated bc Alec was totally stressed out every time visiting a vet, and he was never left alone without us at the vet's office. I am also not sure about 3 blood test throughout the day, are 3 times enough? I rather do a 12 hour curve at home when he is more relaxed. For now, I am really struggled with right dose and type of insulin to give and I want to focus on that first.
suggestions?
I did not skip any shots, missed several preshot testings, Alec and I are still a bit nervous with that, but I am improving.
That's what I figured, Thanks SuzanneWell the food is high carb, yes, so it is not ideal for a diabetic cat. But right now if Alec is getting insulin then we don’t want to do a diet change all at once because it could cause his numbers to drop lower. Either a diet change to an all low carb preferably wet food diet should be made first, prior to starting insulin, or the diet change would have to be made gradually after starting the insulin to slowly see how the change to low carb impacts his BG numbers. He’s already started insulin though.
You are totally right about taking Alec to the vet for the whole day for them to run a blood glucose curve. We recommend doing one yourself at home and testing every two hours for a 12 hour period. Alec will be much less stressed. You can share the test information with your vet if they really want it.Thanks, had another test just now. 2hr 40 mins after the PM shot. 598 down to 480. will do another one at +4 tonight.
Another thing is my vet asked to bring Alec in for a 2 weeks follow up exam (since last Monday's diagnosis), will be a day drop test - was told they will check his blood 3 times during the day, and 1 urine test. Alec will stay there from 7am to 5pm.
I am a bit hesitated bc Alec was totally stressed out every time visiting a vet, and he was never left alone without us at the vet's office. I am also not sure about 3 blood test throughout the day, are 3 times enough? I rather do a 12 hour curve at home when he is more relaxed. For now, I am really struggled with right dose and type of insulin to give and I want to focus on that first.
suggestions?
Well the food is high carb, yes, so it is not ideal for a diabetic cat. But right now if Alec is getting insulin then we don’t want to do a diet change all at once because it could cause his numbers to drop lower. Either a diet change to an all low carb preferably wet food diet should be made first, prior to starting insulin, or the diet change would have to be made gradually after starting the insulin to slowly see how the change to low carb impacts his BG numbers. He’s already started insulin though.
Don’t feel badly. This happens to TONS of people. Most of them are prescribed the Hill’s DM as if it were some kind of diabetic management food and it’s dietetic management. Apparently they were sued over the name and had to change it - that’s the story anyway.I am quite mad about the fact that both prescription ones are high carb! I used the chart to calculate carb for non prescription ones, but since these are all expensive Rx ones, I second guessed myself, chose to trust the vet and the brand!
Not too many things you can trust these days, sigh.
Thank you so much for all the helps, tips and supports here!
My recommendation - slow diet change first. How he reacts to that will tell me a lot about whether ProZinc might work for him, or if it's better to go straight to Lantus (or it's generics, many of them now are roughly the same cost as ProZinc anyway).
This is a pretty convenient chart - https://catinfo.org/chart/index.php
You'll want your regular low carb to be between 3-7%, but we consider anything under 10% to be low carb. You'll also want to some medium carb food in the 10-15% range, and some high carb in the 16%+ range. I also like to keep some very high carb on hand, 23% + just in case - these are all for your hypo kit should he get into trouble (see link). Definitely get the kit together before transitioning.
When you're ready to transition, let me know the day or two before so I can see his numbers and advise on how to adjust dose/slowly transition food.
Another thing I haven't seen mentioned yet - testing ketones. While he's unregulated, you'll want to test ketones at least twice a week. Some people use human urine strips like Ketostix...that would never fly with my cat so I use a blood ketone meter.
Thanks, will Keto strips for human work, https://realketones.com/products/ke...LBDVc_8doMShxEoIcfrjDxMfulYvJi4RoChnAQAvD_BwE, or I must get one for cats? I remember seeing a page on this site last night, but forgot how to find that again.Yep. I was waiting for today to have the ketone talk with you. I was trying not to overwhelm you on Day 1. But with those high BG numbers you have been getting you can first get some keto diastix and try to test his urine while he’s using the litter box. High ketones can be very dangerous and can lead to diabetic ketoacidosis (DKA) which is a life threatening condition. Hopefully Alec isn’t prone to high ketones. Since I didn’t like the idea of chasing my cat to the litter box and sticking something under his urine stream, I bought the NovaMax Plus blood ketone meter from ADW Diabetes Supply. Ketone strips are expensive, but a lot less than a DKA emergency stay at the vet.
so this Ketostix Reagent Strips for Urinalysis - 50ct will work?Human keto-stix or keto-diastix will work fine for a cat.
Yesso this Ketostix Reagent Strips for Urinalysis - 50ct will work?
https://www.target.com/p/ketostix-reagent-strips-for-urinalysis-50ct/-/A-14660510?ref=tgt_adv_XS000000&AFID=google_pla_df&fndsrc=tgtao&DFA=71700000049305059&CPNG=PLA_Health+Shopping|Health_Ecomm_Essentials&adgroup=SC_Health&LID=700000001170770pgs&LNM=PRODUCT_GROUP&network=g&device=c&location=9007275&targetid=pla-616407303065&ds_rl=1246978&gclid=CjwKCAjwk_WVBhBZEiwAUHQCmZRblSiRx4Ae0Jdhjps1EASczYMP38ldDnQ1e0YaLjkrUhvY-X-IDBoC1LgQAvD_BwE&gclsrc=aw.ds
Totally ridiculous. This proves he doesn't know much about insulin. Vetsulin and ProZinc are formulated completely differently! Also, first of all... what business is it of his how much you spend on insulin? But he's proven that he obviously doesn't know that there are several generic equivalents now for Lantus. Well, it will be completely useless for him to do a fructosamine test, but if you think you have to do it? What about it you show him your spreadsheet in a few weeks before you take him?Some updates from my call with the vet: 1. The fructosamine test was NOT done at the time of diagnosis when they did the blood test. The vet insisted to bring Alec in for 2 wk follow up check and he will do fructosamine test then. 2. About insulin, the vet said Vetsulin is very similar to Prozinc, while Lantus will be "too expensive for you". If we have to change, he will do that after 2wk check. 3. I brought up that the increase insulin from 2u to 3U made Alec miserable, he first said it's impossible that adding the dose would lead a higher BG reading, but he insisted to stay on 3- which I did not bother to argue and I will still do 2U.
Short term plan is I will stay with current 2U for at least a week, he's been doing better yesterday and this morning, also updated Alec's SS, I will do Ketone check starting today. I will continue the low carb food.
Open question: 1. should I bring back Alec for fructosamine test next week? he will have to be there whole day though. I feel only if we have that done, the vet may prescribe new insulin, but I am still very hesitated for reasons mentioned previously, plus less trust with this vet.
Appreciate your suggestions, thanks.
In transition, he is not addicted to the Hill W/D and only ate them for less than a week, so it's not too hard for him. Should totally change to low carb in a few days.How's it going with the LC food? Are you transitioning slowly or have you made the switch? Have you found some things he likes?
definitely thinking of that, the challenge is we've been living at where we are now for about 2 years, so we do not know many good vets around. Any tips on how to find one that are more experienced with FD cat?Have you thought about seeing a different vet? This one is not helping your cat.
definitely thinking of that, the challenge is we've been living at where we are now for about 2 years, so we do not know many good vets around. Any tips on how to find one that are more experienced with FD cat?