Newbie here, Woody's first homemade curve

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Featherwood

Member Since 2012
Hello from a confused newbie. I've read through this site and the forum, and it's helped me a lot in the last couple of weeks. This is my first post.

Woody was diagnosed as diabetic about 2 months ago. He is eating Purina DM food, he is supposed to eat 2 meals a day but that is really hard -- he begs for food all the time. When he gets a meal, he eats a bit, then wants to come back and eat again in 15 minutes. I limit him to eating in a 2-hour window, from 7 to 9, then he also gets a snack or two midafternoon.

Woody is an old guy, 15. He also has some dental problems, 2 bad teeth, that can't be treated until he gets his diabetes under control. He no longer will eat kibble, so all the food he gets is the canned DM. He continues to drink lots of water and pee a lot, and is losing weight. His diabetes is far from under control.

He's been to the vet three times, to run a curve. Each time has resulted in a recommendation to increase his dose of Prozinc insulin. Woody now is getting 7 units, twice per day, at 7 am and 7 pm.

I don't really like taking him to the vet and leaving him all day - he hates it, plus it is expensive. I bought a home glucose monitor and then spent about a week figuring out how to get a blood drop! Who knew it could be so hard. I got a big blood drop with no trouble, first time, in my own finger, but Woody was tough. Thanks to this site for the illustrated instructions -- using a small bottle of hot water to heat the ear first makes all the difference.

Now, I've got my first all-day numbers. I don't know how to graph them and attach to this post (a link to instructions would be grand; I've not found any on my own) so I'll just give you the numbers:

7:00 am 600+ Gave 7 units, DM food
8:41 am 600+ a few more bites of DM canned food
10:42 am 600
12:22 pm 531
1:50 pm 503 snack of DM food
3:46 pm 410 snack of DM food
5:05 pm 493
6:32 pm 467

I will call the vet and give her these numbers in the morning, and I expect her to increase his dose.

Any advice from you would be greatly appreciated. In particular, I'd like to know if you strictly limit your cat to 2 meals per day -- does that work for your cat? I've seen some talk of feeding every three hours, night and day. My vet thinks that is a terrible idea, and wants me to give him 2 meals a day, period end of statement. But that is really hard on Woody.

Thanks in advance for your help.
 
Welcome both to the forum and to the Vampire Club! It will be so much easier to figure out what is going on when you test at home.

The most interesting thing I see in your numbers is that he is continuing to drop almost 12 hours after the shot. That might support the idea that he is getting too much insulin rather than not enough. But he certainly does not have a normal looking curve. - his lowest point may be after 12 hours. It can be dangerous to lower the dose to see if you are over his ideal dose. I would want more input from others before considering that.

The other thing that could be the problem is a high dose condition. Here is some info:
http://www.felinediabetes.com/FDMB/viewtopic.php?f=12&t=375. Does any of this sound like your kitty?

And if he has dental problems, that can really elevate his numbers.

Here are the instructions for the spreadsheet. It's a little tricky so ask for help if you need it.

http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

Lots of us feed small frequent meals - it supports the pancreas. And unregulated cats are literally starving. How big is your boy and how much is he eating daily?
 
My vet thinks that is a terrible idea, and wants me to give him 2 meals a day, period end of statement.
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I have no idea why the vet would think that, but to put it bluntly, he's totally wrong. Human diabetics are encouraged to eat several small meals a day so that they spread the boost to BG from eating more evenly. Same thing works for cats. You can feed him as many times as you want, the only restriction is that you don't want him to eat for a couple of hours prior to his shots. You want your preshot test to be free from "food boosted BG".
From what you are saying, he's acting like he's starving, and he's still losing weight. Well that because he is diabetic and he literally is starving. Diabetics can't process food correctly. If a cat who is diabetic were not treated, they would die from starvation.
How much food is he eating daily? And how much should he weigh (I'm assuming that at this point he is underweight?)?

In 2 months, he has gone up to 7u twice a day? What was he started at, and how were the doses increased (what were the increments)? It sounds like his dose was raised too quickly, and in increments that were too large, but if you can give us some dosing history, that will help.

Has your vet had much success in treating FD? Is his insulin of choice Prozinc?
Has Woody been tested for "high dose" conditions like IAA or Acromegaly? I ask because 7u is a high dose compared to what most cats need.

The dental issue is sort of a catch 22. They don't want to do something because he's diabetic and unregulated. But the dental issues can make the diabetes harder to treat because if it causes infection or pain, those things will keep his BG elevated. I'm hoping someone else who had the same problems can help by telling you what worked for them.

The DM canned food is actually a good choice of food. It's low carb, and the only issue people seem to have with it is that many cats get burned out on it. That and it costs a lot compared to Fancy Feast classics, Friskees and other easily available low carb choices.

Carl
 
Woody is about 10.5 pounds now (when he was healthy, he weighed as much as 14 pounds). He acts like he is starving, that's for sure. He's always hungry, wants to eat, yet continues to lose weight. He eats about 1.5 cans of the 5.5 oz cans of DM food per day.

I read your link about acromegaly. Woody does seem to be slightly sensitive to bright light, and he does look scraggly -- he hasn't been grooming as normal. I figured he doesn't groom because he has dry mouth, no matter how much water he drinks. He also has had some breathing changes -- he sometimes sounds like he is snoring. But, Woody definitely does not gain weight without feeding him more food -- just the opposite, he is getting too skinny. So that seems to rule out acromegaly.

The information about Insulin Auto Antibodies is very interesting. I have felt a little bit of despair that Woody does not seem to be responding to insulin. For the first 4 days after his diagnosis, treating him with 2 units, morning and evening, he seemed to respond well -- his water consumption went down dramatically and he had more energy -- he even went outside and stole a mouse from Feather, my young female cat and still-learning hunter. Woody swiped it from her while she was playing with it after catching it.

Then, for the last seven weeks, I've been pulling my hair out trying to get him back to feeling as good as he did those first 4 days, with no luck. I even insisted the vet sell me a new bottle of insulin, because it seemed like it had completely lost its effectiveness. The vet keeps looking at his curves and saying he needs more insulin, but we can't increase the dose too fast. I will talk with her about IAA antibody testing.
 
To add to what I said about how many meals a day is best, here is a link to the AAHA guidelines for management of feline diabetes (Just so your vet will understand that it didn't just come from a bunch of internet crazy cat people, lol)
http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf
Management
• Feeding meals four times daily is ideal to prevent clinical hypoglycemia for cats on insulin. Timed feeders are
useful for cats that require multiple meals per day to
manage weight and control calories. Use of insulin
glargine may reduce the need for timed feedings, as long
as home monitoring of BG is being done. (See Insulin
therapy in the cat.)
• Free-choice feeding is acceptable for underweight cats
on insulin therapy.
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Carl
 
Human diabetics are encouraged to eat several small meals a day so that they spread the boost to BG from eating more evenly. Same thing works for cats.
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I thought this, too. My diabetic father-in-law was encourage to eat lots of small meals per day. But my vet talks about the time-release nature of ProZinc insulin, she says it is meant to work with twice-daily meals. She says that if we feed him small amounts throughout the day, he will constantly be getting sugar highs with not enough insulin to counteract it.
 
He eats about 1.5 cans of the 5.5 oz cans of DM food per day.
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Does it say on the can how many calories are in each can? A healthy 14 pound cat would need between 280-420 calories of food per day in order to maintain that weight (the range takes into account things like how active a cat might be). A diabetic cat would need more calories per day to maintain his weight. If you want him to gain weight, even more so. I'm thinking he probably needs at least 2 cans per day?

Carl
 
Woody started at 2 units, twice per day. Then, about 3.5 weeks later, he went to the vet for a curve, and his dose raised to 3.5 units, twice per day. About 10 days later, he got another curve and the dose raised to 5 units per day. Then, a week later, another curve, and the dose raised to 6.5 units. Then, for the last week, we've been giving him 7 units, twice per day.
 
If I allow Woody to eat whenever he wants to, I'm sure he will go up to eating 2 cans per day. It 's the 2 meal a day limit that restricts his consumption. No matter how hungry he is, he won't eat more than 1/3 of a can at a time.

You are convincing me I should let him eat at will, as much as he wants, except for the 2 hours before his shot.

Thank you so much for all your help.
 
OK, that's just too much too soon. The guidelines call for increases of smaller increments, as little as .25u or at most .5u at a time. What your vet did going from 2u to 3.5 was increase the daily insulin by 75%. That's too aggressive. What if, for example, the "right dose" for Woody was 2.5u? Jumping all the way up to 3.5 makes it impossible to find that "right dose". Actually, the 2u starting dose was too high to begin with. Most kitties start at 1u BID or less.

Sometimes, too much insulin can "look" like too little insulin. A cat's body can fight off low numbers instinctively (we call it liver panic). Especially the way he's been diagnosed (just by curves done during a day at the vet's office). If the BG goes low, the body will react by triggering the liver to produce glycogen (fancy word for sugar) and counter-regulatory hormones. Basically it will flood the bloodstream with sugar to offset the insulin dose. The numbers don't have to even be dangerously low numbers (hypoglycemic levels). If a cat is used to BGs in the 400s, even a drop to the 200 range can cause that to happen.
The body will continue to fight against the insulin until it reaches a point where it just can't keep up any more. If that happens, the cat can "crash" and there's nothing stopping the BG from bottoming out. I am not saying that is what is happening with Woody, but it could be.

These "liver panic" numbers don't just go away all of a sudden either. They can take a couple days to clear the system. Possibly, that has been happening, and on the days you have brought him to the vet, that was the reason behind the higher numbers the vet saw during the curves.
Testing once a week, or once every three weeks is pretty useless. You can't evaluate how a dose is working based on one set of tests over a single 12 hour cycle once every three weeks.

That's why we are so big on home testing. They give you a daily report on what the dose of insulin is doing. It allows you to catch the low numbers during a cycle, and it show you when the "bounces" from low numbers happen. Basically the way your vet has been evaluating and changing the dose is an ineffective way of doing it.

he won't eat more than 1/3 of a can at a time.
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Then you should definitely go with multiple 1/3 can servings. Another thing that can happen is that if he realizes he's only going to get two meals a day, he'll end up gorging more than his belly can handle, and you'll end up with "scarf and barf". He won't be able to keep the food down, and it's important that he have food in his belly when you are shooting insulin. Food and insulin are opposing forces with regard to blood glucose levels. A shot on an empty belly can act "stronger" than it would when there's food in place to counter the insulin dropping the BG.

Carl
 
What now?

How would I go about finding Woody's ideal dose? Go back to 1 unit twice per day? start over, test frequently, adjust dosage gradually? Or, would I move down gradually from his current dose of 7 units twice per day?
 
I think I would first talk to my vet. I realize I've said some things that are critical of the way he's done things so far. But, try to find out what I mentioned earlier. Find out if he's got a lot of experience with FD and with PRozinc. Find out how many cats he's had go into remission. Find out if he's aware of the AAHA guidelines. A new vet might be an option if there's one in your area with a lot more experience or level of success in treating diabetic cats.

Explore the IAA possibility. A 7u dose is not "normal" especially this quickly.

Has anyone mentioned testing for ketones in his urine yet? Any time you reduce a dose, especially significantly reduce it, you want to test for ketones while doing that. Ketones are nasty stuff. They can appear suddenly and quickly turn into DKA which is a life-threatening condition. Ketones can come from a combination of things like an infection, lack of appetite, and insufficient insulin. So when reducing, you have to watch for them. My cat went from "no ketones" to DKA in 3 days. He almost died and spent three days in emergency care. That happened right after he was diagnosed, and his were most likely caused by really high BG numbers, not enough insulin, and not eating much. As far as I know, infection wasn't present.

So, before changing anything, talk to the vet. If he's not open to discussing it, see if another vet is an option. I think you could reduce the dose, but I hesitate to say drop it all the way down to 1u right now. If you were at 3u right now, I'd say give 1u a try, but from 7u to 1u is probably pretty risky without a vet to help you out. At the same time, I don't know if dropping from 7 to 5 is going to tell you much because it's possible that 5 is still too much. If you did that, and his numbers didn't get any worse than they are right now, then that would indicate to me that 7 is definitely too much. You can step down like that, but you still want to keep a close eye on the appearance of ketones.

Carl
 
First comment I have is "that's alot of insulin"

The first thing you can do is feed Woody whenever he wants to eat because he is starving. His body is not capable of extracting what he needs from the food. As has been said, human diabetics would do poorly on 2 meals a day, so why some vets think that's the way to go for our cats is disturbing. Let Woody eat.

Now, be sure to cut out ALL dry foods and treats. You don't need to feed the expensive DM foods, and I bet he will love the Fancy Feast or Friskies pates. Here are some food links to start you off:

Binky’s Food Lists
Feeding Your Cat: Know The Basics of Feline Nutrition

Next, get yourself a blood glucose meter but do NOT get any of the FreeStyle meters or ones with TRUE in the name; they will not give you true readings. If you are in the US, the Relion meters are just fine and have the most economical test strips. Others that are good are the OneTouch and Bayer meters. Also, pick up a container of KETOSTIX from the pharmacy to test Woody's urine for Ketones because the recipe for a very sick cat includes not enough food, not enough insulin/high BG numbers, and infection.

I am not clear why one would recommend testing for IAA because the curve numbers you provided are not anything that would suggest IAA.... maybe acromegaly and IAA as well, but before we get to the tests, first to start recording what Woody's numbers are for a few days, and ensure he's getting enough low carb wet foods. If you do decide to have Woody tested for any insulin resistance conditions, both tests should be done because many cats have one or the other, and some have both. The test result for IAA could well be a false positive, so you would still be left wondering.

If you do find that Woody has one of the above conditions, it would be preferred that you switch to a longer lasting insulin because Prozinc for an insulin resistant cat very likely will require you to dose TID or every 8 hours. I would suggest that you talk to your vet about switching to Levemir (Detemir) - another good insulin would be Lantus (Glargine), but Levemir has been getting better results for many plus humans have stated that Lantus can cause a sting when at higher doses.

Home testing is the way for you to go... most cats will have different numbers, mostly higher, when at the vet.... vet stress will cause curves to be of little use. One of my cats always tested higher at the vet. You will find Woody will have less stress by being tested at home, and most of the people here can give you all sorts of tips to help with testing.... a poke on the tip of the ear and you are done.

So, start feeding Woody more often, pick up some KETOSTIX to test urine for ketones, switch to low carb wet food that is cheaper and tastier for Woody, pick up a BG meter and strips to start home testing.

If you find that numbers continue high, and you want to test for acro and IAA, I think I would try to switch to a longer lasting insulin and once settled, have the 2 tests done.
Without seeing what his numbers are at shot times and after a few hours, there is no way to say for sure what's going on.
Woody may need much more insulin or it could be that the curve was also a bounce combined with stress. Only by your testing at home, where Woody is relaxed and eating known low carb foods, will you know exactly what's going on.
 
Hello Woody and Bean!!!

This is the best place to find out about FD. I echo all others- feed several small meals in the day/night. When DX Sneakers was eating 15-20 oz/day- mainly because she was starving. She ate every two hours day and night. Once the insulin starts working Woody will decrease his food intake on his own. Ask your vet if he only eats two times a day- and I doubt it- why should a cat? And look on Binky's list or Hobo's list for better variety and cheaper food to feed him.

Ketones- with his numbers in such high numbers checking ketones is a must. DKA is an expensive and deadly end result. The ketostixs are the best insurance to check at $7/50.

Meter- you are testing, and since you have been getting high numbers I don't believe you have one that doesn't work on cats. It would help to know which one you have, and whether it is for humans (Relion/Bayer/Accu) or animal (Alpha Track) as the point systems differ between the two.

We keep track of our numbers with a spreadsheet and this topic tells you how to set it up- viewtopic.php?f=6&t=50130

Dose- Sneakers used PZI for three months- 7u seems high but dropping it down to 1u can cause problems of the expensive kind. I would suggest down to 6u or 5.5u first and holding that for 5 days while testing for ketones, then down to 5u or 4u for another 5 days and so on with smaller incriments the lower it goes (by 4u you should decrease by .5u only). It takes a longer time this way but PZI doesn't build up in the system like Lev or Lantus does so you don't have to deal with shed drain but you still need to see how he reacts to each drop in level.

High dose kittys- Sneakers is an acro cat and currently dosed at 25u BID of Levemir- and she hadn't grown 'big' when I got her tested- just a pot belly at first but she was at almost 9u of Lev at the time and you only saw it when she walked. The test is $49 for Acro, $15 for IAA and they both go to the same place so having both tests done at the same time, if you can afford it, would be best for piece of mind. Your own vet can draw the blood and I would suggest spending the extra $15 to purchase the Fed-Ex shipping package from the college through the vet. That way it gets there quickly. I would also suggest you get this done NOW as you are dropping the dose. That way you don't get all the way down to 1u and find out he still isn't doing that well and decide to test- that way leads to DKA or CKD(F?). Sneakers didn't start showing improvement until she got into 20u BID- food went from 20oz/day to 12, peeing is less, and she is a little more active than before. Of course, she's gained some since diagnosis but that is to be expected :lol: Kidneys are still fine, too.
 
Thanks for the thoughtful responses. You've sure given me a lot to think about. I appreciate the time people put into their replies. Woody says thank you, too.
 
YOu mentioned that Woody ate dry food. By any chance was this free fed - meaning did you put it in a bowl and leave it for him to eat whenever he wanted?

I ask this, because my cats were fed this and are considered grazers. Meaning they don't sit an eat a meal, they take several bites, walk away and come back whenever it suits them.

As this is their way of eating, I have adapted using wet food in the same manner. I put out the food in the morning and evening and let it sit until the next "meal" time. My girls will eat what they want, sometimes most of the food, sometimes just a bite or two.

I also add a full can of water to the food - this keeps it moist longer, as it sits out all day/night, and also ensures they get plenty of water in their systems - as Maui tends to no longer drink water from the water bowl.

Also, when Maui was first diagnosed and I transitioned her to wet food - she could eat 2-3 cans of Fancy Feast in one sitting alone. And yes, I let her have it all, as her body needed it.

Now that she is in remission, she rarely eats like that anymore.

so, just some things to think about and options to consider with your feeding plan.
 
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