Newbie seeking advice

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lepick

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Hello, I am seeking advice for a newly diagnosed kitty and an overwhelmed kitty mom. I am mama to Xalli (pronounced Shalee) who is 13 years young and was diagnosed with FD on Monday after I noticed the large volume of water drinking and urination. I have had Xalli her whole life and she is such a love so I am heartbroken. At the vet on Oct. 18 at 2:30 pm er blood sugar tested in the low 300's, and the vet prescribed PZI insulin 2 units administered 1x daily. The vet asked me to pick up the insulin from the compounding pharmarcy and return the next day (Oct. 19) so he could teach me how to administer the shot. The vet gave me excellent instructions on administering the insulin shot and Xalli was given her shot at 11 am (around 21 hours after her original blood glucose). The trouble begins after this, however. First, while the vet gave wonderful instructions and went over very clearly how to administer the shot, he really didn't explain anything about timing feeding with it or explain that hypoglycemia was possible. And I was totally ignorant of this! So I went into the rest of my day knowing really nothing about feline diabetes.

Following the injection Xalli nearly immediately got very lethargic and just laid around barely looking up at me. However since I didn't know anything about hypo symptoms I thought she must be stressed from going to the vet office. She didn't want to walk much and when she did kept low to the ground like she might feel unsteady. At the time I didn't know what this strange behavior was, but hoped that eating would perk her up so thankfully gave her some food. Soon after she was still lethargic but seemed more content and moved around more. I was very concerned, however, that maybe I hadn't gotten the whole picture from the vet and went online and found this site and these boards. Thank goodness! I am so thankful for this and have learned so much.

It seems most likey she was hypo and I am now terrified that I put her in that dangerous situation and did not know how to respond! Now that I have read as much as I could here (up until 3 am trying to take it all in), I am not going to give her the insulin shot this morning until I have more information to use. This is my plan: get stuff to do a home test today and test blood sugar before administering any insulin. I am concerned that even if I took her to the vet the stress of it might be causing an inaccurate reading. Is this the right thing to do? I do not want to be irresponsible by not giving the insulin shot when the vet told me to do it, but the horrible thought of Xalli becoming hypo and me not knowing how to deal with it properly is really terrifiying. I just don't feel like I have enough information yet anyway, and given her response to the insulin yesterday (which seemed to be almost immediate even though the PZI isn't supposed to peak for 6-8 hours (according to the vet) I am really worried about that.

I want to know if this is the right course of action, and would seek advice from those here with experience. Is it OK to hold off giving the insulin until I do the home test? Can I wait 1 day before starting insulin until I have a chance to do this, or is this irresponsible? If the blood glucose comes back high should I go ahead with the insulin at full dose after I tested? Unfortunately I can't get home to do this until lunch or just after. I guess I don't know what to do at this point, and like many others who come here with a new diagnosis I feel overwhelmed. I want to be as responsible for the health of Xalli as I can so I would seek any input y'all might have. Thank you so much!
 
Hi there and welcome

Try not to worry (I know that is tough), you have done the right thing and chances are, things will be just fine.

It does sound like 2 units was too much and it is good that you figured out quickly what was happening. Now, to step back a minute...how was the diagnosis made? That is, was a simple blood glucose test or urine test done, or was a fructosamine test done? A fructosamine is the best route as vet stress would not affect the results.

It is possible that even if your girl is diabetic (symptoms match but could be other issues), 2 units may be too much to start with. What food does she eat?

Side note here....dosing should be twice a day, not once, as I've only read of one insulin (in the UK) that lasts all day.

Regarding your question of what to do...it is a tough decision whether to give insulin without testing or not. The vast majority of us start giving insulin before testing and in the vast majority of cases it all works out fine. But you've already had a potential episode of hypoglycemia so I'd say you are likely just fine waiting till you get a tester.

That said, there are a couple of things to note:
1. test urine for ketones daily while you are getting the hang of things, as ketones are a nasty complication that can happen in a newly diagnosed or poorly regulated cat
2. watch for increase in her symptoms (lethargy, increased urination, etc)
3. if it takes you awhile to get the hang of testing, CONSIDER a very reduced dose twice a day so that at least your cat is getting some insulin. I say consider because it is a risk to dose without testing, but it is also a risk to withhold insulin.

You may also want to post your general location in case one of us lives nearby and can give local help

Jen
 
Yes, it's very very overwhelming in the beginning. Even when you know what to expect, it can be scary -- I can imagine how scary it is to be uninformed and not know what's happening. The sooner you start testing Xalli at home, the better. This is just my opinion, but I think you're better off skipping the shot until you get a better handle on things. 300s isn't that horrible for a vet-tested number. My Donovan was higher than that and he didn't start insulin until a week later -- not saying I recommend doing that, but in your case I think it would be the lesser of two evils. Also insulin is almost always administered twice a day in cats. Something's not quite right here! :?

Others will be along to help -- hang in there.

MJ&Donovan
 
WARNING - do NOT change food while on insulin until you can blood test!!

Changing over to low carb, canned food may reduce blood levels 100 pts (US) and will drastically alter insulin requirements (see my cats spreadsheet - the vet had him on 3 units, twice a day - we're on an insulin holiday after being up all night checking him).

Being at home during BG testing may have values 100 pts (US) lower than at vet too.
 
You did great by giving her food and then going on line and learning more. Hold off on insulin until you learn to hometest. Then, if the number warrants it, I wouldn't give more than 1 unit.

Did the vet run any bloodwork to check for other conditions that cause increased drinking/urine such as Hyperthyroidism?

What type of food does your cat eat? Some kitties who are diagnosed as diabetic can be controlled on food alone.


It is scary at first, but you're doing great and you have a very lucky kitty.
 
I feel so much better already, thanks so much. I think I can breathe again! I'm not actually sure what kind of test the vet administered for the number he arrived at; he just said blood glucose and then when he was out of the room and I looked at the printout of the blood panel it also said blood glucose on it. So perhaps it was affected by vet stress a bit? Also currently Xalli has been eating California Natural but the vet gave us a bag of Hills m/d and I incorporated a bit of that into the dry food. However when I first noticed that she was losing a little weight last week I also got some canned food as I hadn't yet thought of diabetes as a possibility. I got Blue Buffalo and had been supplementing with a little bit of that 2x each day thinking it might help her gain weight. Then I put together that with the urination frequency and that was when I took her in.

I am going to get a glucometer at lunch and try my first home test. Is it correct that I am basically hoping for a blood glucose reading under 150? And that with something over that I should probably administer 1 unit? I am also worried now seeing that most say to administer 2x daily. Is there ANYONE out there with PZI that was ever told to administer 1x daily? I am beginning to worry that perhaps this vet just doesn't have current knowledge!

Thanks again, this is truly amazing to have such thoughtful and quick responses.
 
There are a few things to figure out here....lets sort through them

First, non diabetic numbers are under 120. Cats who are newly diagnosed are usually over 300 or more (generally).

Second, when starting out with insulin, a VERY general guideline is to keep values between 300 and 100. 100 is a very general 'lowpoint' goal because in the beginning you are learning how your cat responds to insulin, and hypoglycemia territory is somewhere 40 or under. So 100 has a buffer to it.

Third, once you get the hang of giving insulin, get your cat stabilized, change diet and learn how to test, then you can start working on those bg numbers. Section 6 (?) of the faq lists different levels of regulation to aim for.

Forth, PZI is NOT a once a day insulin unless you are giving a version used only in the UK. So your vet is setting your cat up to run high 1/2 the day. Starting at 1 unit twice a day is a much better plan (in my humble opinion )

Jen
 
Maybe buy some KetoDiastix when you are picking up a meter. It tests the urine for ketones and glucose. A bg of 300 at the vet is not a confimed diagnosis of diabetes.......did he also test the urine for glucose? If she is on a dry food diet, now is the time to switch to all canned, before starting insulin. Sometimes diet alone may keep a cat in good range. Also, there is PZI and there is PZI! Prozinc is the one now used for cats and the only compounded one that others may use is called BCP from TX. Is there a name for the PZI he gave you? PZI also is a twice a day insulin and 2 units to start out with is too high.

Learn to hometest her first, test her urine for glucose, get her over to canned for at least a day to see what numbers she gives you, and then post back here. I would not give her insulin right now......you were very lucky the first time with that vets advice and dosing......hometesting is going to tell you what you need to know. We will all be looking for an update from you and any questions you may have.......just post. Glad you found FDMB ;-)
 
Good catch on a dangerous situation. As others have said, it is possible that your kitty will only need a change to wet lo carb food or may only need a low dose of insulin. To figure this out, you can test her blood sugar at home.

Get a meter that sips and requires a small drop of blood. Many people here like ReliOn from Walmart. It is cheap and so are the strips.

Here is some info on how it is done. http://www.gorbzilla.com/Gorb%27s%20hom ... primer.htm
 
Sue, Gorb's site is no longer in existance...I think some of the info was moved to another site but I don't have the info

Jen
 
I got a meter and ran the test and the bg level is 348, at about the same time of day the test was run on Monday. I am so sorry to bug y'all for more information, but this then raises some questions for me:

1. Should I go ahead and administer a dose of 1 unit? (The vet originally said 2 units 1x daily). The problem is that then the 12 hour mark from that would be in the middle of the night. Or should I wait, test blood glucose again in the am and then administer 1 unit if the blood glucose is still high? Also, the insulin doesn't say anything on it except PZI Insulin and it came from a compounding pharmacy.

2. If I do administer the insulin, how should I organize feeding around that? I have seen the feeding faq that says you want them to have food at the time of the insulins peak. But I have also seen people say they feed at time of dose. Do I do both? I would be grateful for any advice at all on the specifics of feeding, but especially with PZI in particular.

I feel so much calmer and in control, thank you to everyone for the continued good will and addressing my questions!

-Lea (lepick)
 
Also I forgot to mention that I did pick up something to test for keytones but haven't been able to collect a sample yet. I will also do this as soon as Xalli cooperates.
 
Hi Lea,

I don't know your insulin so I can comment on dosing, but you might want to start a new topic and put dosing advice PZI in the subject heading.

What I do here as far as feeding since I have a furry hoard that is screaming in the morning for Breakfast I test Max, then feed then shoot if necessary. Which (crossing fingers so not to jinx it) so far I have only had to do a couple of times and with my boy it is beginning to look like diet alone may get him into remission. But ECID (Every Cat is Different) and every insulin acts different. I also feed 3 to 4 small meal throughout the day. Many here also use timed feeders as well to provide small meals throughout the day.

Oh and Welcome to the Vampire Club. Secret handshake coming later. :-D Doesn't it feel great to feel like you are in control? Now you will know exactly what is happening with Willow. And we can help guide you through the rest of it.

Mel
 
Welcome to the Vampire Club!

IIWY, I would give one unit tomorrow morning, after testing, assuming you get a shootable number. (For new diabetics, that is 200 or above.). If you have switched to wet lo carb, you may get a more interesting number...

With PZI, you can test, shoot and feed. We always shot Oliver when his head was deep into his food. (With some of the harsher insulins, you want to make sure they have food in their tummies before you shoot. PZI is milder. You're fine unless she is a picky eater or throws up easily.)

We could never get a urine sample unless we substituted aquarium gravel for the litter. He wouldn't pee while we were watching.....
 
Personally? My advice is to start over this evening, choose a 12-12 schedule that works for you and give 1 unit. But that is just me. As for feeding, I would feed prior to shot and give small meals 3-4 times a day if that works for you, as this will reduce the food load....

Does this help?

Jen
 
Has she had dry food to eat today? If so, her numbers might go down with just canned. Lets see what tonight brings. What type of syringe are you using and does the vial of PZI say U-40 or U-100?
 
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