Newby - Need Help

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snorton

snorton

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My 11 1/2 year old male was diagnosed last week with Diabetes. I need some advise on food and feeding schedules. I have been given him 1 U of PZI once a day. The results of 12 hour testing is below. I am using the AlphaTrak meter. I give him ~1/2 can of Science Diet M/D at 5am after testing, he eats about a 1/4 and I leave the rest. Sometimes it is gone by the time I get home and sometimes not. He then gets the rest of the can at ~5pm. He will eat about 1/8 at 5pm and the rest throughout the night. I have been awakened the last couple of nights with him playing and eating about 2am. Should I remove the food early? I think it might be playing havoc with his #'s. Last night he ate and then woke us about 2am with a vomit. I am not sure if this was due to the FF Classic Beef or if something else was going on. I cleaned it up and he purred with us in the bed. He then ate some more and vomited again. Because I figured he was hungry I left him a small amount of dry w/d. He ate some of this and didn't vomit again. I tested his BG at 4:45am as usual and it was 507. Was this stress or the dry W/d?

Day Time Value
5/10/2012 4:50 AM 434
5/10/2012 5:00 AM 414
5/10/2012 5:00 PM 271
5/11/2012 4:57 AM 383
5/11/2012 5:09 PM 244
5/12/2012 4:46 AM 397
5/12/2012 5:02 PM 314
5/13/2012 4:52 AM 416
5/13/2012 4:56 PM 116
5/14/2012 4:45 AM 456
5/15/2012 4:50 AM 434
5/16/2012 4:50 AM 507
 
There could be several reasons for his bouncing around.

One is bouncing. :-D When his body goes down to a number it hasn't felt in a long time, it can release more glucose and send his numbers back up.

It looks like the 116 was a preshot number? We urge new diabetics not to shoot under 200, but to wait without feeding for 20 minutes or so. Not only to be sure the number is nearer 200 and safer to shoot, but to sure it is rising, not falling. That cycle was long if 116 was a preshot - that usually means too much insulin.

And yes, even a few pieces of dry can raise the numbers.

Is the Science Diet wet? If dry, it is an awful food, very high in carbs. (37% carbs) If wet, it is still higher than we like to feed. The flavors seem to range in the 16-22% range. We try to stay in the 8-10%. Have you seen our food chart? Janet and Binky’s chart Lots of us feed Fancy Feast, Friskies, Wellness, Merrick - whatever our cat will eat that we can afford.

The other important part of this is to get mid cycle numbers whenever you can. (around 5-7 hours after the shot) They will help you find his nadir, or the lowest point in his cycle. That number tells you how the insulin is working, and with the preshot numbers, helps you determine if the dose is too high or too low.

If I were you, I would lower the carb count on the food while monitoring the bg levels closely. It may be that the lower carb count will really bring down his numbers. We have a PZI forum where you can post also to get help with your dosing. http://www.felinediabetes.com/FDMB/viewforum.php?f=24

And here is a document with lots of info on PZI: http://www.felinediabetes.com/FDMB/viewtopic.php?f=24&t=32799
 
In addition to the possibility of too much insulin, pancreatitis, cholangiohepatitis, and inflammatory bowel disease can also cause vomiting. These are some possible comorbid conditions for feline diabetics, especially pancreatitis.
 
1) The 116 was 12 hour post shot; the next shot was at 4:56am and was 456. I've been giving him the insulin in the am. The next couple of days he was feeling better and playing, so I elected not to test in the afternoon. Is bouncing good or bad?
2) The science diet was M/D canned.
3) He is also finishing a round of antibiotics. He was diagnosed after drinking a lot of water and urinating large volumes.
4) I obtained the nutritional information from Nestle Purina on the Fancy Feast Classics, but I don't understand them vs the science diet MD (I.e. SC M/D = 52.8% Protein / Carb = 15.7; FF Chicken 10.0% Protein / Carbs 1.10%). How do I read this?

Thank you all for your prompt responses. Trying to wrap my hands around this.
 
1. Does that mean you are giving only one shot a day? Insulin lasts only 12 hours in cats. We all give 2 shots, 12 hours apart. If you only give one, then he may be in decent numbers for the first 12 hours and really high the next 12, as there is no insulin workingduring that time. That may be why you are bouncing from high preshot to high preshot.
Bouncing doesn't feel good - jumping from high to low numbers wouldn't - and it makes it harder for you to figure out what is going on. Here is some info on it, but be aware it is based on the idea of 2 shots every 12 hours: http://petdiabetes.wikia.com/wiki/Somogyi_rebound

2. Better than dry but still high in carbs. Janet spent a long time putting together the food chart. You can't go off the labels on the cans. I am not the nutrition/math expert she is, but it has to do with as fed values. We use her chart to determine carb values and feel it is accurate. It has worked for hundreds of cats.

3. What were the antibiotics for? Any infection can raise bg levels. Did the vet do a fructosamine test? It is a blood test that measures blood glucose levels over the past 2 week period and can tell you if your cat has been in diabetic numbers for that period. A simple blood test in the vet office can be too high because of stress and pain (If he had a UTI or something) Was a urine test done to diagnose diabetes/infection?

I am wondering if you are dealing with diabetes.....If he is getting one shot at day and it is half a unit, he is getting decent numbers for a diabetic (especially the 116) If he had an infection and has been eating higher carb foods, that could be part of the numbers.

Confusing, I know. How about getting some numbers during the middle of the cycle after the morning shot to see how he is doing? Normally we might suggest halving the dose and giving shots twice daily, if you are only givin one. But you are at a low dose already. Maybe when we have some more numbers, we can help more. I am wondering about stopping the insulin, getting him on a good low carb diet and getting lots of numbers for a few cycles to see what the picture really looks like....

Get some more advice and mull it over in your head. We'd like to help.
 
There is no Hills food (prescription or science diet) that is appropriate for a diabetic cat (or any cat at all, for that matter). A diabetic cat needs less than 10% carbs all the time. Hills M/D canned is 14% carbs, and Hills dry W/D is one of the worst foods out there for a diabetic, at 37% carbs. The only prescription food that is appropriate for a diabetic cat is Purina DM canned. However, that food is almost exactly the same thing as Fancy Feast (also made by Purina), so pretty much you're just paying a huge markup for the prescription label. You can get a premium low carb food for less than what you'll pay for the prescription, with better quality ingredients. A good mid-grade food that many feed here is low carb Fancy Feast--here's a link to the diabetic safe flavors: http://felinediabetes.com/glutenfree.htm. Sounds like you already have some--I would get rid of the Hills junk completely and just feed the Fancy Feast canned only. Return both the opened bag of dry and the rest of your cans to your vet and say your cat won't eat it anymore and they will give you a refund because the Hills food has a guarantee.

Sorry if that sounded a bit like a rant, but Hills infuriates me because they sell some of the unhealthiest foods with the worst ingredients on the market for cats and charge a bundle for it because they market it to vets. It would be like if McDonalds constantly went around to all of the pediatricians and convinced them that Happy Meals were the healthiest thing you could feed your kid, and then all these kids started getting diabetes and other diseases because they were eating junk food for every meal, so McDonalds started selling special "diabetic" happy meals--which are the exact same cheap junk food as the happy meals that got the kids sick in the first place. AND charged twice as much for them and shared some of the profit with the pediatrician that recommended their food to your kid to begin with.

Here's a link to the cat food nutrition charts so you can compare the carb content. Fancy feast is on the "old" canned chart, and Hills on the "new". http://felinediabetes.com/diabetic-cat-diets.htm

Question about the vomiting--is it happening immediately after he eats? Some cats gobble their canned food so quickly they barf it back up right away. You can prevent it by feeding smaller, more frequent meals. This is really common so I wanted to mention it. Bandit can't eat more than 1/2 can of Fancy Feast per meal or he'll barf.

I agree with Sue that it's possible the infection could be causing the high numbers along with the diet. I would be very cautious about giving insulin as you're removing the high carb food, because he might go into remission once his diet is adjusted. If he doesn't, you can always start over with the insulin on a lower dose, like .5u twice a day.
 
Hello all - I have been away for a few days and have now started him on 1 unit twice per day rather than 1 unit 1x per day. Any suggestions as we are now 2 weeks into our new diagnosis? I think I have made cat paranoid.
 
Below are numbers from Thursday to Sunday. Just started the 1 U PZI twice per day. I have also made sure he doesn't eat any dry food. While I was away, I think he had some. He is grooming, purring, and jumping in our bed in am on occassion. These #'s are frustrating and confusion. He is eating on his own. I give his shot ~4:45am and the 4:45 - 5pm.

5/24/2012 4:31 AM 530 Started 1 unit 2x day
5/24/2012 10:07 AM 384
5/24/2012 4:05 PM 579
5/24/2012 4:10 PM 564
5/24/2012 4:42 AM 577

5/25/2012 8:02 PM 435

5/26/2012 10:36 AM 471
5/26/2012 1:06 PM 544
5/26/2012 4:54 AM 561

5/27/2012 4:35 AM 537
5/27/2012 2:38 PM 501
 
Can we help you set up a spreadsheet? That would really help you and us see what is happening. Here are the instructions: http://www.felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207 If you want help, just send me a pm. (PM button at the bottom of my post)

The numbers certainly look high. If all the dry food is gone, I would give it another cycle or two and then increase, maybe by .5 units (So 1.5 twice daily). But before then, get some more nadir numbers (+6 after the shot) It doesn't look like he is bouncing from low to high if the nadir numbers you have gotten are an indication.

It can take a few days for the wet food to "kick" in and a few days for the infection to clear. Then sometimes you can see a sudden drop so you want to increase slowly and carefully. While he is sitting in these higher numbers, you do want to be testing for ketones: http://petdiabetes.wikia.com/wiki/Ketoacidosis
 
Okay, i am getting really preplexed. Woke up to him playing and running down hall. What is up with these #'s?

5/27 0hr - 537
5/27 10 hr post - 501
5/27 secon shot 5pm
5/27 4hr post 334
5/27 6hr post 223
5/27 6hr post 119
5/28 7-8hr post 244
5/28 12 hr post - 601
 
Great that you got some numbers! Can I help you get them into a spreadsheet? One you get that done, you might come over to the PZI forum and get daily dosing advice. Everyone there uses or has used your insulin. http://www.felinediabetes.com/FDMB/viewforum.php?f=24

The 119 at nadir on the 27th suggests the insulin is working and the dose is pretty good. The high pmps that day may have been a bounce. (If he goes down into numbers that his body is not used to, the liver releases glucose and it raises the numbers) A few more cycles with nadir numbers should tell us if it was a bounce. His body should get used to the lower numbers and stop releasing glucose and stop bouncing. What we should begin seeing is less of a dive down from high numbers, more of a flatter lower curve in general. (Ideally PZI has a smile curve - starting at amps, dipping slowly down to nadir and slowly rising up to a pmps about the same level as the amps.) One thing you can do to help even out the numbers is to feed small frequent meals to support his pancreas. (The same amount of food spread out in 4-6 small meals)

The other possibility is that the PZI is not lasting long enough. In some cats, it does not last the full 12 hours but lasts more like 10. If this is the case, there are things we can do. But we would want you to have the data that clearly shows that first.
 
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