Newly diagnosed, looking for help

I've been told that under 200 is not safe to give insulin, especially since he is on 2 units. It has been 12 hours since he got his gapapentin with meal, and 11 hours since he tested at 157. He was still hungry so he had a bit more food, roughly another half can so 1 can of fancy feast total in the last 12 hours. I just tested him a few minutes ago and he's at 151. He basically has not elevated at all with food or 12 hours.. Waiting on the vet to call back.
 
espinogena said:
I've been told that under 200 is not safe to give insulin, especially since he is on 2 units. It has been 12 hours since he got his gapapentin with meal, and 11 hours since he tested at 157. He was still hungry so he had a bit more food, roughly another half can so 1 can of fancy feast total in the last 12 hours. I just tested him a few minutes ago and he's at 151. He basically has not elevated at all with food or 12 hours.. Waiting on the vet to call back.
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I think the issue is that 2 units is a big dose to start with and you don’t have any testing yet to know how low the dose takes him. If you start with 1 unit and begin testing as Suzanne suggested, I think you’ll be able to get more confident shooting lower and lower numbers. Eventually you will want to do that - shooting low to stay low.
 
Ok yeah the vet said to give him 1 unit instead and test him a few hours later, I guess I'm just confused because of how he has not elevated in 12 hours with no insulin and with food, and I guess since his glucose is still above a normal range so it should be ok. He needs to eat before getting any insulin anyway so I'm trying to be as accurate as possible.

I only got like 4 hours of sleep but I did at least start on the spreadsheet I just have comprehension issues with ADHD so its a learning curve. I promise I'm working on adding it though.
 
I would like you to take a look at Corky's Spreadsheet, I shoot in low two-digit numbers, of course you should not do thi this this point, without assistance, when Corky left the hospital after hospitalized I was told that he should be in the range of 200-300, THAT IS WRONG! I used to freak out at first when his levels were 150 1 hour before shot, and I would bombard this Forum.
It takes a while got you to get comfortable with low numbers, Corky also uses ProZinc.
REMEMBER: A NON DIABETIC CATS' GLUCOSE LEVELS IS BETWEEN 50-120
ProZinc takes about 2 hours in most cats to kick in
The link below will help get a HYPO KIT together. please read it carefully, make a copy if you can, and if at any time you feel uncomfortable with his level before shot, make a new thread and title it 'HELP LOW BG BEFORE SHOT" it will get our attention and we ca walk you thru it without possibly missing a shot, with ProZinc you can stall a shot up two hours, is best to stall than miss a shot .ProZinc takes about 2 hours in most cats to kick in We can walk you thru on how to stall and raise the BG with food rather than miss the shot, you want Mante's pancreas to start healing, dose consistency is very important, This is why is important to always test before each shot without feeding, and at lease 2-3 times during the day, and feeding 3-4 small meals or snacks during the day to keep the insulin in check, this will create a pattern on how the insulin is working in Mante's system, and you begin to get comfortable on the daily levels

Sticky - jojo and bunny's HYPO TOOL BOX
 
I've just seen so many people say when they're low don't give insulin, so I'm trying to navigate what is the right thing to do going forward. We gave him a whole can of fancy feast at 830 with his gabapentin since he was hungry, tested at 1030, he tested at 202 so we gave the 1 unit as directed by the vet and will test again in a few hours. I'm extremely exhausted so I have to go get a few more hours of sleep but I'm writing everything down so I can get this stuff entered.
 
espinogena said:
I've been told that under 200 is not safe to give insulin, especially since he is on 2 units. It has been 12 hours since he got his gapapentin with meal, and 11 hours since he tested at 157. He was still hungry so he had a bit more food, roughly another half can so 1 can of fancy feast total in the last 12 hours. I just tested him a few minutes ago and he's at 151. He basically has not elevated at all with food or 12 hours.. Waiting on the vet to call back.
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It is safe to shoot insulin with a preshot under 200. However, that will come after you have more data and experience. The 200 recommendation is for new members who don’t have much or any data on their cats. If you read through the dosing protocols (see the ProZinc forum) you will see that it says if you are new to numbers under 200, you should post for assistance with dosing. It doesn’t necessarily mean that you can’t shoot under 200. Eventually, you can be shooting green numbers between 50 and 99 for pre-shot numbers, but this takes time to achieve and a lot of data on the spreadsheet — so in the beginning, you would gather some data and see how he’s low going. Hopefully you plan to shoot a lot less than the 2 units your vet recommended. It is far safer to work your way up in dose than to have a crisis and manage low blood glucose.

Please post here — or preferably on the ProZinc forum because I’m far more likely to see it — but tag me either way. To sum up, when you’re new and you have a lower than expected pre-shot number, post for assistance. There are a number of different strategies that we can employ.
 
espinogena said:
I've just seen so many people say when they're low don't give insulin, so I'm trying to navigate what is the right thing to do going forward. We gave him a whole can of fancy feast at 830 with his gabapentin since he was hungry, tested at 1030, he tested at 202 so we gave the 1 unit as directed by the vet and will test again in a few hours. I'm extremely exhausted so I have to go get a few more hours of sleep but I'm writing everything down so I can get this stuff entered.
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Please start entering the numbers on your SS so I can help you. Did you get a mid cycle test today? You went with the 1 unit I recommended? Please enter 1 unit along with your preshot test into the spreadsheet for today.
 
You can do this! I will help you. You are doing great! I have a lot of experience helping ProZinc users. It’s going to be okay and you are not alone. You also can find a lot of support here from people who understand.
 
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espinogena said:
He needs to eat before getting any insulin anyway so I'm trying to be as accurate as possible.
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He actually doesn’t not need to eat before getting ProZinc. You can test, feed and shoot and he can even still be eating while you shoot. ProZinc doesn’t onset (lower BG) for about 1.5 to 2 hours so there is no need to feed and wait any length of time before giving the insulin.
 
Thank you Suzanne, I really appreciate the support. He was 202 at 10:30am after his meal at 8:30am, we went with the 1 unit the vet and you all suggested and I was going to test him sooner but I was absolutely sick with exhaustion. I have chronic health issues that love to flare up when I'm exhausted, and combined with the fact that Manten accidentally dislodged his nose scab today and was hurting and bleeding badly, I honestly just didn't want to stress him out with more handling beyond me getting the fallen goo out of his mouth so we waited and tested him at 7:40pm, just a bit ago. He tested at 125 after not having eaten since this morning besides a few licks of the kitten food bowl after the kitten got full.

I am going to enter all this into the spreadsheet as soon as I can get this dreaded statistics exam done. My goat also decided to break out of the fence the second I fell asleep for what was going to be a tiny nap as it is, so I had to run out grab her chunkiness and cut my foot in the process. That's not even the end of it but at least Manten's numbers are looking good now that we're getting enough blood.
 
espinogena said:
Thank you Suzanne, I really appreciate the support. He was 202 at 10:30am after his meal at 8:30am, we went with the 1 unit the vet and you all suggested and I was going to test him sooner but I was absolutely sick with exhaustion. I have chronic health issues that love to flare up when I'm exhausted, and combined with the fact that Manten accidentally dislodged his nose scab today and was hurting and bleeding badly, I honestly just didn't want to stress him out with more handling beyond me getting the fallen goo out of his mouth so we waited and tested him at 7:40pm, just a bit ago. He tested at 125 after not having eaten since this morning besides a few licks of the kitten food bowl after the kitten got full.

I am going to enter all this into the spreadsheet as soon as I can get this dreaded statistics exam done. My goat also decided to break out of the fence the second I fell asleep for what was going to be a tiny nap as it is, so I had to run out grab her chunkiness and cut my foot in the process. That's not even the end of it but at least Manten's numbers are looking good now that we're getting enough blood.
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Oh my! I was going to ask about his nose and how that was doing. I am sorry. How was his nose injured? I had a cat who had nose surgery due to squamous cell carcinoma and he scraped it off about a week after surgery. It really looked horrific. I would send a photo, but it’s too nasty. It did heal up pretty well though.
 
125 is a great number to get at about +9 as I calculate it. I am not worried about Manten now since you told me that. He probably was lower than that at approximately +6, but I don’t think it would be anything dangerously low. I am confident in that.
 
Is it okay if I talk about a suggested feeding schedule for Manten? I don’t want to overwhelm you with too much all at once. A good feeding schedule for a diabetic cat is to feed a morning (or evening) meal amd the give small meals after that (snacks) at about +2 ( because that is about when the ProZinc onsets and begins to lower BG) and again at +4, which continues to help support blood glucose and prevent steep drops in BG (which can contribute to a bounce.) We can tweak things as needed, but the main point is to feed most of the food/carbs during the early part of the cycle when the insulin is strongest. It is a good starting point. We can talk more about your particular kitty and situation, of course.
 
Don’t worry about the testing today. You are just beginning. Be gracious to yourself! Manten is doing great too. How’s it going with the Gabapentin. The thing about Gabapentin is that it takes about two hours to reach its peak concentration in most cats. Then it starts tapering off from there. So you may have some times when he’s not as calm as others. How often are you giving it? What dose are you giving?
 
I really don't know how he was injured, it seemed to have come out of nowhere truly and the vet didn't seem as concerned as I am, just attributing it to the diabetes. As for the mouth ulcer, my other cat actually has a tiny sore and red gums right now and I think its because my boyfriend didn't wash the water fountain like I asked him to and it got too dirty.

I have two Nigerian dwarf goats and they're my weird doggy pets lol, Mavis busted out of a patched up hole and my neighbor luckily knocked to let me know. Luckily she was just yelling at me in the driveway instead of going into the road. My foot got cut because I ran out without shoes on to grab her and stepped on something in the yard.

The goo is because his nose is clotting and dripping alongside a snotty nose so he gets clogged up easily.
I agree with the feeding schedule, I just worry about days we are both working or at school and wouldn't be able to give him small meals in the middle of the day. I know that doing my best whenever I can is the most important thing. Luckily he's not picky so he hasn't turned away the fancy feast, unlike my senior girl (the one with the gum issue currently) who only really likes the churu meals. Hopefully she'll like Dave's when I can try that out too.

The Gabapentin is truly a lifesaver, I highly doubt he would be doing this well without it. From what I understand it helps with pain to some degree as well as stress, which is exactly what he needs right now. He is so much happier and less scared with it, I don't know if prozac could do the same but I know its much cheaper. He gets 1cc every 12 hours.
 
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espinogena said:
I really don't know how he was injured, it seemed to have come out of nowhere truly and the vet didn't seem as concerned as I am, just attributing it to the diabetes. As for the mouth ulcer, my other cat actually has a tiny sore and red gums right now and I think its because my boyfriend didn't wash the water fountain like I asked him to and it got too dirty.

I have two Nigerian dwarf goats and they're my weird doggy pets lol, Mavis busted out of a patched up hole and my neighbor luckily knocked to let me know. Luckily she was just yelling at me in the driveway instead of going into the road. My foot got cut because I ran out without shoes on to grab her and stepped on something in the yard.

The goo is because his nose is clotting and dripping alongside a snotty nose so he gets clogged up easily.
I agree with the feeding schedule, I just worry about days we are both working or at school and wouldn't be able to give him small meals in the middle of the day. I know that doing my best whenever I can is the most important thing. Luckily he's not picky so he hasn't turned away the fancy feast, unlike my senior girl (the one with the gum issue currently) who only really likes the churu meals. Hopefully she'll like Dave's when I can try that out too.

The Gabapentin is truly a lifesaver, I highly doubt he would be doing this well without it. From what I understand it helps with pain to some degree as well as stress, which is exactly what he needs right now. He is so much happier and less scared with it, I don't know if prozac could do the same but I know its much cheaper. He gets 1cc every 12 hours.
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Prozac doesn’t work the same as Gabapentin. It’s not going to make him cooperative or as relaxed. It just doesn’t work like that. Believe me, I have currently got two cats who take Prozac and I have had quite a few others on it over the years. Gabapentin is the way to go. It does relieve certain types of pain, yes. I imagine the liquid is more expensive than the pills. I have these little compounded 50 mg tablets of Gabapentin (although one cat is so difficult that I have to give him a 100 mg capsule just to trim his nails — other than that he’s a pretty nice cat.)
 
espinogena said:
I agree with the feeding schedule, I just worry about days we are both working or at school and wouldn't be able to give him small meals in the middle of the day.
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Do you have an automated feeder to dispense snacks during the day for when you’re away? At night it’s very handy for the same purpose.
 
Suzanne & Darcy said:
Do you have an automated feeder to dispense snacks during the day for when you’re away? At night it’s very handy for the same purpose.
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I've looked into them before but I have multiple cats and he's never eaten any treats before besides churu tubes. I just got freeze dried minnows, tuna, and chicken, and it's possible he may consider them if his injuries heal but overall he has been a wet food only kind of cat. We are really not doing well financially so I don't know when I'd be able to afford automatic feeders if Manten would even use them, but I really have looked since one of my cats is 18lbs and has urinary crystals (female, on scrip food)
 
I understand about strained finances.

Have you been able to get any tests today? When I looked earlier this morning there was still nothing on the SS. How is Manten today? How is his demeanor? How’s the drinking and litter box use?
 
He doesn’t have to eat treats. A little wet food can be the “treat” if that’s what he likes. I used to do that when Darcy was super hungry all the time from being in such high numbers.

Did you say he was underweight?
 
I just woke up an hour ago, my boyfriend tried to test him at 9:20 and couldn't get a reading (he's still learning and I guess he didn't want to wake me up because of how tired I was), fed him at 9:45 and got a successful test after food at 10:35 of 138. I'm about to go update the spreadsheet, my schoolwork last night had me ripping my hair out because the proctoring service is extremely glitchy. After getting that reading he told me he decided not to give him the shot because he was worried about how low it was after food, I'm going to test him again in a bit, he's very snotty drippy today.
 
I’m glad that no shot was given. I would have probably only given a very small dose if any at this point because we just don’t have data yet. What I hope that you can do is to get a test on him today — now would be good.
 
Please write NS in the units cell of the spreadsheet for no shot.

Please record the numbers that you get with the tests though. Those are still important.

If you tell me (again sorry) what his shot time normally would be, I can tell you where to put the numbers.
 
can you please put any insulin that he’s received so far since starting the spreadsheet and any tests. You got at least one yesterday (or two?) Did he get insulin last night?
 
I think I put everything in there right. So what time he ate/got shots isn't recorded on there, just the times of testing and dosage?
 
You already shot 125 last night with 1 unit so he probably should have gotten at least some insulin today based on that, but he needs a test at about +4 or +6 to see how low he is going before I can really feel comfortable with it.

I don’t see any mid-cycle test on there for today.
 
Your note says he tested 151 before food and 202 after food. If 202 was the BG before he got the shot, then 202 was the AMPS and needs to go in the AMPS cell for yesterday because it was the actual preshot number when insulin was given.
 
He tested at 125 at 7:40 and didn't get his shot till 10:45 so we figured by then it should be ok since I was worried about constantly missing shots. I wrote that he tested at 145 today at 1:27pm but I didn't know if that should go on the chart because he didn't get a shot.
 
It’s good to stack all of the BG test in that cell. The 151 and the 202. Just indicate how many minutes the 202 was after the 151. Let me show you…
 
More Advanced Recording

Sometimes it is necessary to stall at PS if the BG is too low to shoot and tests are taken every 20-30 minutes apart and must be recorded. The BGs are then “stacked” as shown below and, in this case, recorded in the +11 column so the PMPS, which was at +14 can be recorded in the PMPS column:

Stacking 1.png
The above tells anyone looking at the SS that testing for PMPS began at +11.75 but the BG was too low; subsequent testing every 15 minutes occurred until the Caregiver felt the BG was safe enough to shoot at +14.

Additional testing might also occur during the cycle and should be recorded as shown below:
Stacking 2.png
In the example above, the first test of 103 was taken at +2 followed by another test (57) at +2.5. Two tests were taken from +3 to +4 and are recorded in the +3 column. Two tests were taken from +4 to +5 and are recorded in the +4 column; two tests were taken from +5 to +6 and recorded in the +5 column. The last test was taken at +6 and recorded in that column.

It will be necessary to manually color in the cells when recording more than just a whole number in the cell. To do this:
  • record the data in the correct cell (e.g. 185 @ +3.25)
  • select the color from the ranges at the top of the SS which coincides for the test (e.g. 185 would be blue)
  • in the SS toolbar at the top, click on the icon which looks like a pitcher which should also show the text “fill color” when you move the arrow over it
  • next, in the SS toolbar at the top, click on the underscored A to the left of the pitcher; this should show the text “text color” when you move the arrow over it.
 
espinogena said:
He tested at 125 at 7:40 and didn't get his shot till 10:45 so we figured by then it should be ok since I was worried about constantly missing shots. I wrote that he tested at 145 today at 1:27pm but I didn't know if that should go on the chart because he didn't get a shot.
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Yes. Whether or not he gets the shot it’s important to put any test data in the spreadsheet. In fact, it can be especially helpful to know how high (or not the cat goes with no insulin.)

So in this case the 125 was at 7:40 p.m. last night? But he got his shot at 10:45 p.m. and was at 202 then? So you shot late? So the 202 is still the p.m. preshot number and still should be in the PMPS cell.
 
Just put the 145 in the cell that is closest to the time it would be after he would have had the shot. Since his morning shot would have been around 10:45 a.m. this morning (because last night he didn’t get the shot until 10:45) then he 145 BG test for today would go in the +3 cell because that was about three hours after he would have gotten insulin this morning.
 
Sorry for the confusion! This sticky note on how to do basic recording on the spreadsheet and then the section on more advanced recording (like what we are already talking about 🤪 is really helpful.)
 
You are doing great except that we don’t put clock time into the cells of the spreadsheets. You and I (and others) are on different time zones so putting the local time in there doesn’t help explain things.

Oftentimes people do put the local time in their notes section though, as well as the + hours, because the + hours will help anyone looking at their spreadsheet to understand and the local time will make sense to you.
 
Manten is not really going very high today. So far he is staying in the blue BG numbers. If he is in the mid-blue numbers tonight at his normal shot time, I would reduce his dose to .5 units. But you should get a test sometime during the cycle. How many hours after his shot time do you think you will be awake?
 
We have to go pick up my boyfriend's son from his moms so I cant edit more until we get home. I'm unfortunately feeling very overwhelmed and overstimulated so I'm definitely going to have my boyfriend do a lot of the spreadsheet translating as that is hard with my comprehension issues, but I'm learning no matter what. If my senior car wasn't also in pain right now I know it wouldn't be as bad, she is everything to me and I'm just so scared everyone is going to die when I'm not looking lately.

We planned his shots for 9am and 9pm so we have been trying to work with the variance in testing and the 1045 was late because we were so exhausted time got away from us for a bit. We just fed him again before we left and I will test him again when we get home. He himself is doing so much better though so I'm feeling relieved with Manten at least. He is out more, not running away and hiding constantly, and after blowing off his scab by accident his nose is looking better. The first scab was pretty thick and loose so as gorey as it was it was probably a good thing. I'm just happy he seems happy and I appreciate the advice on a half unit shot if his numbers are still low, I definitely don't want him to keep having none.
 
Yes, don’t worry about taking it all in at one time. I am never going to make a big deal or freak out about any of this. I can always ask questions and hopefully will be patient with me 😊 In the early days of feline diabetes it’s like “drinking from a fire hose” there is so much new information. Nobody expects you to master all this at once. You have to try to take things at your own pace, and I promise it really will get easier as you go along. Just write some notes into the comment section of the spreadsheet — that might help clarify things. And you’ve already started doing that! No worries!

I really understand what you’re going through with your senior cat. My heart went out to you when I read what you wrote about her in your previous post. I am dealing with the same thing right now with my 15 year-old girl…. well actually I have two 15-year-old cats with kidney disease right now. They are litter mates sisters; one is named Grace and the other one is Emma. Grace in particular is not doing really well right now, and I fear she may be at the end. She has pretty severe kidney disease and today hasn’t been doing well at all — and is quite dehydrated. I am currently trying to rehydrate her and get her feeling better. I may be taking her to the vet for IV fluids tomorrow … and maybe several days this week. I haven’t given up on her yet, and she is so chipper and sweet despite her horrendous kidney values.

I am so sad about your senior girl.
 
Thank you, I really appreciate it. I got her some oratene gel and have been putting it on her gums twice a day, and it does seem to help her a bit. It says its an enzymatic antiseptic gel that helps relieve periodontal disease, stomatitis and gingivitis in cats and dogs, so I would love it if that was enough I'm just worried that she may need an antibiotic shot to fully heal. The fact that two of my cats have mouth issues at the same time seems too coincidental, I am going to be absolutely adamant about keeping their fountain clean and using vinegar weekly, as well as getting a fresh bottle of water additive for their oral health. I just know I can't lose her, she's been with me through some of the worst times of my life. I always say we're like E.T. and the kid who was attached to him physiologically, I can't go on without my Winona.
 
Does she actually have stomatitis? Has a vet confirmed that? Has she ever had teeth extracted? Has she had a Depo-Medrol injection (long acting steroid used for stomatitis) before? There are better alternatives for stomatitis, but they’re wicked expensive. I currently have two with stomatitis and they have been on a new medication that is compounded with an anti-viral for calicivirus which is believed to cause stomatitis and Doxycycline which has immunomodatory properties. It’s called GingiPro Duo and is made by Stokes Pharmacy. It has cured the first cat’s stomatitis completely. His mouth is normal now. And my second cat is coming up on two months of the treatment and has one more month left to go. She’s acting so much better now. One month to go. She can eat normally now and is doing great.

I am telling you it’s been a bad year here for cat health problems. And I have one with mammary cancer currently undergoing chemotherapy.
 
I just recently noticed this so I haven't been able to take her to the vet yet. I don't know what she has I just know that she's got a little red sore on her bottom lip and her gums look a bit red. She's very clearly in pain by the squinty facial expression and barely moving and not wanting to eat. She's normally very spicy and powerful so she's definitely in pain and her bottom lip looks dirty and wet, as if she ate wet food messily but hasn't.
 
espinogena said:
I just recently noticed this so I haven't been able to take her to the vet yet. I don't know what she has I just know that she's got a little red sore on her bottom lip and her gums look a bit red. She's very clearly in pain by the squinty facial expression and barely moving and not wanting to eat. She's normally very spicy and powerful so she's definitely in pain and her bottom lip looks dirty and wet, as if she ate wet food messily but hasn't.
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She probably just has a bad tooth and it probably needs extracting. That’s much better than stomatitis. She may need a course of Antirobe (Clindamycin) or maybe just the tooth removed. The red sore could just be a rodent ulcer (eosinophilic granuloma). You can look it up and see if it looks like what your kitty has. Those can also be treated with a Depo Medrol long acting steroid injection.
 
You do have U-40 syringes with half unit markings, I hope? I was just thinking about the .5 unit dose. It should be almost his regular shot time now and you should soon have a PMPS number.
 
We just got home and he just tested at 129, we're getting everyone's food and his gabapentin ready now. I just realized the syringes they taught us with at the vet have half unit lines but these ones do not. They sent us with the sharps container that has needle bags in the bottom slot
 
Also I got some pictures of Winona's mouth, she's got small sores on her top and bottom lips but as far as my novice eye can see, her teeth don't look rotten.
 

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I know its all over the place and that you suggested he get a half unit, but we don't have the proper syringes with the half lines and I did give him that 1 unit last night when he was around the same number, the 120s. I just went ahead and gave him 1 unit since I hadn't heard back and didn't want to push his shot out too late again, worrying that I couldn't properly measure a half unit. I'll test him every hour for the next few hours to see how he does with it.
 
espinogena said:
I know its all over the place and that you suggested he get a half unit, but we don't have the proper syringes with the half lines and I did give him that 1 unit last night when he was around the same number, the 120s. I just went ahead and gave him 1 unit since I hadn't heard back and didn't want to push his shot out too late again, worrying that I couldn't properly measure a half unit. I'll test him every hour for the next few hours to see how he does with it.
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Oh. I was hoping you would eyeball about a half dose
 
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