Newly diagnosed Ralph, seeking between-shots feeding guidance please!

R

ralphralph

Member Since 2026
Hi there,

I'm new here seeking more advice after realising my vet didn't appear to be fully informed about the ProZinc guidelines.

I've read a lot of questions on here and understand how useful a BG spreadsheet is. I'll be working this week to create one with more accurate testing from the Alpha Trak 3. At the moment, Ralph has a Libre 3 attached. Ralph was diagnosed on the 18th September 2026 and is only 7 years old.

He stayed in hospital with high ketones for a few nights, and he came back with me two nights afterwards. A blood test two days after that revealed his ketones had fallen further. I will be ordering some gear to do at-home ketone testing today.

The original dose of ProZinc was 1.0 units. This worked for the first few days but his BG quickly fell to numbers around 4 mmol (72 mg dL) on the Libre 3. This sometimes wouldn't rise past 7 mmol (126 mg dL) by the time of his next shot. After phoning the vets, they recommended that I didn't administer at this level. My vets were originally adamant on only giving him two separate meals a day with his insulin, but I was confused because he couldn't eat half the recommended amount of food for his weight in one sitting. The vets just said that's a fine amount of food. After digging up the ProZinc website myself, I discovered that it's actually fine for some cats to "graze" on food between cycles. I was slightly disappointed with my vet for not knowing this because it's quite clear that Ralph needs that extra food to steady his graph and keep him well fed. This led to a cycle of low readings, skipped doses, then inevitable high readings until the next shot.

In the last week we lowered his dose to 0.5 units, and it's much of the same. Often hitting a nadir of 3 mmol (54 mg dL) which is, of course, too low! I've convinced my vet that after reading the guidelines and his graph, that Ralph needs this extra food between shots. I'm an anxious person but trying to look at the positives that 1. he is back to his normal behaviour (for the most part) and 2. even a dose of 0.5 units seems very effective at steadying his BG levels.

My question is if there are any "standard" guidelines on when these should be given? His BG tends to drop off a cliff after the shot, often hitting a concerning low just 3 hours after the dose. He is currently on a wet food only diet of Sheba Fine Flakes Poultry, though I did take delivery of "PRO PLAN VETERINARY DIETS DM Diabetes Chicken Wet Cat Food" so I'm tempted to see how he likes it.

I believe I read somewhere that a small meal at +2 and +4 hours post-shot would be good. (perhaps half a packet at a time? His daily recommended amount is around 4.5 - 5 packets a day) If I did that for both shots (9am and 9pm) the schedule could look like:

9am: 1.5 packets
11am: 0.5 packet
1pm: 0.5 packet
9pm: 1.5 packets
11pm 0.5 packet
1am: 0.5 packet

for a total of 5 packets. Is this something that sounds sensible? When I was giving him 2 packets at a time in the morning and evening, he could only finish what I would assume to be around 1.7 packets.

Thank you for reading. This forum has given me a lot of great info and I'll be doing my best to help my sweet boy Ralph with your guidance!
 
Hello and welcome to you and Ralph! I am heading out the door right now, but I saw this message, and I wanted to respond quickly. I can respond more in full later. You sound like you’re on the right track with getting the spreadsheet set up and doing the home testing for ketones and also for a check of the libre meter which often reads alarmingly low in the lower numbers when his actual blood glucose is probably higher than what the Libre is indicating. This is what I have seen over and over with the Libres. This applies to the lower numbers, of course, and usually the Libre will track more closely with the handheld glucometer in the higher numbers…. really anything close to or above 100 in US numbers.

With regard to feeding, I always recommend for my new ProZinc users to feed a small meal/snack at +2, which is two hours after the shot and then again at +4 — four hours after the shot. It can really help to smooth the cycle — prevent steep drops in blood glucose, and help reduce bouncing where the cats BG can go higher …and I will explain that more in-depth later.
 
Ask lots of questions that you may have and I will come back later, and I will try to answer them.

I don’t recommend feeding very much food at all after nadir because it can shorten the duration of the insulin and can cause the BG numbers to rise prematurely toward the end of the cycle when the PZ is not at its strongest.
 
That is great, thank you. I did hear that the Libre can give false-lows so I've just been keeping an eye on him. He's been happy enough so probably not as bad as I originally thought.

+2 and +4 sounds good yes, I doubt I'll give him his shot at 9pm tonight as he's still reading in the 4s at the moment but we will see!

Thank you for getting back to me so quickly, I see you in the replies of a lot of questions and it's very sweet you take the time to help everybody. Currently supposed to be working but I'll get thinking of some more questions I have in the meantime! :)
 
Suzanne & Darcy said:
If your shot time is at 9 a.m. then this seems reasonable
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Yes those are his shot times, thank you!

His current reading is 10.3 mmol (185 mg dL) on the Libre, so well above the 8.3 mmol (150 mg dL) cutoff for no-dosing. He is due his food in about 15 - 30 minutes from now. I'm going to wait and hope it rises a little bit more in the next 20 minutes. If it reaches 12.3 (221 mg dL) do you think I should give him his 0.5 units and then schedule those two feeding times later on to hopefully keep him happy and fed?

Thanks so much for getting back to me! :)
 
Suzanne & Darcy said:
Ask lots of questions that you may have and I will come back later, and I will try to answer them.
Click to expand...
Just as a little update - after further reading of the dosing guidelines, I saw that if their nadir is lower than 5 then to reduce by 0.25 immediately. He was hitting 2.8. I understand you said that we see low readings on Libres very often, but this combined with the same advice for "lower than pre-shot numbers" and me having to wait for him to reach 11, I decided to reduce it. I will do more practice with the ear-prick glucose method as I've only done it once before and it took me an hour with him hiding! I need to get better with it though haha.

Do you think I should start my spreadsheet with the libre or should I only use a more accurate tracker so the numbers are more consistent? Thanks again for your advice!
 
You can start your spreadsheet with the regular World spreadsheet for a human meter (Libre) since that’s what you are using. We can convert the spreadsheet later if you change to mainly using a different type meter.
 
ralphralph said:
I saw that if their nadir is lower than 5 then to reduce by 0.25 immediately. He was hitting 2.8.
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Yes. In the beginning when you are new to Feline Diabetes and ProZinc, we would recommend following the Start Low Go Slow dosing method for at least the first 30 days. This means that you would reduce the dose if he drops below 90 (5). The idea with a “no shoot” preshot number is to gradually learn how to shoot lower preshot numbers as you gather data on how he is responding. We can work on that. Having said that, if Ralph has high ketones we would fast track his dosing a little bit to customize things. I would recommend getting a blood ketone meter. If you need some tips and tricks to help with the ear testing, let me know. It can be difficult at first. Be sure to use a lot of treats — no matter if you get a successful test or not.
 
What is the food you are feeding him? I assume it is low carb wet food. Oh, you said Sheba fine flakes and I am familiar with that although I don’t recall the actual carb percentage on a dry matter basis. I believe the Purina DM wet is low carb (not the dry food). Do you have other foods available that are medium carb and high carb foods — as well as honey or corn syrup — for managing low numbers?
 
Suzanne & Darcy said:
Where do you live/what time zone are you in? I am on US Eastern time.
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Sorry I was in bed, I'm in the UK which is currently GMT+1 for a few more weeks


Suzanne & Darcy said:
Do you have other foods available that are medium carb and high carb foods — as well as honey or corn syrup — for managing low numbers?
Click to expand...
Yes I have honey ready to go if he needs it, along with the regular kibble food he used to eat which is fairly high in carbs. At the moment he is only on the wet food. Google says Sheba has a carb rating of 1% or lower which is great, but I can't seem to find a proper study to support this. I'll keep digging. I'm considering trying to slowly replace some meals with the Purina DM low carb wet food, he did enjoy it for a meal so perhaps 1 or 2 meals a day can be that to slowly take him over. Before his diagnosis he would have 2 packets of the Sheba wet food but then also graze on the kibble during the day.

Suzanne & Darcy said:
if Ralph has high ketones we would fast track his dosing a little bit
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He had a reading of 3.1 when he went into the hospital two weeks ago, which dropped to 1.5 after a few days. The last 4-5 days he has spent a good amount of time around or above 20 mmol (360 mg dL) because I just can't seem to get his dosing correct. I just read it as 20 mmol (360 mg dL) +6 after his morning dose of 0.5 units. I'm so confused why it's so high. This time yesterday his Libre was saying 2.8 (50 mg dL) which we discussed was probably lower than the truth but today it's at 20! I'm struggling to stabilise his readings but I am trying to stay positive about it. We're only 2 weeks in and ProZinc's website says it can take up to 6 weeks to get used to it and steady his readings. He still spends a good amount of time in a good range so trying to focus on that whilst doing my best for him!

That reading of 20mmol today was with the Alpha Trak, which I'm getting more used to. I'll start with the spreadsheet with the Alpha Trak readings tonight as it's more accurate. He does go into the vets tomorrow to have a new Libre fitted too.

Thank you for the replies and the help, I really appreciate it. This is a great resource as I was feeling a bit left out in the cold trying to figure it out by myself!
 
So did you give .5 units today? I thought you were reducing the dose to .25 after his low reading of 2.8? I hope that’s the correct BG number because I am struggling without a spreadsheet.

He could definitely be bouncing from that low number. A bounce is where the cat's body reacts to lower numbers that he is not used to being in anymore... since becoming diabetic. It's a protective mechanism where his central nervous system perceives either a steep drop in blood glucose or simply being in lower numbers (which could even be normal healthy BG numbers— like even a 50) and this triggers the release of adrenaline, cortisol, glucagons and growth hormone, all of which create insulin resistance and can keep numbers high for up to six cycles (the bounce). Bounces don't have to last that long, but in some cats they will. Over time, many cats will start to clear the bounces more quickly. When the bounce does clear, the BG numbers will come back down and give us an accurate picture of what a dose is doing for Ralph. So not all high numbers mean that he’s not getting enough insulin.
 
Suzanne & Darcy said:
So did you give .5 units today? I thought you were reducing the dose to .25 after his low reading of 2.8? I hope that’s the correct BG number because I am struggling without a spreadsheet.

He could definitely be bouncing from that low number. A bounce is where the cat's body reacts to lower numbers that he is not used to being in anymore... since becoming diabetic. It's a protective mechanism where his central nervous system perceives either a steep drop in blood glucose or simply being in lower numbers (which could even be normal healthy BG numbers— like even a 50) and this triggers the release of adrenaline, cortisol, glucagons and growth hormone, all of which create insulin resistance and can keep numbers high for up to six cycles (the bounce). Bounces don't have to last that long, but in some cats they will. Over time, many cats will start to clear the bounces more quickly. When the bounce does clear, the BG numbers will come back down and give us an accurate picture of what a dose is doing for Ralph. So not all high numbers mean that he’s not getting enough insulin.
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Sorry for late reply! I gave him the 0.25 at that stage but it appeared to do nothing, so I went for 0.5 afterwards. I do think he was in a bounce though. I'm always in to keep an eye on him and he was fine which is good.

I met with a different vet today who is helping me plan out the dosage and food timings. I can update when needed but might be difficult doing things without asking them first seeing as they can be hands-on.

Thanks again for helping me and I'll keep you updated with how Ralph is doing :)
 
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