On Prozinc for 4 months / not responding / neuropathy /considering euthanasia

Hello everyone, first post here. Been lurking a week or so. The following post will be quite lengthy but I hope to thoroughly cover the timeline to the best of my memory.

My cat, an 18lb 10 year old male, Fluffy was diagnosed with Diabetes in mid-late January after a visit to the emergency clinic following a night of extreme increased thirst and urination. He was placed on 2 units of vetsulin at the time. Following a visit to a non-emergency vet (that would eventually see him over the course of the last few months) he was placed on Prozinc and I was instructed to give him 3 units due to a glucose reading in the upper 500s. Initially the vet wanted to do follow up checks in THREE MONTHS, however after monitoring for two weeks and seeing little improvement i insisted on a checkup at the end of the same month (late February). The vet did one glucose check at that following visit and since it was still above 550 decided to move to 4 units and committed to a fructosamine test. Never once did the idea of at home testing come up. Following the results of the fructosamine lab work i received a call to increase to 5 units, with another fructosamine test a month later.

As the date of the second test approached (late april) i began to notice him struggle with the use of his back legs. He began to struggle mightily with jumping on the bed. The day of the test it became ovbious he was developing diabetic neuropathy and he was having difficulty just walking around. I didnt even get to speak to the vet at this point and had one fo the lead techs ask me if i managed to accidentally poke him in the legs ???.

At this point I finally made the decision to commit to home testing, which i know i shouldve done much sooner but my vet at the time insisted it wasnt necessary. A few days later I recieved a call from the vet with the results that showed fructosamine levels at 676. I also asked about diet changes and she said that might be a good idea and so we moved to purina pro plan DM dry food. She also suggested that his insulin resistance might be due to an underlying infection so prescribed him clavamox as well. At this point she upped him to 6 units.

Over the following days I transitioned away from his old dry food (IAMs indoor weight control) to the new dry food. I also did a few readings (not knowing how a real glucose curve was supposed to be done) and these were the results.



The clavamox immediately gave him loose stools. He's also been icredibly lethargic and depressed. He spends a significant amount of time just lying down next to his water bowl much like in the early days of diagnosis (i had seen improvement with the increased thirst but it seems like all that has completely gone away over the past week) I finally had enough and decided to switch vets but am afraid it may be too late. The new vet saw him and performed a blood work and took a urine sample. Unfortunately I dont have those results avaialble but the gist of it was that most of his vitals looked good. Only one level of the kidneys numbers were slightly elevated but she didnt think that was the primary culprit of the increased thrist. Urine levels looked good as well and she pointed out a result that indicated the inslulin was being properly absorbed ( i wish i could say which level that was but it was so much info to take in at once). She did want to cut the clavamox and instead sent him home with metronidozale to help with his gut, as well as fluids under the skin.

She was hesitant to chage his insulin dose because at this point he had only been on the new food and increased dose for approx 4 days. She asked to make a followup check for this Friday and asked that i perform a glucose curve a couple of days prior. If she saw no improvements she mentioned wanting to switch to a glargine insulin but said she would have to start back at the beginning with a small dose

Fast forward to today and nothing has improved. His appetite is still good but he still has loose stool. He still spends half of this time lying at the water bowl. His neuropathy seems even worse. I've taken a couple of glucose readings and they were between 592 at their highest and 345 at lowest. I just feel like I'm watching him detriorate in front of my eyes, he looks like he's suffering and in a great deal of discomfort. To the point Im not sure I can watch him like this for another week and am seriously considering euthanasia over the next few days. At the same time I feel like his veterinary care has been so poor that he hasnt really had a fair shot at getting the right treatment. Obviously Im really really conflicted.

I could really use any advice that yall have to offer. Ill be checking this post regularly and would love to answer any questions

 

Clavamox can make some cats feel just awful.
I'll tag a few people to answer your questions.
Hang in there. All is not lost.
@Suzanne & Darcy
@Wendy&Neko
@Bron and Sheba (GA)

 

A lot of cats (and people) respond poorly to Clavamox. If you can get a probiotic, and feed it a couple hour apart from the Clavamox, that might help his tummy feel better. Personally I'm not a fan of giving antibiotics "just in case" there is an infection. A urinalysis should have been done first to confirm an infection first. How long have you been giving the Clavamox now? You can ask the vet for the blood work and urinalysis results - you paid for them, they are legally yours. They should be able to email them to you.

I am not a fan of metronidazole - it can make the gut system worse. S. boullardi is a product that can help loose stools. Also feedint a prebiotic like pumpkin or psyllium husk fiber.

Have you thought about giving your kitty a food that appropriate for a diabetic? The DM dry is not - it is called dietetic management, not diabetic management because it is too high in carbs for a diabetic cat. Normally we suggest food under 10% in carbs. Do you think he'd eat wet food at all? There are a lot more food options for low carb wet or raw food. I'm guessing you are in the US. If so, the Dr. Elsey's Clean Protein chicken (you can get at Petsmart) is a look carb dry food if he absolutely will eat nothing else but try. Young Again is another option, though some cats find it hard on their tummy.

I'm giving you a link to a post for new people. New? How You Can Help Us Help You!
There are some things you can do for us to help you better. One is to record the blood sugar numbers in a spreadsheet, the other is to add some data to your signature.

And finally, there are ways to help neuropathy. More about it here: Feline Diabetic Neuropathy Methyl B12 can help. Along with getting Fluffy into better blood glucose numbers.

 

About the neuropathy
Tap on this link
https://felinediabetes.com/FDMB/threads/holy-cow-i-got-one.289932/#post-3179122
Post # 10
I wrote what you can buy for it

 

Hello thank you for the response. I actually just bought a few cans of Purina DM wet food Pate since I still had the prescription for it. He's always enjoyed wet food in the past. I'm fairly confident he'll eat it as long as his appetite remains intact, which it has so far. Unfortunately I never realized the harmful effects of dry food until I started reading around here. Do you think it's a good idea to just cold switch to the wet food, since his gut is already struggling, or should I do a gradual mix?

Also he's been off the Clavamox since the 8th of this month and that's when he started the metronidazole. Today was supposed to be has last dose of it but I didn't give it cause I feel like it's made the diarrhea situation worse as well.

I purchased this from Amazon and it should be here tomorrow morning before his first morning feeding. I'm thinking this is the correct probiotic?

 

Yes, that's a good version of s. boullardi. This page talks about dosing for cats: https://www.ibdkitties.net/supplements/probiotics/

DM wet food isn't anything special either, but good to hear he likes wet food. There are lots of other better quality and cheaper food options out there. I would transition him over very slowly to wet. In addition to wanting to prevent tummy upset from food change, his insulin needs can drop quite a bit with a transition to low carb. You'll need to be testing his blood sugars regularly to catch when he needs less insulin.

 

Here is a link to a FOOD CHART. Look for carbs 10% or less. You will need to be monitoring very closely as you transition to a low carb diet.

I’m going to tag @Bandit's Mom to help you with a spreadsheet. Once we can see BG data we can help you a lot more.
I’m sure we will be able to help you.
I am going to tag @Suzanne & Darcy as she is a Prozinc user.
Please do not consider euthanasia … feline diabetes is a very treatable disease. It is often mismanaged by vets who do not know a lot about feline diabetes

 

After reading around I went and purchased a case of Fancy Feast classic chicken and began the process of transitioning him off the dry food. Hoping to have the transition done this time next week.

I love my little dude and so the last thing I want to do is euthanize but it's just been awful to see him in the state he's been in the last two weeks especially.

I was supposed to start a glucose curve period tomorrow morning but I was so scared of causing additional stress if it indeed was time to say goodbye, however, the responses here have given me a bit more hope that maybe we can make it though this.

I intend to have a conversation with this new vet who seems much more capable of providing quality care than the previous one. If I start the glucose curve tomorrow morning then I should be in a good spot to update the spread sheet. I will also try and get a copy of his most recent blood work and urine tests to see if that offers any additional insight.

 

Do you need help with the spreadsheet?
I can ask @Bandit's Mom to help you if you like.
I am quite sure with the right care you will see a big improvement. And if they have been stuffed around it takes longer.
A lot of kitties take a while to settle down and start responding. My Sheba had very bad neuropathy. She was very unsteady, sliped and slid on the wooden floors, had to sit down every few steps and had trouble holding herself up in the kitty litter. I put her on Zobaline and followed the wonderful advice here and within about 6 months she was completely back to normal as far as the neuropathy went.
Keep posting and asking questions

 

I think I was able to get it working. Its empty now but I'll start the process of better tracking first thing in the AM.

Im relieved to hear that the neuropathy is able to resolve with the proper care. My biggest concern at the moment is the dramatically increased signs of excessive thirst and overall lethargy. He's had loose stool for approximately 12 days now, coinciding with him starting the clavamox on the 4th of May. Surely that's contributing to the increased thirst and dehydration. I purchased the S. boullardi and it should be in later today so my intention is to start that immediately now that he is off all antibiotics.

Thank you and everyone else for taking the time to both educate me and give me hope that there is light at the end of this tunnel.

 

S boulardii is very good. It has solved diarrhoea on my cats.
Have you tested for ketones in the urine? If not I would get a bottle of Ketostix from Walmart or a pharmacy and follow the directions on the bottle. There should be no ketones if there are any more than a trace tell the vet and us please.
Are you offering food during the cycles as well as the 2 main meals ? We suggest 2or3 snacks during the first half of all cycles.
The thirst could be from the diarrhoea or higher BGs. Are you adding any warm water to the food. A teaspoon each snack is a good idea.
Clavamax does affect some kitties and gives them diarrhoea. I found plain cooked pumpkin was good for loose poops. You can buy a canof plain cooked pumpkin or cook your own in water with nothing added. Drain and mash. Give a teaspoon a couple of times a day in food. You can give more if needs be.
Don’t lose hope. We have so many people arrive here with stories similar to yours.

 

When I was at the vet last Wednesday, we were able to get a urine sample and I believe they checked for ketones but I'll verify with her today when I ask for a copy of the lab results.

As far as meal times, my cats would free feed throughout the day with their dry food with no water added. I just now started the switch to wet so I will attempt to go to set meal times. I have another non -diabetic cat and thankfully they both loved the fancy feast and ate it enthusiastically.

I have a couple bags of Pure Bites cat treats and they both love the chicken and fish flavors. I'm fortunate that I have two very non-picky eaters. I can supplement those treats as snacks between meals if you think that would be a good idea.

 

Are these the freeze dried treats? If so they are fine. They would be good as a treat after testing the BGs.
For the snacks I would offer a couple of teaspoons of normal low cats food each time.

another thing… when you swap to a new insulin you dont go back to the beginning. You take into account what the dose has been with the previous insulin. We can help you with that. You may find that the swap to low carb wet reduces the amount of insulin needed. Going back to the beginning is a backward step and will not help Fluffy

 

Yep those are the ones, and I'll do the snacks today as well.

My vet appointment has been moved to tomorrow morning so I may reach out about the dose conversion if I get moved to Lantus. I'll be updating the spreadsheet today as I'm about to start the glucose curve in the next hour.

 

Just so you're aware, Prozinc is a good insulin for feline diabetes, as is Lantus (glargine). Given the diet change, you may start to see improvement with Prozinc. If you were feeding a high carb food, it would counteract the effectiveness of the insulin. (In other words, you're feeding your cat cookies, cake, and candy and expecting blood glucose levels to respond to insulin.)

As Bron suggested, I would not drop your cat back to a starting dose of insulin. You may want to reduce the dose slightly but do not go back to a starting dose.

 

Will be on my way to the vets shortly. Will report back the discussions I have with them.

Continued the transition to wet food diet, as well as integrating the probiotic to help with his stool and have had no problems getting him to eat. I thought his numbers were slightly trending in the right direction but I just took his pm +9 reading and it jumped up to 669. It's so alarming, I don't know what to make of it.

I've updated his spreadsheet for yesterday's glucose curve in case anyone wants to take a look.

 

I would not be surprised if he is bouncing from lower numbers you are not picking up yet as you are not testing enough.
Don’t let the vet increase the dose until you are testing every day to see what is going on. He may in fact need less insulin.

 

Definitely noted. Me and fluffy are still getting accustomed to the process and to minimize the stress ( on both of us ) I'm trying to space it out a little bit. Though I'm dedicated to testing before each and every injection at minimum.

Just some updates though. On the home front the wet food transition process is still going well, gradually adding a little more wet food each go around with zero complaints from Fluffy. And the really really good news is that he's taken to the probiotic very well. Already today I noticed a DRASTIC improvement in his stool. The probiotic seems to be helping a ton already, and while it may be placebo I feel like I can see a small improvement on his overall demeanor and water intake now that his gut is stabilizing.

We went to the vet today as well. I followed up with the doctor to ensure there were no ketones in his urine and she confirmed that was correct. Unfortunately the doctor is still pretty set in the "prescription diet" mindset but I held my ground and told her I want to continue using the fancy feast classic and she agreed that would be ok.

However she did want to try giving the Lantus a try but not start it until Monday in case there were any negative effects so that he could be looked at at the office instead of over the weekend when they were closed. I insisted we not go back all the way to beginner dose but she was adamant about doing only 2 units of the Lantus. She agreed that we can make micro adjustments to the dose in a smaller time frame vs the approach with the prozinc from the the previous vet where we would make full unit changes at the end of the month. I reminded I would be testing before every dose if that made her more comfortable with a higher dose but she stuck to get guns on the 2 units. She asked me to do another full 24 hour curve, 48 hours from the first Lantus dose and we could adjust from there.

I'd love to get y'all's thoughts on that dosage and whether or not I should stick to that plan or modify it. He's been on 6 units of prozinc for about 2 weeks now but as of writing this I'm only on day 2 of the wet food transition.

@Wendy&Neko
@Sienne and Gabby (GA)

Apologies for the tags, but y'all have been such a huge help so figured I'd check in with you all as well

 

I’m glad the probiotic is working. That’s great.
And well done sticking to your guns with the food!
With starting Lantus…because it is a depot insulin (more about that later below)…you will need to stay at the starting dose for 5 to 7 days for the depot to fill. The only reason to change before that is if Fluffy drops below 90.
Let’s see what Wendy and Sienne say about the starting dose. I would be inclined to do the transition of the food first and see where Fluffy lands with the dose of insulin, before swapping the insulin as it is not a good idea to do 2 changes at once.

Information about THE DEPOT

I’m not sure your vet knows a lot about the insulins and diabetic cats. In the meantime, I would get a bottle of ketostix from Walmart or a pharmacy so you have some on hand as it is very important to be monitoring ketones when the BGs are unregulated or if you are swapping over to a new insulin and not staying with a similar dose to the previous insulin. Just because he didn’t have ketones at diagnosis doesn’t mean he can’t get them later on.

 

Just a quick update. The diet transition continues to go well. He's on a majority wet food portion with only a little bit of Purina DM dry. Hopefully in the next 2 or 3 days we'll be on pure wet food as both of their tummies have seemed to handle it well. Fluffy 's stool is almost completely back to normal.

My gut is also heavily agreeing with the thought process of only switching one thing at once so I want to give the prozinc a longer window given that it seems like his numbers may be trending in the right direction over the last few days. I know they're still high but seeing levels under 500 before his doses gives me a little hope. I don't want to get my hopes up too high but in addition to slightly lower numbers, his demeanor and behavior have improved from where they were last week. I even woke up to him on the bed with me which hasn't happened in almost 2 weeks. I almost cried seeing him in the morning next to me.

I'll follow up with my vet and provide his numbers and I think she'll agree to hold off on switching.

Unfortunately my work schedules make it very difficult to get tests in between doses. But I should be able to get more frequent numbers on my days off.

 

Posting a new thread on the prozinc forums as I look to fine tune his dosage.

https://www.felinediabetes.com/FDMB...wonders-now-concerned-about-high-dose.290171/

 

I agree with Bron about seeing what effect the food change has. Let's see what the numbers are saying. One immediate thought is that you saw a nadir of 195 last night. If you notice, Fluffy was back to the 300s by +7. There's a good chance that your cat has been seeing lower numbers at times when you're not able to test and you're missing some of the low points. It's not unusual for a cat that drops into low numbers to bounce back up into higher numbers. That may have been what's causing the high numbers.

Generally, when someone switches from a different insulin to Lantus, the dose does not need much of an adjustment. That said, some cats do have a marked response to a new insulin. I'd probably think about dropping the dose back to 5u. I'd be curious what some of the other think.

@Wendy&Neko
@Suzanne & Darcy