Oscar 4/7 - still don't understand his curve

[Kelly & Oscar]

So we've upped his dose to 3U BID and his blood ketones have dropped to 0.1mmol. Even at 3U he still doesn't seem to be curving any more than he did at 2U, and his nadir is around +7 or +8. The interesting thing is that he seems to drop quicker and lower at night for some reason confused_cat

Are we at the point that we need to consider changing insulins? We have a vet appointment on Friday to check up on things. As of now, I plan on raising his dose tomorrow morning another 0.5U. So far he has gained a total of 1 pound back from his lowest weight a month and a half ago.

 

[Joanna & Bix (GA)]

His #s don't make a lot of sense to me either. It's weird how it seems like the #s are almost the same regardless of the dose, and that some days you get a U-curve and other days an inverse curve. Some cats get freakishly different results when you change by 0.2u, and then others seem to hum along in yellows all the time no matter what you do. I can't make any sense of that at all!!! Hopefully others will have more insight.

I don't know on the other insulin question either. You could try posting in the Lantus and Lev forums and get opinions there as well. I did that a while back and ended up getting really good advice on how to use PZI more effectively. From what I have seen, switching insulins isn't a quick fix for many cats, but then others get really good results, so to me it seems like a bit of a roll of the dice.

 

[Nancy and Cody]

Kelly,

Take a look at Cody's Nov, Dec ss. It has lots of flat curves, and minimal change of anything when I upped the dose. I don't know if the gradual curves are from the acromegaly (excess growth hormone/IGF1 block the action of insulin),
or if he has been so use to never dropping below 200, that his liver panics and keeps it from dropping.

 

[Kelly & Oscar]

Kelly,

Take a look at Cody's Nov, Dec ss. It has lots of flat curves, and minimal change of anything when I upped the dose. I don't know if the gradual curves are from the acromegaly (excess growth hormone/IGF1 block the action of insulin),
or if he has been so use to never dropping below 200, that his liver panics and keeps it from dropping.

Have you had Cody diagnosed with acromegaly? We are getting tested for heart disease at his vet appointment this Friday, and I have been worried that it may be acromegaly. He is a long, big boned cat, and always has been. His paws are big, but his head isn't (despite the profile pic - its quite skinny now that he lost a lot of weight).

Here's a couple of pics from 2 weeks ago... he's gained almost 3/4 of a pound since then.

 

[Gator & H (GA)]

Oscar is such a pretty kitty. Meow. cat_pet_icon. His weight seems OK to me?

As far as the insulin switch. If you do post over in Lev or Lan, make sure they understand Oscar has keytones [or history of them]. Since it takes a while to get going with one of those insulins they may recommend shorter acting insulin on top of the L or L to start with. And have the old LRS on hand if you don't already. But I would have it very nailed down and thought out ahead of any switch. Of the choice between Lev or Lan, Levimir has been spoken of to share qualities of both Lan and a bit of the flexibility of PZI.

I think you are doing the right thing by increasing the dose. I don't see anything in your spreadsheet that makes me go, "wow" Xu is too much. Maybe on 3/16 - but that was pretty wonky anyway. And you are having keytones which is a sign of not enough. I don't know, I'd be confused too.

 

[Kelly & Oscar]

That is interesting to note about Levemir, and I will be sure to keep that in mind. Weight wise, he looks just fine, but he felt quite boney at 10 pounds. You could feel every rib and each vertebra when you petted him. He seems to be optimal at around 11 to 11.5 pounds. 2 years ago he was 16 pounds no matter what I fed him. I have been policing his food intake for years now, so to see him at a more healthy weight is actually a good thing now. Small blessings :thumbup

After reading the stickies in the high dose/acro forum, I think we will keep with our protocol of dose raising until we hit around 5U BID and then I will ask for a IGF-1 and IAA test.

 

[Gator & H (GA)]

Forgot to mention too that some think Lantus stings and I think I recall one high doser mentioning they went with Levimir because of the sting factor in conjunction with the larger doses.

 

[Donna & Buddha]

What a handsome boy! In the last picture it looks as if he's about to say something really important. Was he about to sneeze? Does the asthma make breathing difficult? I wonder how other cats with asthma respond to insulin ...

 

[Kelly & Oscar]

He is mouth breathing a lot less than he used to before we started his inhaler treatments. He still mouth breaths a little, but I think it is a little out of habit because he closes the gate whenever I tap his chin! :lol: We are going to have him tested for heart disease on Friday just to be sure though. What has really helped him the most is changing him from clay litter to Swheat Scoop. I think that any disease that causes stress on the system can have an effect on diabetes, I just don't know how much that effect is.

 

[Nancy and Cody]

Yes, Cody got the official word about acro in Feb 2010. He does have an enlarged heart, thus the aspirin to thin his blood, and enelapril is for blood pressure.

Snoring is almost universal it seems, and this is from the obstructed airways. Could this be diagnosed as asthma?? I don't know?

One recent article talks about increased spacing (front to back) between the upper and lower canines when the mouth is closed. This happens because the lower jaw grows faster, and juts forward of the upper teeth. Oscar does possibly seem to have a prominent jaw. He's very handsome!

Some are big cats, some just have pot belly's. Supposedly they don't lose weight as rapidly as other uncontrolled diabetics, but if you were restricting food ?? maybe. Many have voracious appetites and attack food like they are starving to death.

Are you having an US on friday? If they see other enlarged organs, you might get more suspicious. The trouble is that vets think acro is very rare, although I seem to remember some research shows as many as 1/3 of diabetic cats test positive for IGF-1.

I would be happy to give you more details about the testing if you get to that point. Your vet would need your help, because only 1 place in the US does it. let me know.

Gator is right about the levimir. Supposedly large doses of lantus sting. I have been sticking with PZIR as a test case, the only thing I'm starting to wonder about is the u40 vs u100 cost difference. We get PZIR for $84 from the vet, and I think a lev vial costs more, but would have 2.5x more units. I'm just not ready to change anything else....and he seems to be doing OK.

 

[Kelly & Oscar]

His asthma was diagnosed via x-ray. He has tram lines and "donuts" of trapped air and inflammation in his lungs. The asthma treatments and litter change has resulted in a big difference in his breathing, but the mouth breathing hasn't gone away completely. He has never snored, and the x-ray showed a normal sized heart. There is apparently a new blood test for heart disease that we are getting tomorrow. No ultrasound because our vet doesn't have a machine, and it is very expensive elsewhere. He used to get the same amount of food as my civie: a full 6oz can of wet food a day and about a half a cup of high carb dry food. He held steady at 16 pounds for a while, and dropped just over 5 pounds between middle of December and beginning of February this year due to the diabetes. I have not noticed a "pot belly." It seems to be the same as my smaller female civie. I am really hoping that he doesn't have acro - I know I would probably want to treat the tumor instead of the symptoms, and I am afraid of the cost. nailbite_smile

 

[Nancy and Cody]

I'm betting you are safe,
that weight drop doesn't sound like an acrocat at all, and the snoring and hunger is surprisingly common in acrocats, so he probably just needs more insulin. Maybe the inhaler effects the insulin in some way. Maybe you have a bad vial that got frozen in transport.

Good luck tomorrow! thinking healthy heart thoughts

 

[Gator & H (GA)]

the only thing I'm starting to wonder about is the u40 vs u100 cost difference. We get PZIR for $84 from the vet, and I think a lev vial costs more, but would have 2.5x more units. I'm just not ready to change anything else....and he seems to be doing OK.

Nancy, you are actually the one person I would highly recommend checking out BCP PZI in the U100 strength. Supposedly if you have the vet send a script to BCP rather than buy from BCP then they will sell it to you at the right price. One way to do this might be to ask BCP to fax your vet a "prescription request" for 10ml of the U100 strength. I think you might be able to reduce the cost/unit especially if you had multiple vials shipped at once which again you are in the position to do. BCP is kind of weird to deal with because they will not tell you the cost - or at least they would not tell me. BIV is pretty customer service oriented, BCP is kind of the opposite in my experience. But I think that has to do if they ship to the vet and not you. Of course this is all if you want to stick with PZI anyway.

 

[Nancy and Cody]

Sorry to hijack your thread

Gator, Wow, I never thought of that, interesting idea! It made me look back at the original vial the vet gave me when we stopped vetsulin, (which I saved) and it was a 5ml bottle from Wedgewood Pharmacy and it is labeled PZI 100u/ml. At the time I didn't understand the u40 u100 thing at all, I seem to remember calling to ask if I should use my u40 syringes, and got the off the cuff comment that PZI is always u40 so yes use the vetsulin syringes..... wow, good thing cody is an acrocat (and had been getting about 11u of vetsulin). I was giving him 2.5 x the dose I thought I was.... she had me start at 2u 1x/day, which would have been like what..?. 5-6u in a u100 syringe? wow hard to trust anybody....

I just called BCP and spoke to a tech and the pharmacist. BCP is the 100% bovine stuff, and it is available in u40, u50, and u100. They said, they don't talk $ with the consumer until they get the prescription in house, with an OK from the vet to bill me directly. Cody does test with some insulin resistance (Cody =8, + = >20) so I'm thinking this could be a logical choice. Has anybody out there gotten u100 or u40 bcp pzi directly from BCP? What was the cost? If it's still available, why are folks switching to PZIR?

 

[Gator & H (GA)]

Yea, well I did not think of it until just now either. :smile: Again, I only recommend the U100 for you because you guys are high dose. You could get a bottle and try it out and see what you think I guess, and then you could always go back down to a lower strength. Since it is a different insulin amino acid wise you Cody might take a little while to get used to it [in terms of nadir settling at +n etc] - so I would keep a close eye on things during any switch.

The thing with BCP is that it's expiry is 6 months - but with the amount of insulin you give it is not an issue. I have not been able to get anyone to confirm anything about BCP. There was a topic in the D Health forum where presouzkitty was talking about how she recently got from BCP for something like $60 shipped to her door. I PMed her and asked in that topic what strength and if it was 10ml and never heard anything back :sad:

So.... If you find out more [please ask for the price of EACH strength if/when you can and what shipping costs and all the other details] please tell me because I would like to create BCP sourcing instructions in the PZI sticky.

It is still available, and I switched to ProZinc because a) it is AVAILABLE most everywhere even at local pharmacies and vets and I did not want to be dependent on something that would have to be shipped in. b) ProZinc is not a compounded insulin like BCP and compounded insulins have been shown to have variable strengths [but I would trust BCP over some local compounding pharmacy to get it right consistently] c) someone [insert derisive name] in my neighborhood horded five vials of PZI Vet that I thought I could go pick ONE up from at a local pharmacy and then a few days later they were gone and I had little insulin and didn't have time to really explore the BCP route and d) some other minor reasons having to do with H's vets.

 

[Carolynn FletcherGA & RobbieGA]

Nancy, I used the U100 BCP with Fletcher and it worked fine. It's been a couple years since I ordered it, but at the time it was like $75 per vial including shipping. I ordered 2-3 vials at a time with no increase in shipping. Only the free vial is sent to the vet's-- an actual paid order goes to your home/work shipped with ice packs. I never had any issues with it not arriving within 2 days of ordering. My vet just gave the insructions to "inject as directed" since we used a sliding scale and the doses were never the same. And you definitely don't need to worry about the 6 month expirey!

 

[Kelly & Oscar]

Hijack away Nancy! We are here for the kitties first and ourselves second cat_pet_icon

Oscar got his blood drawn for the test today and we should hear back mid week hopefully. Our vet didn't think he looked like an acro cat either. He has always had a ravenous appetite though - but that could be the diabetes talking lol. He did gain another ounce of weight this week though. He's up to 11lbs 2oz from 10lbs 5oz. I also got the go ahead to keep upping the dose from the vet.

 

[Nancy and Cody]

Kelly, seriously don't worry about the diagnosis one way or the other, it doesn't really change much at this point. If he needs more insulin, give it to him, especially with those lurking ketones. For now spend your money on the insulin!

Isn't 'not enough food' one of the causes of ketones, so if he's really hungry, maybe you could feed a bit more. Cody really got happier when I increased it.

FYI

"Our vet didn't think he looked like an acro cat either."

Many/most of us have heard that. Cody was about 10-11 lbs at diagnosis and my vet told me the same thing. I heard the same thing from other acromoms when I was asking these questions.

Do you know the name of the blood test? I wonder if its something for cardiac enzymes like they do on humans after a MI. Humm just curious.

Oh and Gator- BCP said shipping to private homes is Fed Ex with ice pack M-TH, and is about $13.50? and about $12 to the vet/businesses.
Carolynn-Thank you for the info! The biggest obstacle I see is the fact that my vet just bought a bucket of PZIR, and I'm the primary reason.... so it may be awhile before they are "happy" to give me a new script....

 

[Gator & H (GA)]

Oh and Gator- BCP said shipping to private homes is Fed Ex with ice pack M-TH, and is about $13.50? and about $12 to the vet/businesses.
Carolynn- The biggest obstacle I see is the fact that my vet just bought a bucket of PZIR, and I'm the primary reason.... so it may be awhile before they are happy to give me a new script....

So can't your vet return it? Tell him you'll pay for the return shipping to their distributor if that's an issue! Hehe, or give them your FedEx number again. :smile: My guess is vets have to be able to return to their distributor and if not then I would call BIV and see what their policies may be regarding refunds/returns for vets. I don't think BIV would want to make an enemy of a vet and I bet they will do everything possible to stay in your vet's good graces.

 

[Kelly & Oscar]

Kelly, seriously don't worry about the diagnosis one way or the other, it doesn't really change much at this point. If he needs more insulin, give it to him, especially with those lurking ketones. For now spend your money on the insulin!

This is good to hear. BTW we finally tested a zero for ketones this morning! :RAHCAT

Isn't 'not enough food' one of the causes of ketones, so if he's really hungry, maybe you could feed a bit more. Cody really got happier when I increased it.

Not enough food and not enough insulin can cause ketones. I have been putting food down when ever he asks for it. He gets a certain look on his face and has a little ritual to tell me he wants food :lol: He has been getting 4 cans of food a day. (FF)

FYI

"Our vet didn't think he looked like an acro cat either."

Many/most of us have heard that. Cody was about 10-11 lbs at diagnosis and my vet told me the same thing. I heard the same thing from other acromoms when I was asking these questions.

I was thinking this exact same thing in the vets office today. My DH was with me and I told him that catching cats in the early stages, they won't show many of the physical signs for a while.

Do you know the name of the blood test? I wonder if its something for cardiac enzymes like they do on humans after a MI. Humm just curious.

I don't know the name of the test, but I can ask what it is next time I stop in. I know that my vet is on top of the latest research and has a special interest in medical cases (not the standard "I need my shots" vet visit). She said it was a new test and it costs $75 at our vet, but it is still less than an echocardiogram.

 

[Kelly & Oscar]

Do you know the name of the blood test? I wonder if its something for cardiac enzymes like they do on humans after a MI. Humm just curious.

Just found out today that the test was for BNP, which is elevated when the body has to compensate for heart disease. Oscar's came back negative thankfully!

 

[Joanna & Bix (GA)]

I can't speak for Kelly, but chime in all you want Steve!!! We are sort of the blind leading the blind around here, though every now & then an expert drops by and sets us on the right path. :lol: Well, I do like to think we have at least partial vision :shock: , but most of us are newish here, though I have finally graduated the 1 year mark, which I guess makes me an offical old-timer? IMO the more people chime in, new or not, the more the ideas get bounced around and that helps all of us learn & see what works & what doesn't for each cat. I have learned a ton from seeing the progress with Blue & with other cats around, & I think it's great whenever people can share. :mrgreen:

 

[Steve and Blue]

You talking to me? :lol:

Thanks J&B. I got rid of the post you are referring to only because I realized looking further down on the SS that K&O had already started to do what I was suggesting at 2.8U and it was somewhat redundant.

I was hoping it would be gone before it was read - but basically to me it looked like Oscar was very sensitive to the dose changes and that a steady dose of ~3.0 for 3 days may turn things around - while being monitored especially around nadir. This was even though he dropped down into that 'iffy' zone around 50 BGL. Like I had said Blue was somewhere less than 30 and showed no signs of hypo even though I made a noobish mistake under doc's orders - but ECID of course. ;-)

I keep reminding myself of Dr. H.'s quote, "You must give up the fear you have been taught about taking a diabetic cat into the normal BG range,or your patients will always be diabetic." This is stated upon that the cat has been on a very gradual insulin increase and is on the strict high protein diet. Dr. H has also stated that most non-diabetic cats operate at rest between 50-80. Personally, I'm now more concerned with the liver's rebound effect than hypo, myself.

I will repeat myself again and say that Oscar was too cute a cat and I couldn't help my 'noob' self from trying to help out - even if I had to state the obvious. It was good to see his Ketones were way down too.

Now, back to reading...

 

[Nancy and Cody]

I googled it (BNP) and came up with an interesting article:
http://www.health.harvard.edu/press_rel ... blood-test

was it expensive? kind of makes me want to ask my vet to do it. Be nice to know if Cody's enelapril is helping enough. Great, something else to spend $ on....

 

[Gator & H (GA)]

$75 right? Sounds cheaper than a $300 cardiac ultrasound!

 

[Nancy and Cody]

it was the $300 US (or was it $350?) that got Cody on heart meds. They did it to check for a tumor of his intestines, liver, pancreas, I think, and found the BIG heart as a SURPRISE... well gotta love him... today he's being a good boy in the yellows and making mom proud. :lol:

 

[Kelly & Oscar]

$75 right? Sounds cheaper than a $300 cardiac ultrasound!

Yup, our vet only charged $75, but they tend to be on the low side for pricing. They only charge us $72 for a vial of ProZinc too :mrgreen: We already knew that he didn't have an enlarged heart because of his x-rays for his asthma diagnosis but we were worried about possible constriction of the inside of the heart because of his persistent mouth breathing. The BNP test was a much cheaper option than driving an hour to Indianapolis for a very expensive test.

Oscar is back into the mid level greens tonight after holding steady at 2.8U for today. This is looking like it might be our dose for a while!

 

[Joanna & Bix (GA)]

Yay! Glad his #s are good at this dose.

On the low #s question, Dr. H's statement that 50 - 80 is ideal, I remain convinced this has to do with human meters running low. I can go on for a LONG time on the topic ohmygod_smile it is one of my pet peeves. Short version for me is that these #s are what you want for nadirs not because they are actually the BG #s cats like, but because the meters show 50 when you are looking at an actual 80. To me, it would be simpler if the powers that be would frame it that way, rather than trying to convince people that low #s are not actually hypo #s (which I have found can be dangerous when you actually DO use a cat meter - I kept my cat in extended hypo #s due to not respecting the meter differences, and being swayed by public opinion on the topic). I think Dr. Rand puts it nicely in her protocols - use 50 as your lowest acceptable BG, but if you are using a cat meter (which most people aren't, so it's not mentioned much around here), add 30 pts to #s stated in the protocols to get the ideal target # (for low end #s at least).

Well, that was longer than I intended. :roll:

 

[Nancy and Cody]

Do you think that maybe 2.8u is too much. It looks like he hasn't hit a nadir from this mornings dose and he's dropping pretty low at only +3, +4. Time to crack a can?

 

[Joanna & Bix (GA)]

Was too busy on my soapbox to actually look at the #s. ohmygod_smile Having now looked at the SS I see what Nancy means - looks like dose may have been too high today - inverted curve & late drop, followed by early drop now. Looks like he wants to keep you on your toes with dose reductions! :mrgreen:

 

[Kelly & Oscar]

Do you think that maybe 2.8u is too much. It looks like he hasn't hit a nadir from this mornings dose and he's dropping pretty low at only +3, +4. Time to crack a can?

Yup, he got a can before I went to bed. When I went down to 2.5U we didn't even see DD# and today he isn't dropping again :YMSIGH: His numbers are going to be off for the next day because his shot tonight is going to have to be 2 hours early due to me needing to be in Indianapolis at 7pm.

 

[Joanna & Bix (GA)]

And it looks like on the 2.5 the ketones came back too.... darn!!!! If he gets lowish again, maybe try 2.7...? It's a pain to measure, but sometimes those tiny changes work like a charm.

Have a nice trip!!! Indie sounds cold to me, but hopefully it is pretty & springlike there.

 

[Nancy and Cody]

Since he's not fat, and does have a big long, frame, what if you fed more, which might offset the ketones, and make 2.7 /2.8 the right dose?
Don't ketones happen because the body is burning its fat stores to provide cellular energy (ketones are the metabolic result of fat metabolism?). Maybe increasing his food to 15ounces/day is what he needs? I know that sounds like a lot, but Cody is about 11-12 lbs and gobbles 11ounces/day. Oscar looks like he has the frame of a 15-16 lb boy. One of those other diabetic websites I was skimming one day seemed to downplay obesity as a cause of FD if I remember correctly. Something to consider... You could try it, and see if that helps the curve and the ketones. I would try to break it into steady meals I think, to keeps his Mr P trying to help.

 

[Gator & H (GA)]

Nancy,

I was just reading last night in the latest Discover Magazine an article called "Child's Plague." It seems Type 1 diabetes is on the increase too! Among other things, the article is about a potential central cause to both Type 1 and Type 2 diabetes in humans - weight gain. The article will probably not be up on their website for another month. Anyway, the idea is called the "accelerator hypothesis." That people with a strong disposition to diabetes will get it at the drop of a hat - and even a modest increase in childhood weight, will get what is called Type 1. And that someone with a little bit less genetic susceptibility to diabetes will develop it more slowly, requiring more time, more weight and more insulin resistance. But that it is the increase in weight, whether Type 1 or 2 that accelerates the development of diabetes.

Anyway, there is more to the article than just that, but I thought that it was interesting that weight was even being pointed at as a cause for Type 1 let alone Type 2.

Google has more reading on the accelerator hypothesis:
http://www.google.com/search?q=accelera ... s+diabetes
Of course the idea that Type 1 and 2 might have a common root has been controversial to say the least... But I know you talk about "big" boned as having something to do with acrocats.

 

[Kelly & Oscar]

Oscar used to be 16 pounds about a year ago. This is what he looked like then:

I personally think he needs to gain at least another pound or pound and a half to be at an ideal weight (ending up around 12-13 pounds). He is a really long and big boned kitty!

As for food - I try to feed him as much as he will eat right now. Usually it is around 4-5 cans a day right now, never less than 4. Why can't he be easy to understand? lol

It is beautiful here in central Indiana right now! Lilacs and azaleas are just starting to bloom and pollen is in the air :lol: Too bad its going to turn colder here on saturday!

 

[Gator & H (GA)]

H has family in Naptown [Indy]. They have frequently gone to Lafayette for treatment, so I understand the driving. I was recently pining for a good ol' "country vet" and is sounds like you may have been lucky enough to find one. Sure wish I could find one out here :YMSIGH:

 

[Nancy and Cody]

What a funny picture, I'm sure somebody creative could come up with a great caption. Was he checking out that jackpot of dry dog food? :lol:

Speaking of pollen- its unbelievable here, everything is covered with thick yellow-green dust. I blow the driveway, cars and porches off almost everyday and its coated again in an hour. Pollen count was around 5500 last week, down to 2500 this week, 30 bothers folks with allergies... everything is in bloom and is beautiful, but yikes! Walk in the grass and your shoes are yellow, drooler is a greenish yellow lab this week! We need rain to wash it away! By May it will be back to normal, but this is a tough 3 weeks every year. :shock:

 

[Kelly & Oscar]

What a funny picture, I'm sure somebody creative could come up with a great caption. Was he checking out that jackpot of dry dog food?

haha, well I can probably tell you what was going through his mind there. He gets fed on top of the dryer so that the dogs don't get to the food. He was probably sitting there thinking "That camera sure doesn't look like food. Mommy - do you know that isn't food? There is a starving kitty here!"

I call this one "hmmmm.... I see what you did there......"

 

[MicheleS]

Hi Kelly,
Coming late to the party but I wanted to say a couple of things.

1st: LOVE the name "Oscar". My favorite kitty was named Oscar. Sadly, I had to euthanize him (very old and had intestinal lymphoma) Jan 2009. I still miss him.

2nd: I may be in the minority, but I think your glc values are pretty good. He's below (usually) the renal threshold. That's so key for preventing things like renal and eye issues later.

3rd: I'd feed him whenever he is hungry (within reason!). From the pics, he looks like a big kitty without a lot of fat. He has room to go before you'd need to be concerned about excessive body fat.

4th: Did your vet do 2 views when he/she was diagnosed with asthma? You can tell a lot about the heart from 2 views.

Hope that helps!

 

[Kelly & Oscar]

Hi Kelly,
Coming late to the party but I wanted to say a couple of things.

1st: LOVE the name "Oscar". My favorite kitty was named Oscar. Sadly, I had to euthanize him (very old and had intestinal lymphoma) Jan 2009. I still miss him.

2nd: I may be in the minority, but I think your glc values are pretty good. He's below (usually) the renal threshold. That's so key for preventing things like renal and eye issues later.

3rd: I'd feed him whenever he is hungry (within reason!). From the pics, he looks like a big kitty without a lot of fat. He has room to go before you'd need to be concerned about excessive body fat.

4th: Did your vet do 2 views when he/she was diagnosed with asthma? You can tell a lot about the heart from 2 views.

Hope that helps!

Our vet did 2 or 3 views to diagnose the asthma, so we are good there. The problem with his glucose values (before the all of a sudden drop into the greens) was that they weren't any different than what the values were before we started insulin. He varied between 210 and 300 before we started with ProZinc.